CHILD HEALTH DOMAIN
Nebraska Application for the 2021-2022 Year
In this section, Nebraska MCH Title V describes planned activities in the Child Health Domain for the period October 1, 2021 to September 30, 2022. This represents the second year of activity in the Title V five-year needs assessment cycle for 2020-2025. The numerical sequence of headings used to organize the narrative below correspond to the narrative guidance for the Annual Report year as found on page 43 of the Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, OMB Number 0915-0172, Expiration Date 1/31/2024.
The Nebraska Priorities in the Child Health Domain with 2021-2022 NPM, SPM, and ESM statements are as follows:
- Priority: Child Abuse Prevention
SPM: The rate of substantiated reports of child abuse and neglect per 1,000 children ages 1-9 years.
ESM: None.
- Priority: Access to Preventive Oral Health Care Services
NPM: Percent of children ages 1-17 years with a preventive dental visit in the past year.
ESM: The number of sites participating in the Nebraska Early Dental Health Starter kits program.
- Description of Planned Activities
OVERVIEW OF THE CHILD HEALTH DOMAIN
Systems Partners
Nebraskans care about child wellbeing, and there are several strong systems-level efforts led by state organizations and foundations to improve child and family services and outcomes. First Five Nebraska, the Nebraska Children and Families Foundation (NCFF), and the Buffett Early Childhood Institute at the University of Nebraska-Lincoln all bring strong infrastructure and policy-building assets to helping Nebraska families succeed. Title V MCH has collaborative relationships with all, and in particular partners with NCFF on a variety of activities. NCFF is the lead agency for Prevent Child Abuse Nebraska, which in turn heavily supports the infrastructure of community collaboratives across the state. In addition to these well-established organizations, Nebraska participates in a Preschool Development Grant, and First Five Nebraska leads a Pritzger Prenatal to Three project. Title V and N-MIECHV have both actively participated in the development of the state plan under the Families First Prevention Act which includes home visiting services for families at-risk of involvement in the child welfare system. Additionally, Title V participates on the Child Abuse Prevention Fund Board, on workgroups focused on Preventing Child Maltreatment Deaths, and ensures Child Welfare representation on the Child Maternal Death Review Team. This is an example of the Nebraska DHHS approach to integrated service delivery in health and human services that has grown collaborative opportunities for Title V and related programs to participate in discussion and planning for alternative interventions for families and children at risk of involvement in the child welfare system.
Title V School Health Program
In addition to systems- and state-level collaborations to build a comprehensive system of child and family supports and services, Title V MCH invests in the ongoing operations and services of the School Health Program, located within the Maternal Child Adolescent School Health (MCASH) Team. The program has been in existence for nearly three decades. The School Health Program Manager is also Nebraska’s designated State School Nurse Consultant, and is a Registered Nurse with considerable pediatric experience.
The School Health Program offers a slate of services in support of child health and well-being for children and youth with, and without, special health care needs. The Program provides a focal point within the department for the support and growth of high-quality professional school nursing practice, available to the entire population of children enrolled in school. The impact of the school health program initiatives is amplified in the practice of Nebraska’s 300-plus professional school nurses. The visibility of the School Health Program, and the availability of the State School Nurse Consultant, provide a reliable infrastructure for timely and accurate communications and response to immediate, emerging, and systemic needs of schools and children. The communication mechanisms of the School Health Program also provide an asset to Title V in that open communication channels also provide information about what is happening “on the ground” with children and school concerns in real time. This was especially evident, and actionable, during the pandemic. The School Health Program has been positioned to offer valuable, credible resources to School Nurses during COVID, particularly in the areas of screening, staff self-care, and disease management guidance from credible authorities.
Priority: Child Abuse Prevention
2021-2022 Objectives and Proposed Strategies
Objective CH4a: By 2025, reduce rate of substantiated child abuse or neglect by: supporting prevention, early identification, and early intervention strategies; and investigating disproportionality of children and families involved with the Child Welfare Agency.
Strategy CH4a (1): The Nebraska MIECHV program will expand evidence-based home visiting services Nebraska families at-risk for child abuse and neglect in a collaboration with DHHS Division of Children and Family Services.
