NPM #7 Injury Hospitalization – Reduce intentional and unintentional injuries among children and adolescents.

Please note that some of the strategies and activities listed below impact both the Adolescent and Child Health domains. To avoid duplication, the information will only be listed in this domain, for which it is anticipated to have a larger impact.

The Bureau of Community Health and Wellness serves as the state lead for Safe Kids Worldwide and provides funding for 10 Safe Kids Coalitions. The coalitions reach 59 counties to provide unintentional injury prevention services to children aged 0-19 years. The coalitions are led by a variety of agencies including local public health agencies (LPHAs), non-profit entities, and local hospital systems. The coalitions address priorities including teen driver safety, sports safety, medication safety, fire safety, and water safety. The coalitions offer a broad array of activities and education to parents and children on injury prevention priorities, such as the National Safety Council’s Defensive Driving Course (DDC). Teens ages 14 and up are encouraged to take DDC and learn state and local traffic laws, distracted driving prevention, and safe driving practices. Additional injury prevention activities include: hosting educational and drug take back events, conducting media campaigns with prevention messages, and working with policy makers to address gaps in policies that could prevent injuries. The coalitions work closely with law enforcement officers, fire fighters and paramedics, medical professionals, educators, parents, businesses, public policy makers, and, most importantly, adolescents, to reinforce teen driver safety. The Department of Health and Senior Services (DHSS) will host quarterly conference calls and offer a one-day workshop for all coalitions to gain knowledge of evidence-based interventions and network with other coalitions.

The Injury Prevention program will continue to build program capacity and partner with current Safe Kids coalitions to provide programs, identify gaps in current services, and increase the number of partners that could support programs. The Injury Prevention program will continue to collaborate with TEL-LINK and Text4baby to provide information and resources about car seats and seat belts. Family engagement will also be a priority for Safe Kids coalitions, and families will continue to be incorporated within coalition activities.  DHSS will provide technical assistance to further that effort. 

The Injury Prevention program coordinates the Missouri Injury and Violence Prevention Advisory Committee (MIVPAC), which serves to provide advice, expertise, and guidance to the Missouri Injury Prevention Program and to establish injury prevention as a state priority. The Committee consists of representative members from state agencies, local and regional government agencies, non-government bodies, and consumers. The Committee’s goal is to reduce the morbidity and mortality of children aged 0 -19 years due to injuries and violence. MIVPAC completed its strategic plan in FY21 and will focus work in FY22 on implementing the plan. The plan includes strategies to promote partners and collaborate with partners to improve injury prevention efforts in Missouri and to promote MIVPAC as the resource for best-practice recommendations to address injury and violence prevention.

Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) inclusivity refers to the degree to which programs are sensitive toward, responsive to, and encompassing of, the diverse experiences and needs of LGBTQ youth and families. The Adolescent Health Program (AHP) will continue to disseminate a LGBTQ training to contractors and partners to improve inclusivity across youth-serving organizations. Improving inclusivity and the ability for adults to better understand and support LGBTQ youth will improve outcomes across health indicators. The AHP will also continue to provide Foundations trainings to school personnel across Missouri in order to help the districts evaluate and improve their health curriculums for inclusivity.

The AHP will continue to implement evidence-based teen pregnancy prevention and positive youth development programs across Missouri’s highest need areas in conjunction with the Personal Responsibility and Education Program (PREP) Grant and the Sexual Risk Avoidance Education (SRAE) Grant. These programs (Teen Outreach Program (TOP), Becoming a Responsible Teen, Making Proud Choices, and Making a Difference) will continue to improve not only the knowledge of Missouri’s youth, but also their self-efficacy, health outcomes, and school outcomes.

Finally, the AHP will continue to work towards having adolescent input at the state-level. The AHP plans to implement youth advisory councils as part of the aforementioned teen pregnancy prevention grant contracts. Each contractor will soon be required to start a youth advisory council (YAC), and these youth will be part of a network that DHSS can reach out to for advice on issues facing youth. AHP will work with contractors to grow skills related to developing YACs over the next few years.

The MCH Services Program will continue contracts with a total of 19 LPHAs that identified the reduction of intentional and unintentional injuries among adolescents as the Priority Health Issue to be addressed in their FFY 2022-2026 MCH work plans. The Program will continue to support LPHA efforts to prevent and reduce injury related to:

• Fire and water safety;
• Motor vehicle safety/accidents;
• Child abuse and neglect;
• Violence; and

Lead poisoning

Young Children Specific

The CCHC Program will provide continuing education training, consultation, and technical assistance to child care providers and health promotions to children enrolled in child care on a variety of injury prevention topics to promote safe child care environments and encourage healthy and safe behaviors.,

Safe Kids coalitions address priorities including child passenger safety, bicycle safety, crib safety, TV and furniture tip-over, pedestrian safety, poisoning, and other areas such as farm safety based on identified community needs. The coalitions offer a broad array of activities including: providing cribs and car seats with parental education, conducting car seat checks and certification training for child passenger safety technicians (CPST), conducting media campaigns with prevention messages, and working with policy makers to address gaps in policies that could prevent injuries.

The DHSS Injury Prevention Program Manager will represent District 5 (Central District) on the MO Child Passenger Safety Advisory Committee. Responsibilities include, maintaining regular contact with all CPSTs/inspection stations in the district, being available to sign off on seats for CPST/instructor recertification, mentoring new instructors, being the main point of contact when the Missouri Department of Transportation orders car seats for the area inspection stations, recruiting new inspection stations, and attending CPS Advisory Committee meetings.

