Priority: Strengthen the capacity of the health system to promote mental health and emotional well-being.
Objective 1 (NPM 6). By 2025, increase to 40% from baseline (37.3%, 2017-2018 NSCH) the percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year.
WIC
MA MIECHV
MA MIECHV home visitors will continue to screen children with the Ages and Stages Questionnaire (ASQ) at the AAP-recommended intervals of 9, 18, 24 and 30 months and make referrals as needed. They will also continue to assess parent-child interaction using the PICCOLO or CHEERS Check-In screening tools, in adherence to the MIECHV parent-child interaction performance measure. MA MIECHV will provide technical assistance (TA) and support CQI activities to increase screening completion and use of screening tools. In addition, home visitors will continue to assess and report on the extent to which parents engage in activities to promote early childhood literacy. MA MIECHV will support local implementing agencies to establish partnerships with Raising a Reader to promote early literacy.
Beginning in summer 2024, MA MIECHV will implement a Learning Community focused on addressing inequities in the MIECHV performance measure focused on increasing assessments of parent-child interaction using a validated tool (i.e., PICCOLO or CHEERS Check-in). Home visiting programs will have access to performance data disaggregated by race, ethnicity, gender, and language. Through the Learning Community and TA, the programs will engage in CQI activities in partnership with CQI Parent Leaders to identify and address inequities and improve performance.
Young Children’s Council (YCC)
The MDPH YCC will continue to meet quarterly in FY24. Council goals include: 1) alignment of MDPH and partners’ work related to infant and early childhood social/emotional wellness and family well-being, 2) advising programs in the Division of Pregnancy, Infancy, and Early Childhood that focus on systems building, and 3) leading with the voices of families of young children from communities across MA to ensure these programs are designed and delivered fairly, equitably, and effectively. FY24 YCC meetings will also include advising on the HRSA grant, Transforming Massachusetts Pediatrics for Early Childhood (TMPEC). The YCC will advise MDPH on strategies to address barriers to equitable early childhood development services within pediatric primary care, including opportunities to strengthen connections between pediatrics and the early childhood system of care.
YCC membership will continue to include state and community agency representatives as well as growing family and community representation, including male caregivers and families with a diversity of life experiences. Compensated family leaders will take on increasing levels of leadership, including co-designing agendas, providing presentations, and leading discussion groups. Family leaders will also collaborate with MDPH staff to develop an electronic newsletter for Council members and caregivers of young children that will provide a streamlined process for sharing important resources and information as well as increase opportunities for engagement with the family leaders through co-designing and providing newsletter content.
Early Childhood Mental Health Integration
Building on the success of MA LAUNCH and LAUNCH Expansion, for which funding ended in FY20, MDPH staff will continue to promote this recognized model of integration of early childhood social and emotional health in pediatric primary care, particularly highlighting the value of the Family Partner role in supporting families. MDPH staff will continue to provide TA to MassHealth and other partners to implement MassHealth’s 1115 Waiver, which includes a pediatric value-based payment model, to allow for team-based care to promote the integration of behavioral health, similar to LAUNCH. MDPH staff will also continue to participate in the Infant and Early Childhood Mental Health Primary Care Integration Workgroup.
The MA Pediatric Mental Health Care Access Expansion program will utilize learnings from an intensive landscape analysis in FY23 to test enhancement of the MCPAP for Early Childhood Team to better support primary care providers on autism spectrum disorder (ASD) diagnoses for children from birth to age six with less complex presentations. The project aims to ensure that children under 6 receive ASD diagnosis to support access to interventions as early, equitably, and effectively as possible, with strong support to their families throughout the process. The Title V team will work to ensure that families, primary care, state agencies, providers, and insurers will continue to advise on strategies to expand pathways to diagnosis and support.
MDPH will continue implementation of the TMPEC, a 4-year grant awarded by HRSA in September 2022. TMPEC aims to increase equitable access to high quality early childhood development services, including Family Partners with lived experience, within integrated pediatric primary care practices that serve a high percentage of children insured by MassHealth. The project also aims to demonstrate the sustainability of integrated primary care models for young children through new payments mechanisms available within the 1115 MassHealth Waiver. TMPEC activities will focus on supporting implementation of Early Childhood Development (ECD) integration models in eight pediatrics practices across the state, including site specific training and TA as well as participation in a cross-site learning collaborative focusing on race equity, infant and early childhood mental health competencies, and family engagement and leadership. MPDH will also procure a second cohort of four pediatric practices to embed a Family Partner with lived experience within their integrated primary care team.
