Child Health, Application Year FY 23

The needs assessment process identified the priority for the child population: improve nutrition, physical activity, and overall wellness of children. Ohio has a lower rate of obesity among 2-4-years-olds than the U.S., but a higher rate among ages 10-17. Children in Ohio are also more likely to experience adverse childhood experiences. While more children in Ohio receive developmental screenings compared to the U.S., this only represents one-third of children and early data indicates that the COVID-19 pandemic has decreased screening due to the suspension of face-to-face visits in health and home settings.

Emerging Issues

Since the completion of the needs assessment, the COVID-19 pandemic has reduced the number of children with documented developmental screenings performed by Home Visiting due to visits being transitioned to virtual and the temporary suspension of face-to-face visits.

Because of the temporary closure of facilities and discontinued face-to-face trainings, there was an increase in online offerings for ECE trainings for professionals around nutrition and health along with other COVID-19 related topics. There was also an increase in telehealth visits, which created a need to share more information virtually for parents and caregivers around nutrition, physical activity, and overall health issues.

In-person visits were gradually re-introduced in late spring 2021, and fluctuated with the resurgence of COVID in the fall and winter of 2021-22. To date, a significant number of virtual visits are continuing across the home visiting system. ODH has recently shared guidance with home visiting providers on best practices around in-person visits. Developmental screenings are being completed and referrals made when appropriate. The full set of Tools Completion dashboards is nearly complete in DataOhio, which will allow home visiting providers and ODH to see their screening completion rates.

The COVID-19 pandemic also highlighted the importance of the Cross-Cutting equity and ACEs priorities. In FY 23 the Child Action Group will continue to explore the integration of these priorities within the Child Action Plan.

Priority: Improve nutrition, physical activity, and overall wellness of children

Measures:

• NOM 19: Percent of children (0-17) in excellent or very good health
• NOM 20: Percent of children (2-4) and adolescents (10-17) are obese
• NOM 25: Percent of children (0-17) who were not able to obtain needed health care in the last year
• SOM: Percent of children, ages 0-5, with elevated blood lead levels (BLL ≥5 ug/dl) (confirmed only)
• NOM 14: Percent of children (1-17) who have decayed teeth or cavities in the past year

• NPM 6: Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year

• ESM: Percent of children, ages 1 through 66 months, receiving home visiting services who have received a developmental screening

To address the priority of improving overall child health efforts must address a broad range of issues impacting children. Pediatric primary care visits represent a key opportunity for monitoring and addressing the comprehensive needs of children’s health. The selected NPM relates to the critical role of developmental screening in monitoring and supporting child development. The SOM was established to measure the efforts to address child lead exposure in Ohio, which also relates to the Cross-Cutting domain and is aligned with the measure in the State Health Improvement Plan. Home visiting services also play an important role in monitoring and supporting child development. The ESM will measure the impact of efforts to improve rates of developmental screening for the child population served by Home Visiting.

Objective 1: By 2025, coordinate across programs to implement a plan to increase rates of primary care providers conducting quality comprehensive well child visits that include developmental and other screenings.

Strategies:

1. Increasing provider education/training for comprehensive well visits (Bright Futures, screenings and referrals to include: developmental screenings, lead, hearing vision, oral health, immunizations, BMI, social determinants of health, and ACEs).
2. Partnership between programs that can mutually promote comprehensive well visit (e.g., state immunization).
3. Explore opportunities to support/implement evidence-based models for pediatric primary care
4. Increase the awareness of the need for developmental screenings and other screenings amongst parents and caregivers.
5. Educate primary care providers on billings for provision of services (expand QI initiative for vision screening billing and use results to inform efforts on other billing codes).

Ohio collected public comments on the objectives and strategies for the child population and this will serve as a guide for FY 23 and beyond. We will move from creating a plan to implementing the plan through ODH programs and with state partners. Over the next year, ODH will partner with Ohio Chapter of the American Academy of Pediatrics (Ohio AAP) to develop and provide trainings and resources to medical and allied professionals around key topics appropriate for children and their caregivers. The Ohio AAP trainings will also help to lay the groundwork for Quality Improvement projects during FY 23. During FY 23, ODH will also explore partnerships to promote comprehensive well visits along with vaccination education and increase developmental screenings by reaching out to other populations such as public health nurses and the foster care community. The ODH Lead program is also working on creating a targeted testing model in high-risk areas by zip codes and working on billing coding for professionals around assessments. Educating primary care providers on billing for the provision of services will continue to be provided under the Save Our Sight Vision Screening Training and Equipment grant component in SFY23; however, it will not be a separate QI with Ohio AAP. Statewide vision screening training for primary care providers will continue to incorporate billing education for the provision of vision screenings in the primary care setting during SFY23.