SPM #2 Suicide and Self-Harm – Promote Protective Factors for Youth and Families.

Mental Health

DHSS School Health Program (SHP) will continue to partner with the Department of Mental Health (DMH), Department of Social Services (DSS), Department of Elementary and Secondary Education (DESE), and other agencies and organizations to identify training and resources, and to facilitate the connection with school districts across Missouri. SHP will support professional development for school health staff to implement actions for becoming trauma informed and for local school health staff to implement best practice recommendations for creating safe spaces for all students to attend school, including LGBTQ and other at-risk students.

Through the Show Me School Based Health Alliance partnership, the SHP will support school based clinics to provide services on school campuses or nearby, and include mental and behavioral health. These school based clinic services are effective in providing comprehensive care especially when they are established in partnership with a Federally Qualified Health Center.

AHP will continue to focus on Social-Emotional Learning (SEL) through the training and expansion of TOP Clubs across Missouri. AHP will expand Missouri’s SEL through continued Youth Thrive and SEL Institute trainings, which were started in FFY18 in conjunction with Wyman, Inc. These trainings are targeted to youth-serving organizations such as schools, LPHAs, DHSS contractors, and social service agencies. The trainings teach the basics of adolescent brain development and trauma-informed care as well as increase the SEL knowledge of the adults who work directly with youth.

AHP is working on a new program with a long-time partner, Wyman, Inc. This program, Teen Connection Project (TCP), focuses on building communication skills, SEL, and developing connections between high school aged youth and their peers and adults in their lives. These protective factors meld well with achieving the goals of Missouri’s Title V block grant. Wyman has piloted this program, including a rigorous evaluation, in parts of Missouri and across the country. If the grant currently under review is approved, DHSS will help Wyman implement the program at a number of sites across Missouri, with the hope that a continued partnership with the Title V program will be able to grow and expand TCP in the near future.

AHP also will continue to work on adult/child relationships through the Connect with Me campaign, funded through adolescent pregnancy prevention funds. This campaign encourages parents/guardians, teachers, coaches, and all adults to have stronger relationships and deeper conversations with the youth they care about. Topics included in the conversation starter cards for this campaign include trauma, healthy body image, taking action, and others. AHP is working to expand this campaign to include a phone app, which will enable the program to expand outreach capabilities and the variety of topics available.

Missouri’s State Adolescent Health Coordinator (SAHC) currently serves as the Vice President for the National Network of State Adolescent Health Coordinators (NNSAHC). She will be the President of the network during the 2022-2023 year. Missouri is part of Region VII, and the four SAHCs collaborate to share information and provide similar messaging and trainings. The NNSAHC is a resource to communicate ideas to build knowledge and expertise. Missouri recently reached out to this network to gather ideas regarding addressing adolescent mental health and suicide prevention. This is how the idea for the Toolkit listed below was developed.

DHSS was accepted for participation in the second cohort of the Children’s Safety Network Child Safety Learning Collaborative (CSLC) to reduce fatal and serious injuries among infants, children, and adolescents. The CSLC will conclude in October 2021.he CSLC strategy team, which includes the Title V MCH Director, the Injury Prevention Program Manager, the AHP Manager, and the Manager of Trauma-Informed Treatment at the Missouri Department of Mental Health, will continue to collaborate to improve Missouri’s efforts to address suicide and self-harm. The Injury Prevention Program, in partnership with the AHP, will complete the pilot of the Mental Health Crisis Toolkit for Missouri families. The toolkit provides comprehensive guidance in midst of youth experiencing a mental health crisis. Missouri’s toolkit is adapted from the Society for the Prevention of Teen Suicide toolkit. Missouri made the adaptions with a group of stakeholders to make it more appropriate for use in the school setting. DHSS will partner with stakeholders, such as LPHAs, Missouri School Board Association (MSBA), and school nurses, working to address mental health to distribute the adapted toolkit with local school districts during the fiscal year. 

The MCH Services Program will support LPHA and/or community partner efforts to provide education, screening, and referral for adolescent mental health needs. The Program will continue contracts with 30 LPHAs that identified the prevention and reduction of suicide and/or self-harm in their local adolescent populations as the Priority Health Issue to be addressed in their FFY 2022-2026 MCH work plans. These efforts will include, but are not limited to, preventing substance use, preventing and reducing the impact of toxic stress, and building resiliency. Examples of LPHA planned contract activities include:

• Cass, Gasconade, Pettis and Ray County Health Departments plan to increase the number of certified Youth Mental Health and First Aid instructors within their counties and increase trainings to providers (parents, grandparents, school faculty, childcare providers, medical providers, and anyone else who provides services to adolescents and families).
• Gasconade County Health Department plans to work with local law enforcement and implement a You Card, We Care Program that encourages preventing underage substance use by recognizing responsible servers and vendors who check IDs before completing a sale.  Plan to implement a school based program in collaboration with the Council for Drug Free Youth.
• Montgomery County Health Department plans to create a mental wellness community resource guide and increase the mental health resources that are given within the health department.  Plan to use the Crisis Text Line resources.  Plan to implement a school based program (i.e. Trauma Smart).
• Washington County Health Department plans to work with local EMS/Fire Department to educate community on poisonings, burns, and substance use (prevention and treatment).
• Nodaway County Health Department plans to host a Mental Wellness 5k annually that will provide education along the walking trail.  Will also provide the Crisis Text Line information on a wallet sized card. 

In addition to the above activities, the Child Care Consultation (CCHC) Program will also provide training designed to help child care providers identify children with mental health needs, and help address mental illness prior to reaching adolescence.