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 Child and Adolescent Health domains. To avoid duplication, the information will only be listed in this domain, for which it is anticipated to have a larger impact, but it should be noted that some strategies and activities may address a wider age range.

The Bureau of Community Health and Wellness (BCHW) serves as the state lead for Safe Kids Worldwide and provides funding for 10 Safe Kids Coalitions. The coalitions reach 60 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 work to increase knowledge, attitudes, and skills to address priorities such as teen driver safety, sports safety, medication safety, fire safety, and water safety. The coalitions offer a broad array of activities and education, such as the National Safety Council’s Defensive Driving Course (DDC), to increase parent and child awareness and knowledge on injury prevention priorities. Teens ages 14 and up are encouraged to take the DDC and learn state and local traffic laws, distracted driving prevention, and safe driving practices. Additional injury prevention activities include: participating in health and safety fairs, providing education through school and community events, hosting drug take back events, conducting media campaigns that incorporate prevention messages, and working with policymakers 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, community agencies, 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 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 into coalition activities. The DHSS will provide technical assistance to further that effort. 

The Injury Prevention Program will continue to coordinate the Missouri Injury and Violence Prevention Advisory Committee (MIVPAC), which provides 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-governmental 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 will continue to focus efforts on implementing the strategic plan, including strategies to promote partnerships 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.

The MCH Services Program will continue contracts with 23 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;
  • The Hickory County Health Department is working with the Sea Tow Foundation’s Life Jacket Loaner Program to implement life jacket loaner stations in state parks that have water access points. Those participating in water activities may borrow the life jackets at no cost and are asked to return them when they are finished. Additionally, the Health Department plans to partner with the Summer Reading Program at the local library to provide water safety education to children and adolescents. 
  • The Camden County Health Department has established life jacket loaner stations within state parks that have water access points. The life jackets are intended to be borrowed, free of charge, for those participating in water activities, and returned when finished. The health department also partners with the Missouri State Highway Patrol- Water Patrol Division to provide water safety education to preschool and school-aged children and adolescents. 
• Motor vehicle safety/accidents;

• The Sullivan County Health Department will work with Think First Missouri to bring the ThinkFirst for Teens School Assembly Program to schools in the county. The Program will be offered free of charge and provide a high-impact injury prevention message from a speaker who has sustained a brain or spinal cord injury, usually due to a motor vehicle crash.
• The Moniteau County Health Department will continue to provide education and safe driving resources to those who come to the health department to get a birth certificate for the purpose of obtaining a permit/driver license.
• The Osage County Health Department will work with local schools to implement the Buckle Buddy Program. The Program, sponsored by the Missouri Coalition for Roadway Safety, aims to teach children the importance of proper seatbelt and booster seat use and start them on the path toward lifelong seatbelt usage and includes a stuffed toy dragon, “Buddy”, a story and a song.

• Child abuse and neglect;
  • The MCH Services Program, in partnership with MO KidsFirst, will continue to offer and/or support and promote partner offerings of the Stewards of Children training for LPHAs and other community partners. The Stewards of Children framework teaches how to prevent, recognize, and react responsibly to child sexual abuse. The framework is built on the foundation of The 5 Steps to Protecting Children, uses real people and real stories to show how to protect children and is available in English and Spanish. 
  • The Schuyler, Putnam, and Clark County health departments will work with organizations serving youth to determine if they have child-adult contact policies and if not, help them to develop policies and provide trainings to staff.
• Violence
  • The Kansas City Health Department will work with the KC Blueprint for Violence Prevention and Healthy Communities. KC Blueprint was developed by the Violence Free Kansas City Committee (VFKCC), a citywide multisector collective impact effort of public and private entities with the mission to ensure that violence prevention and deterrence efforts are coordinated and rooted in public health and community resilience approaches. The goal of the KC Blueprint is to reduce incidence of violence and trauma affecting youth and families and ultimately heal the city together. (KCBlueprint, 2020)
  • The Linn County Health Department will work with Dr. Shayla Sullivant from Children’s Mercy in KC to bring her Prepped and Ready Program, including a home safety component and safe storage of firearms, to their communities.
• Lead poisoning
  • The Johnson County Health Department will work with local child care providers to develop lead testing policies within their organizations and provide on-site lead testing for children along with education and referral to resources as needed. Child care providers that develop policies and practices will be recognized by the health department with a “seal of greatness”.