Interagency Early Childhood Workgroup
Title V staff will continue to participate in the cross-secretariat Interagency Early Childhood Workgroup through efforts connected to the Massachusetts Preschool Development Grant (PDG), which was awarded to the Department of Early Education and Care (EEC) in December 2022. The PDG supports the work across multiple state agencies to promote optimal educational, health, and economic outcomes for young children and their families. EEC is entering into an Interagency Service Agreement with MDPH to support agency staff, including funding of a full time Coordinator, to participate in grant activities, including: developing strategies for authentic inclusion of family voice in ongoing program development and policy planning, expanding ASQ and early literacy screening, and coordinating eligibility processes and easier access to benefits. MDPH will also partner with the PDG interagency partners to coordinate efforts to support early identification of young children who may need access to EI, special education, or other developmental, health or mental health supports through effective screening, referrals, and family support. MDPH will support common cross-systems professional learning opportunities on inclusive practice and comprehensive services.
MDPH staff will continue to participate in the Early Childhood Integrated Data System (ECIDS) Governance Board and support efforts to enhance use of data for analytics by coordinating participation of the three DPH programs currently in the ECIDS: EI, WIC, and MIECHV. The Governance Board plans to initiate several projects, including development of a data story to communicate findings from the ECIDS dashboard to agency partners to build awareness of the system, with an anticipated focus on equity in enrollment and engagement in ECIDS participating programs.
Priority: Foster healthy nutrition and physical activity through equitable system and policy improvements.
Objective 1. By 2025, increase the percent of families with children ages 0-5 years old who can always afford to eat good nutritious meals from 77.9% (2017-2018 NSCH) to 87%.
Key strategies to address this objective focus on maximizing the access that families with young children have to food resources for which they are eligible, increasing the availability of and access to fruits and vegetables, and identifying and implementing more upstream approaches to promoting food access and physical activity.
WIC
WIC will continue data sharing activities with MassHealth, SNAP, and Head Start. Through a data match with MassHealth and SNAP, WIC identifies individuals who are likely eligible but not participating in WIC, contacts those households via text message, and includes a link to the online WIC application. WIC provides data back to SNAP to allow outreach to WIC participants that are likely eligible for but not participating in SNAP. Strengthened relationships between WIC and SNAP during the pandemic will continue to result in improved coordination between programs related to outreach and messaging. With Head Start, data sharing activities aim to streamline and minimize program reporting burden and are specific to health data that are required by both programs (i.e., height, weight, hemoglobin) as well as nutrition care plans.
The WIC Marketing Manager will work in partnership with WIC Nutrition, Operations, and IT teams to increase awareness of the program through social media, connecting families to the WIC online application, and maximizing use of online application data in the WIC Management Information System. Ongoing use of the Loving Support breastfeeding outreach materials will further enhance this effort. Loving Support is part of USDA’s breastfeeding promotion initiative and provides resources for local and state WIC programs and participants.
To ensure equitable access to WIC retailers across the state, WIC will continue to actively monitor vendor coverage and reach out to potential vendors in communities in need of additional retail locations. Members of the WIC Vendor Unit will provide leadership in national and state efforts to determine a stepwise process to modernize WIC retail transactions and eventually facilitate online ordering for WIC families. The WIC program will continue to facilitate the Vendor Advisory Group to seek advice from and provide guidance to MA WIC retailers in maximizing the WIC shopping experience. WIC will also continue ongoing enhancements of the WICShopper app.
WIC plans to continue in-person implementation of the WIC Farmers’ Market Nutrition Program in partnership with the MA Department of Agricultural Resources, which it did for the first time since the COVID-19 pandemic started. Mailing coupons was necessary during the height of the COVID-19 pandemic, but in-person redemption resulted in significantly higher redemption rates. Local programs will once again plan safe, in-person distribution days or events and provide information on locations where coupons are accepted, instructions for their use, nutrition education resources, and information about the Healthy Incentives Program, which is a dollar-for-dollar incentive that SNAP participants can earn when they buy fresh produce at participating farmers’ markets, farm stands, and community-supported agriculture plans. It is anticipated that an increased number of local programs will host coupon distribution events at farmers’ markets, thereby boosting redemption. The value of Farmers’ Market Nutrition Program coupons will continue at the level of $30 per eligible participant.
WIC and Mass in Motion will continue to explore collaboration opportunities to support healthy food access and reduce food insecurity among families with young children, with a focus on ongoing impacts of the COVID-19 pandemic.