Objective 2: By 2025, increase the percent of children, ages 9-35 months, that receive developmental screens via home visiting programs.

Strategies:

1. Support MIECHV and other home visiting programs to provide developmental screening using Ages and States Developmental Screening tool.
2. Implement Medicaid/CHIP reimbursement claim code for developmental screening activities at provider level.
3. Educate parents about developmental screening tools.

The Home Visiting program saw a decrease in developmental screenings in 2020 because of the COVID-19 pandemic and the suspension of face-to-face visits. ODH advised home visiting providers in mid-March 2020 to use only telehealth visit options (phone, video, text message, and drop off materials) and providers have indicated it is challenging to complete required screenings and assessments due to technological issues and distractions during telehealth visits. With the upcoming return of face-to-face visits in 2021 and 2022, ODH anticipates an increase in screenings and education provided to caregivers. In addition, Home Visiting protocols require completion of an ACEs screening tool and additional required screenings which cover some of the social determinants of health (housing employment, insurance, food insecurity, etc.). A tools completion report is under development to allow providers and ODH to track screening completion rates more easily to better address gaps and missing data. Finally, Home Visiting will continue to explore ways to implement Medicaid/CHIP reimbursement claim codes at the provider level.

Other Efforts Supported by Title V MCH

Many of the programs presented in the Perinatal/Infant Application section also serve children and adolescents. Several program summaries are included below to highlight additional relevant programs. Please see the Program Map (section V. Supporting Documents) for the full list of programs.

School Hearing and Vision Programs

The Ohio Department of Health (ODH) Children's Hearing and Vision Programs set the screening requirements and guidelines for school-based preschool and K-12 schools. ODH is given the authority by the Ohio Revised Code (ORC) to set the hearing and vision screening requirements for school-aged children and to track the data (ORC Sections 3313.50 and 3313.69). ODH works in partnership with ad hoc committees to develop the requirements. These requirements determine the grade levels routinely screened each year, approved screening tests and equipment and referral criteria. In addition to establishing school screening requirements, the program conducts annual statewide surveys of school hearing and vision screening to monitor compliance with screening requirements.

Oral Health

The Oral Health Program is near completion of the development of “Help Me Smile: Ensuring the Oral Health of Young Children”.  This course is made up of 7 educational modules that will be Ohio Approved for professional development.  The goal of this course is to equip early childhood educators, healthcare professionals, and providers of home visiting services with the knowledge and tools needed to educate young children and parents about oral health, help them establish good oral health practices, and help parents ensure that their children’s oral health needs are met.

The Oral Health Program is in the very early stages of planning a combined oral health/BMI screening for 3rd grade students.  At this point, the screening would take place during the 2023-24 school year. 

The Oral Health Program currently funds 12 subrecipients for the School-based Dental Sealant Program, providing services in 34 counties in Ohio.  Qualifying schools have at least 40% of the students eligible for the Free and/or Reduced-Price Meal Program.  The sealant programs primarily target students in 2nd and 6th grades and follow-up with students in 3rd and 7th grades.  (The Oral Health Program just completed the 2023 competitive solicitation for the Dental Sealant Program, which should be posted on 6-15-22.)

Early Childhood Health and Safety, Ohio Healthy Program (OHP), Early Childhood Obesity Prevention Program (ECOPP)

The Early Childhood Health and Safety program works collaboratively with other state agencies to identify learning needs of the early childhood educators in diverse setting such as public preschools, childcare centers, and family child care. Based on the assessments, the professional development program for health and safety designs and implements quality, relevant, accessible, cost-effective opportunities for professional development related to provision of safe and healthy environments for children in their care. Such topics include, responding to allergies, asthma, cold and flu season and other pertinent health topics.

The OHP provides technical assistance for Family Care, Child Care Centers, and Public Preschools by providing the training they need to make policy and environmental changes that will lead to OHP designation through Step Up to Quality and that ultimately will improve the health and wellbeing of children and families they serve. The OHP is part of a larger effort within the Early Childhood Obesity Prevention Program (ECOPP), which is a coordinated and comprehensive approach involving families, early childhood education professionals, health professionals, and community organizations working together with consistent messaging and strategies to ensure a sound foundation for health in the future.

Parenting at Mealtime and Playtime (PMP)

Parenting at Mealtime and Playtime (PMP) is a professional development initiative for a variety of health care providers to optimize obesity risk assessment, prevention counseling, and family support for children 0-5 years of age and their families. PMP curriculum offers providers developmentally appropriate guidelines on nutrition, healthy activity, and sleep to share with families within the context of building resilient family-child interactions that support healthy habits.