Strategy CH4a (2): Title V staff will work with the Division of Children and Family Services to further evaluate Nebraska’s Community Well-Being prevention model and its ability to address social determinants of health and increase protective and promotive factors within families and communities.
Discussion of Activities for this Objective – Relevance to Identified Priority
N-MIECHV Expansion
In 2019 through 2020, N-MIECHV, in the Division of Public Health, developed a formal collaborative partnership with the Division of Children & Family Services (DCFS) in order for NE DHHS to access available funding for the Healthy Families America (HFA) model of evidence-based home visiting through the Family First Prevention Services Act (FFPSA.) While meeting to decide how the FFPSA funding opportunity might best be developed, DCFS presented a different funding opportunity: Temporary Assistance for Needy Families (TANF) for the expansion of HFA evidence-based home visiting programs across the state. Written into the NE DHHS 5-year Business Plan, the partnership allocated $500,000 the first year, with an increase of $500,000 each year through 2024. First the existing HFA programs expanded capacity to serve more families, then one small, previously privately-funded program in the southeastern corner of the state was brought onto the N-MIECHV network and expanded as the first “new” program for the Business Plan.
N-MIECHV conducted an updated needs assessment in 2020 to identify the counties in Nebraska whose community data shows most “at risk” of child maltreatment due to factors such as the rates of poverty, teen pregnancy, exposure to violence or substance abuse. Utilizing TANF funding over the next four years, between four and six new HFA programs will be implemented in identified priority counties that do not have existing services. N-MIECHV uses a community planning approach where local early childhood stakeholders decide whether there are system gaps for needed services in their community, and whether an HFA program might help close those gaps. Once a local implementing agency is identified, N-MIECHV will issue awards to the community to serve vulnerable pregnant and parenting families.
Child Welfare Disparities
The Child Abuse and Neglect Issue Brief created as a result of the Title V Needs Assessment process clearly identified disparities between racial groups in NE when looking at alleged and substantiated child abuse and neglect rates. As a result, the Division of Children and Family Services committed to an in-depth analysis of data to further describe existing disparities. DCFS found that in certain locations across NE, Native and multi-racial children have a rate of screened in reports at least twice that of White children. Despite this, one encouraging finding is that American Indian/Alaska Native families were represented in the Community Response population at a significantly higher percentage as compared to the Alternative Response population (10.3% vs 2%), with the same situation existing for Black families, though showing less difference between the programs (12% vs 8.6%). Community Response is the local system of supports and services for vulnerable families intended to prevent unnecessary entry into the child welfare system, while Alternative Response is a program offered to lower risk families that have already entered the child welfare system. Additionally, evaluation of the child well-being collaboratives has shown that people participating in Community Response made significant improvements in the areas of Concrete Supports and Resilience in particular, but generally improved Protective Factors in a majority of measured areas. The DCFS has used this data to support an application for Family Support through Primary Prevention funds from the federal Children’s Bureau, which if awarded will provide the opportunity to further evaluate the prevention model and spread successful interventions statewide.
Priority: Access to Preventive Oral Health Care Services
2021-2022 Objectives and Proposed Strategies
Objective CH5a: By 2025, increase the percent of children ages 1 to 17 years who receive preventive oral health care services.
Strategy CH5a(1): The DHHS Office of Oral Health will identify needs for translation of existing health literate oral health education materials.
Strategy CH5a(2): Title V will assist the Office of Oral Health in acquiring and distributing Dental Health Starter Kits in the population. The DHHS Office of Oral Health will report evaluation measures of the project.
Strategy CH5a(3): The DHHS School Health Program and the Office of MCH Epidemiology will participate in the planning and implementation of the statewide Oral Health Survey.
Discussion of Activities for this Objective – Relevance to Identified Priority
The DHHS Office of Oral Health will conduct a scan of translation needs including identifying languages to translate educational materials to, and identifying which oral health educational materials to translate. Increasing the number of languages oral health materials are available in will increase the knowledge of families in Nebraska about the importance of oral health and the need to get preventive oral health services for their children.
The distribution of the Nebraska Early Dental Health Starter Kits to families of children birth to age five will educate these families not only about the importance of daily oral hygiene, but also provide examples of age appropriate oral hygiene tools to use. Increased understanding of the need for preventive oral health care will lead to guardians taking their children in for routine dental care and the establishment of a dental home. In addition, the Nebraska Early Dental Health Starter Kits contain a listing of Dental Public Health Clinics in Nebraska where families can access lower cost oral health care services.