Metabolic Food and Formula Program
The Metabolic Food and Formula Program provides medically prescribed formulas and special low-protein foods for children and adults with a diagnosis of phenylketonuria (PKU) or other related metabolic disorders who lack insurance coverage for these items or are MassHealth recipients. The program will continue to directly provide medically appropriate food and formula to low-income and/or underinsured children with metabolic disorders.
Growth and Nutrition Program
The Growth and Nutrition Program provides multidisciplinary care to children up to 6 years of age with faltering growth or Failure to Thrive. In FY23, services were expanded in order to serve additional regions of the state and to support a rise in caseload. It is anticipated that more than 1,200 children will receive Growth and Nutrition services in FY24.
School Health Services
The Comprehensive School Health Services program will continue to focus on school health needs, health disparities exacerbated by the pandemic, and data collection and reporting for all performance measures in FY24. Per federal and state legislation, each school district must have a Wellness Committee (also known as a Health Advisory Committee) at the district and individual school levels to monitor data and work with community partners, including local Mass in Motion groups, on strategies to promote healthy eating and active living. School food service departments work closely with the Department of Transitional Assistance to identify families who might qualify for free and reduced meals who do not self-identify through the application process. These programs will continue to address food insecurity that predates and was exacerbated by the pandemic, with the support of school nurses.
Objective 2. By 2025, increase from 103 to 150 the number of injury-related data, technical assistance, and press requests that are completed by Injury Prevention and Control Program staff annually.
Injury Prevention and Control Program (includes activities of the Injury Surveillance Program)
Injury prevention initiatives are important for increasing safe physical activity for children and youth. IPCP conducts an annual review of completed TA requests and uses that information to guide program activities, including updating and improving accessibility of IPCP webpages and identifying unmet community needs. IPCP will assess the FY23 12-part injury prevention training series for home visitors, community health workers, EI specialists and other family support service providers and develop a plan for future training. The initial goal of this training series was to improve providers’ knowledge of injury risks and prevention tactics and improve service providers’ capacity to connect families with free or low-cost safety equipment, such as car seats. IPCP staff will assess the need for training, evaluate how to best meet home visitors’ needs, and determine whether there are other audiences to serve. The assessment will factor in any need to support certification requirements as well as any appropriate alignment with other funded programs in MDPH. By the end of FY24, IPCP will have a workplan for a restructured training series that maximizes efficiency. IPCP will also review the structure and content of its webpages to ensure material is up to date, logically organized, culturally responsive, and accessible.
There are several activities/subprograms within IPCP that will be continued in FY24 and expand the reach and specificity of IPCP TA requests. These include the following:
Traffic Safety
The IPCP director will continue to guide and support the activities of the MA Traffic Safety Coalition. Guided by TA requests, IPCP staff will recruit presenters for quarterly coalition meetings, and assist with dissemination of timely information to inform prevention of motor vehicle injuries. IPCP staff will provide TA to the team developing and implementing the action plan for the recently released 2023 Strategic Highway Safety Plan and to the state Department of Transportation around implementation of a new law protecting vulnerable road users, including pedestrians and cyclists.
Sports concussion
The IPCP will continue to enforce the MA Sports Concussion Regulations by collecting year-end reports and letters of affirmation from schools that have sports concussion policies in place. The program will also provide TA and support to schools who receive a complaint about how they have handled concussions that occur during extracurricular athletic activities. IPCP will explore the evolving concussion science, especially the consequences of repetitive concussions, as well as potential racial inequities in the implementation of post-concussion return-to-learn and return-to-play protocols with the aim of providing specialized support to under-resourced schools. IPCP will provide training and education to home visitors, community health workers, EI specialists and other family support service providers about identifying and responding to suspected concussions. The IPCP also plans to review the online training which is promoted with schools as part of the sports concussion regulations requirements.
MassPINN
The MA Prevent Injuries Now! Network (MassPINN) will convene quarterly and continue broadening their membership where able. ICPC will continue to support the development and dissemination of a MassPINN monthly newsletter with information about events, opportunities, research, and injury prevention in MA. MassPINN will explore new venues to disseminate information, attract new members, and provide TA.
Water safety
IPCP staff will develop a sustainable, repeatable, adaptable communications strategy for summer water safety. Staff will review past campaigns and create a year-round timeline for reviewing previous year’s performance, forecasting the next year, revising content as necessary, and facilitating dissemination of messages.
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