ODH’s Early Childhood Obesity Prevention Program (ECOPP)

ODH’s Early Childhood Obesity Prevention Program (ECOPP) partners with the Ohio Chapter, American Academy of Pediatrics (Ohio AAP), to deliver PMP physician training that grants Maintenance of Certification (MOC) Part-IV professional development credit. Visit Ohio AAP’s PMP site for more information and to sign up for the PMP Resource Toolkit.

PMP training and resources are also available for healthcare providers such as home visitors, community health workers, and WIC professionals. These include a series of one-hour independent study courses for health care providers working with families in the early childhood population. In these courses, local experts address the latest information about PMP to prevent obesity and improve the health of children 0-10 years of age.  In FY 23, the PMP material will include information and education for children up to the age of 18.  The purpose of the trainings is to increase understanding of developmentally appropriate guidelines on nutrition, healthy activity, and sleep, all within the context of building resilient family-child interactions that support healthy habits.

Farm to ECE Implementation Grant (FIG)

Farm to early care and education (farm to ECE) offers increased access to the three core elements of local food sourcing, school gardens and food and agriculture education to enhance the quality of the educational experience in all types of ECE settings (e.g., preschools, child care centers, family child care homes, Head Start/Early Head Start, programs in K – 12 school districts). Farm to ECE offers benefits that parallel the goals and priorities of the early care and education community including emphasis on experiential learning opportunities, parent and community engagement and life-long health and wellness for children, families and caregivers.

Ohio’s Farm to ECE team will continue to implement a key system change by expanding and strengthening our state-level coalition to include diverse representation from affected communities and establishing sustainable and equitable coalition recruitment and governance. 

The coalition focuses our scalable strategies and intended impacts on children, families and caregivers who lack access to healthy food in care settings and at home, farmers, and food distributors.  Through a very deliberate process, a diverse, cross-sector coalition with partners who would bring new perspectives, resources, and skills was created. The number of members tripled in year one, however there are many more layers of the community we must seek out and engage. This will be guided by our Equity Consultant.

The expanded coalition of diverse early childhood educators, young families, farmers, distributors, educators, and others affected by food procurement at ECE sites is accomplishing most of the work through three subgroups: Coalition Expansion/Development, Policy Guidance, and Procurement Innovation.  The Coalition Development group will continue to conduct assessments, monitor needs, and recommend and guide practices for sustaining the coalition.

The Ohio Farm to Early Care and Education Coalition is working to become a sustainable group working towards advancing F2ECE in Ohio that is integrated into the Ohio Farm to School Network at the state and regional levels.

School Nursing

The ODH School Nursing program provides school nurses, schools, and school communities with resources to support the health and academic achievement of students. The program provides technical assistance, creates resources, manages the School Nurse Bulletin Board communication system, collects data regarding school health needs and services, and provides extensive professional development for licensed nurses working in the school setting.

The professional development offered by the School Nursing program includes a library of more than 40 online independent study courses house in OhioTRAIN. Program typically hosts three live, in-person Regional School Nurse Conferences, one summer conference, and one three-day New School Nurse Orientation each year. With the onset of COVID-19, the program has pivoted to offer these as live, virtual events. Continuing Nursing Education contact hours are offered for all courses. Program also develops and disseminates resources, such as handouts and resources for school nurses to use to teach school staff how to administer medications to students. These resources are heavily used by school nurses, with more than 700 nurses attending the live conferences and more than 1,000 participating in the online independent study courses annually.

Using ARPA funding, ODH School Nursing program is hiring 6 special project nurses to provide additional support and the state level and within five identified regions of the state.  These nurses will work with schools and community organizations to support child health through the school through June 20, 2023.

Ohio Healthy Homes and Lead Poisoning Prevention Program

Lead can damage nearly every system in the human body and has harmful effects on both adults and children. It is a serious environmental public health threat to children in Ohio. The Ohio Healthy Homes and Lead Poisoning Prevention Program (OHHLPPP) addresses the needs of lead-poisoned children from birth through 5 years (up to 72 months) of age. The program assists family members, medical care providers, and other community members to reduce and prevent lead poisoning. OHHLPPP recognizes that children under the age of 3 years (36 months) are at greatest risk for lead poisoning. The program receives funding from the Centers for Disease Control and Prevention (CDC), Maternal and Child Health Block Grant, and the Ohio Department of Medicaid (ODM) for childhood lead poisoning prevention efforts in Ohio. OHHLPPP receives all blood lead testing results on Ohio resident children and performs inspections of homes, childcare facilities, and schools to determine the source of a child’s elevated blood lead level. The program coordinates funding to complete lead hazard abatement for qualified families.