The completion of the next basic screening survey of Head Start and third graders across Nebraska will provide updated surveillance data to the DHHS Office of Oral Health. The Office of Oral Health will look at trends for the two age populations related to the number of children with caries experience, those who have received previous dental treatment, the urgency on needed dental treatment, and numbers of third grade children with sealants. This information allows the DHHS Office of Oral Health to adjust program activities to increase the number of children receiving preventive dental services across Nebraska.
- Alignment of planned activities with annual needs assessment updates.
Priority: Child Abuse Prevention
Stakeholders in the 2020 Needs Assessment recognized not only the problem of child abuse, but the opportunities for prevention services embodied in the Families First Prevention Act, the collaborative Bring Up Nebraska, and evidence-based home visiting such as the Healthy Families America programs funded by N-MIECHV. Stakeholders advocated for universal home visiting services for all families. Increased family supports help children.
Alignment: Planned activities for 2021-2022 are aligned with the needs assessment findings and recommendations of stakeholders. Title V will continue collaborative relations with state and systems-level partners to support infrastructure development for expanding home visiting services statewide through N-MIECHV. The considerable interest among child advocates in the state as to data showing disparities (by race/ethnicity, gender, and/or geographic status) in child welfare involvement of families has been leveraged for a grant application that, if funded, could enhance prevention work and continue efforts to reduce rates of child abuse/neglect.
There are no new findings to update the needs assessment in this priority area.
Priority: Access to Preventive Oral Health Care Services
When stakeholders selected this priority in 2020, they were well-aware that dental health issues are the most chronic health problem among children. The Office of Oral Health at DHHS is an active partner with Title V in needs assessment activities. Stakeholders particularly pointed to the preservation, if not expansion, of public health dental services, particularly those available to children at school, and to low income families.
The pandemic cause significant disruption to the activities of the Office of Oral Health in collaboration with schools. The statewide children’s Oral Health Survey is planned for 2022-2023. Stakeholders wish particularly to see the disparity between urban and rural access to dental services for children addressed.
Alignment: Activities proposed for 2021-2022 are consistent with findings and recommendations of the Needs Assessment. The Office of Oral Health indicated a need for additional translated materials in order to reach all families in Nebraska with prevention information. The distribution of dental kits is a measure of reach in the population. In 2021-2022 the Office of Oral Health has been invited to present an educational session with Community Health Workers, including the dental health kits, in order to enhance reach to families as well.
There are no new findings to update the needs assessment in this priority area.
- Emerging new priorities taking precedence over the established priority needs.
The following two emerging priorities do not displace the established priority needs, however are noted as they will involve Title V MCH in the Child Health Domain in the coming year.
Impact of School Closure
In the school-aged population in Nebraska, as in other states, the pandemic caused many disruptions in the delivery and availability of family support services so important for child development and the routine early identification and interventions that promote child well-being. As school resumed in the 2020-2021 school year, as tumultuous as it was for both educators and children, evidence began to emerge that all children did not fare equally well, academically or socially, during remote learning and home isolation. The effects of the pandemic on child well-being continue to be reckoned with, as some school districts are seeing record numbers of children and youth enrolled in summer school in order to catch up with their peers and expected levels of performance. Some consequences, as in behavior and mental well-being, are more difficult to assess. The School Health Program will continue to provide a focal point for understanding and addressing the consequences of disrupted childhoods and learning experiences.
Mental and Behavioral Needs of Families and Children, with and without special health care needs
As discussed in other areas of this application, Title V, along with stakeholders and advocates statewide, are acutely aware of the many ways mental health issues are manifest in all MCH populations in Nebraska. The combination of social and health vulnerabilities existing prior to the onset of the pandemic, extraordinary and prolonged stressors of isolation and services shut-down, the uncertainties, loss, and grief all have created a toxic mix for some families that has yet to be relieved. Title V MCH sees there is a role for the block grant to be a committed and invested asset for the state to meet these needs particularly focusing on the most disadvantaged and disproportionately affected families.
- Relevance of ESM to selected NPM; changes in ESM.
Priority: Access to Preventive Oral Health Care Services.