Young Children Specific

The Child Care Health Consultation (CCHC) Program will continue to provide consultations and trainings for child care providers and health promotions for children in child care on a variety of injury prevention topics to promote safe child care environments, encourage healthy and safe behaviors, and prevent injuries in children. Consultations for child care providers will assist in the assessment of health and safety environments using evidence-based tools, development and review of policies, implementation of health and safety procedures, promoting active supervision, and utilizing safe and developmentally appropriate equipment in the indoor and outdoor environments of the child care facility. Training and health promotion topics will include, but not be limited to: abuse and neglect, mandated reporting, behavioral health, emergency preparedness, CPR/First Aid, active supervision, medication administration, poisoning prevention, lead poisoning prevention, fire safety, gun safety, injury prevention, motor vehicle and car seat safety, playground safety, safe sleep, stranger safety, water safety, and sun safety. Health promotions will continue to provide children in child care with meaningful experiences regarding health and safety and injury prevention that can be implemented in their lives outside the child care facility, and provide educational materials for their parents/guardians. All CCHC program services will continue to be inclusive and promote family involvement.

Safe Kids coalitions will address priorities including child passenger safety, bicycle/helmet safety, crib safety, TV and furniture tip-over, pedestrian safety, poisoning, home safety, and other areas such as farm safety based on identified community needs. The coalitions will 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 continue to represent District 5 (Central District) on the MO Child Passenger Safety Advisory Committee, 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  for the area inspection stations, recruiting new inspection stations, and attending CPS Advisory Committee meetings. The MCH Director will continue to participate on the Missouri Brain Injury Advisory Council, MIVPAC, and the MO Council for Adolescent and School Health (CASH). The MCH Director, Injury Prevention Program Manager, MCH Program Manager, and MCH District Nurse Consultants will continue to serve on statewide and regional safety coalitions, such as the Missouri Coalition for Roadway Safety state and regional coalitions and the Occupant Safety Subcommittee, and partner with safety advocates to prevent intentional and unintentional injuries.

The violence prevention team in the Office on Women’s Health (OWH) will leverage the Rape Prevention and Education Grant to promote shared risk and protective factors for violence prevention to prevent teen dating violence, sexual violence, and harassment in the middle school population in the state.

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

Mental Health

The 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 connections with school districts across Missouri. The SHP will support professional development for school health staff to implement best practice recommendations for becoming trauma informed and 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, including mental and behavioral health services, on school campuses or nearby. These services are effective in providing comprehensive care, especially when established in partnership with a Federally Qualified Health Center (FQHC).

The SHP will host a two-day collaborative for 40 school nurses and social workers to learn best practices in suicide prevention. The focus will be on best practice strategies to promote students returning to school after a mental health crisis.

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

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

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

In partnership with the OWH, the AHP will pilot a new sexual health curriculum developed for youth and young adults with intellectual and developmental disabilities. This population is up to seven times more likely to experience interpersonal violence in part due to a lack of quality sexual health education. Friendships and Dating (F&D), an evidence-based curriculum, will be piloted within a public school and a few out-of-home care facilities in Missouri to assess its quality and fit for Missouri’s youth and young adults.  F&D is shown to significantly decrease the incidence of interpersonal violence and increase social network size for those completing the program.

The AHP will continue to focus on Social-Emotional Learning (SEL) through the training and expansion of TOP Clubs across Missouri. The AHP will expand Missouri’s SEL through continued Youth Thrive and SEL Institute trainings, which were started in FFY18 in partnership with long-time partner, 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 and increase the SEL knowledge of adults who work directly with youth.

The AHP will continue to work with Wyman, Inc. on the Teen Connection Project (TCP) to build communication skills, SEL, and connections between high school aged youth and their peers and adults. These protective factors will help achieve the goals of Missouri’s Title V MCH State Action Plan. If an additional grant application is approved, the DHSS will partner with Wyman, Inc. to implement the program at a number of sites across Missouri, with the hope that continued Title V MCH Block Grant collaboration and support will help sustain ongoing TCP growth and expansion.

The AHP will continue to leverage adolescent pregnancy prevention funds to work on adult/child relationships through the Connect with Me campaign. 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 the campaign include trauma, healthy body image, taking action to support health needs, and others. The AHP will work to expand the campaign to include a Connect with Me phone app, enabling the program to expand outreach capabilities and the variety of topics available, including expansion of the mental health section and addition of a diversity category.

Missouri’s State Adolescent Health Coordinator (SAHC) will serve as the President for the National Network of State Adolescent Health Coordinators (NNSAHC), a resource to communicate ideas and build knowledge and expertise. Missouri is part of Region VII, and the four SAHCs collaborate to share information and provide similar messaging and trainings.