NPM: Percent of children ages 1-17 years with a preventive dental visit in the past year.
ESM: The number of sites participating in the Nebraska Early Dental Health Starter kits program.
In April 2021, Nebraska was provided with the ESM Report from MCH Evidence Center for the state. The MCH Evidence Center assesses ESMs aligned to NPMs for the degree to which they are supported by evidence, and through the lens of Results-based Accountability. For the Child Health Domain, the number of sites participating in the dental kit project aligns with the Emerging MCH Best Practice strategy of Caregiver/Parent Education/Counseling. The ESM is an effective measure of reach, which could be strengthened by using a denominator (total # of relevant group addressed) to show %.
In addition to assigning ESM to at least one Priority in each Population Domain, corresponding to a selected NPM, Nebraska Title V uses Results-based Accountability Measures. Since 2015, Nebraska Title V has been writing and utilizing Results-base Accountability (RBA) measures in an effort to make annual impacts and achievements more discernable to front line staff and stakeholders. In addition, use of RBA often highlight inclusion and equity-focused efforts that have been transforming Title V work.
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Results Based Accountability (RBA) measures Priority: Child Abuse Prevention |
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Proposed for 2020-2021 |
Proposed for 2021-2022 |
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How much did we do? |
How many new sites and families were added to N-MIECHV during the period?
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Measure N-MIECHV expansion. |
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How well did we do it? |
In what ways was the influence of unconscious bias considered in the data review on child abuse and neglect alleged and substantiated cases? |
Are there actionable findings identified through data?
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Is anyone better off? |
Do families enrolled through TANF expansion on N-MIECHV have the same rate of achievement on benchmarks compared with other N-MIECHV families? |
What percentage of TANF expansion MIECHV families still participating in MIECHV after one year? |
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Results Based Accountability (RBA) measures Priority: Access to Preventive Oral Health Care Services |
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Proposed for 2020-2021 |
Proposed for 2021-2022 |
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How much did we do? |
How many Dental Health Starter Kits were distributed by the Office of Oral Health in the period?
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Measure of Dental Kits distributed.
How many children were provided preventive dental services? |
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How well did we do it? |
How many materials were newly translated?
How many schools participated in the Oral Health Survey? Are diverse children and underserved areas represented? |
Is the statewide Oral Health survey ready to launch with necessary staff, supplies, and logistics?
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Is anyone better off? |
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How do the findings of the Oral Health survey compare with the results of the previous study? |
- Are changes needed in the established SPMs and SOMs, if applicable.
Priority: Child Abuse Prevention.
SPM: The rate of substantiated reports of child abuse and neglect per 1,000 children ages 1-9 years.
ESM: None.
The SPM is aligned with the Priority, and further is copied almost exactly from the Issue Brief drafted by stakeholders during the Title V Needs Assessment. Stakeholders also expressed concern with perceived disproportionality reflected in child welfare cases, with minority families suspected to be disproportionately reported, and investigated, by child welfare authorities. Additional strategies in this area should include an equity lens to comprehensively address Child Abuse Prevention.
- Updates or changes to the Five Year Action Plan Table.
The effort to describe a five-year trajectory of planned and proposed activities is a new approach for Nebraska. The goal is to provide stakeholders regular information on the efforts of Title V in relation to Priority Statements, Objectives, and Strategies that is readily accessible and even engaging. A synopsis of the five-year action plans for this domain is shown in the tables below.
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Priority: Child Abuse Prevention 5-year Action Plan, 2020-2025 |
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Period |
Summary activities of the period |
Status 7/2021 |
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Year 1 |
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Year 2 |
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Year 3 |
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Year 4 |
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Year 5 |
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In the priority area of Child Abuse Prevention, with the data review complete the new strategy is to further evaluate the preventive model in NE and its ability to support vulnerable families. This work will be significantly enhanced if the submitted grant application is funded.
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Priority: Access to Preventive Oral Health Care Services 5-year Action Plan, 2020-2025 |
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Period |
Summary activities of the period |
Status 7/2021 |
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Year 1 |
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Year 2 |
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Year 3 |
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Year 4 |
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Year 5 |
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In the priority area of Access to Preventive Oral Health Care Services, there are no changes proposed for the action plan in 2021-2022.
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