The Injury Prevention Program, in partnership with the AHP, will complete the pilot of the Navigating Your Child’s Mental Health Crisis Toolkit. The toolkit provides comprehensive guidance for families with a youth in the midst of a mental health crisis. The toolkit was distributed to local school districts during the 2021-2022 school year. The school districts will pilot the toolkit and provide feedback to the DHSS during the 2022-2023 school year. Once the pilot is completed and any necessary changes are made, the toolkit will be available to all schools in the state.

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 32 LPHAs that identified 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 will increase the number of certified Youth Mental Health and First Aid instructors and  Youth Mental Health and First Aid trainings for parents, grandparents, school faculty, child care and medical providers, and others who provide services to children and families.
• Nodaway County Health Department will work with school districts to implement Character Strong, which provides research-based PreK-12th grade SEL curricula and professional learning services that positively impact lives.
• The Stone and Taney county health departments will use QPR, an evidence-based suicide prevention program, with various community organizations serving youth and adolescents, such as the Civil Air Patrol (CAP) Cadet Program and the Greater Ozarks Centers for Advanced Professional Studies (Go-CAPS). The CAP Cadet Program is a congressionally chartered, federally supported non-profit corporation that serves as the official civilian auxiliary of the United States Air Force. The Program transforms youth into dynamic aerospace leaders through a curriculum that focuses on leadership, aerospace, fitness, and character. As cadets participate in these four elements, they advance through a series of achievements, earning honors and increased responsibilities along the way. Many of the nation’s astronauts, pilots, engineers, and scientists first explored their careers through CAP. Go-CAPS participants experience real world, project-based learning strategies through collaborations with business and community partners. These interactions enhance the learning experience by preparing students for college and careers.

In addition to the above activities, the Child Care Consultation (CCHC) Program will continue to provide trainings and consultations to help child care providers identify children with mental health needs, promote evidence-based protective factors for children and families, and address mental illness prior to reaching adolescence. Such training topics will include trauma-informed care, resilience, depression and anxiety, divorce, grief, separation anxiety, SEL, positive behavior support, positive discipline, healthy relationships in child care, and substance abuse awareness. Training topics for child care providers that focus on staff mental health and wellness will include suicide prevention and awareness, trauma-informed care, resilience, self-care, stress management, the relationship between physical and mental health, substance use awareness and prevention, and de-escalation in times of crisis. Consultations with child care providers will promote the implementation of policies and procedures that optimize the mental health of staff and children and provide referrals to outside resources as needed. CCHCs will continue to provide for children in child care health promotions that promote mental health in young children on the topics of bullying, emotional expression, anger management, regulation of emotions, sleep, screen time, empathy, self-esteem, celebrating differences and diversity, and living tobacco and drug free. CCHC program services will continue to provide evidence-based and educational resources for child care providers and families of children in child care that promote mental health, and provide children in child care with meaningful experiences, coping strategies, and mental health support that will benefit their lives inside and outside of the child care setting. Participation of parents/guardians of children in child care will continue to be encouraged in all CCHC services. 

The violence prevention team in the OWH will leverage the Rape Prevention and Education (RPE) Grant to promote shared risk and protective factors for violence, suicide, and self-harm prevention. These components will be incorporated into new prevention strategies funded by RPE to be implemented in college and university settings.

The Missouri DSS launched a new Specialty Health Plan, called Show Me Healthy Kids, to help provide unified healthcare coverage to children and youth in DSS custody, former foster children, and individuals receiving adoption assistance payments. This specialized managed care plan, administered by Home State Health, will allow some of the most vulnerable members of MO HealthNet (Missouri Medicaid) to access a care network specifically designed to meet their needs. Coverage under the Show Me Healthy Kids plan began July 1, 2022. Individuals who qualify for coverage through Show Me Healthy Kids will automatically be moved to this plan from their existing health plan, or enrolled in this health plan the day they are approved for MO HealthNet (Missouri Medicaid) benefits. They will continue to receive their healthcare coverage through this plan as long as they are eligible. Eligibility groups for Show Me Health Kids include:

• Children in the care and custody of the Missouri Department of Social Services;
• Children or youth in alternative care;
• Children receiving adoption or legal guardianship subsidy;
• Former foster care youth under the age of 26, who were in foster care on their 18th birthday and covered by MO HealthNet (Missouri Medicaid), and who meet other eligibility criteria; and
• Former foster care youth under the age of 26, who were in foster care on their 18th birthday and covered by Medicaid from another state, and who are not currently eligible for Medicaid coverage under another program