FFY2016 Title V State Plan State Performance Measures (SPMs)

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1 Table of Contents FFY2016 Title V State Plan State Performance Measures (SPMs) SPM 1: The degree to which the state MCH Title V program improves the system of care for mothers and children in Iowa... 1 SPM 2: The degree to which components of a coordinated statewide system of care for CYSHCN are implemented... 2 SPM 3: The degree to which Iowa s state MCH Title V program addresses health equity in MCH programs measured through the MCH Title V index... 6 SPM 4: Percent of family planning clients (women and men) who are counseled about developing a reproductive life plan... 7 SPM 5: The degree to which the health care system implements evidence based prenatal and perinatal care... 9 SPM 6: Percent of Medicaid enrolled women receiving preventive dental health services during pregnancy SPM 7: Percent of Medicaid-enrolled children ages 0-5 years who receive a dental service SPM 8: Rate of hospitalizations due to unintentional injuries among children ages SPM 1: The degree to which the state MCH Title V program improves the system of care for mothers and children in Iowa Last Year s Strategic leadership: BFH and CHSC Staff continued to communicate the goals and objectives of the Title V programs across the state. A workgroup was formed to develop materials to educating policy makers on the importance of the Title V program in reaching Iowa's most vulnerable populations and how Title V fits within the ACA. The Title V Director and CYSHCN Director serve on the AMCHP Board and several staff members serve on AMCHP Committees. Through these roles, Title V leadership can help influence decisions made on behalf of the Title V program. Partnerships across public and private sectors: Staff has been following progress being made related to the ACA to ensure Title V programs are integrated into the health home and with accountable care organizations (ACOs). 1 QI: Iowa's Title V program worked with the MCH Workforce Development Center at UNC Chapel Hill to assess the state level preparedness for integration of the ACA and Title V.

2 Use of available resources: Iowa's Title V program has continued to seek out new funding opportunities, especially as they relate to integration into the ACA. Coordination of service delivery: IDPH staff has worked on developing a baseline assessment of services for special populations and care coordination services. CHSC has maintained service delivery improvements through telehealth. Data infrastructure: The BFH embarked in a data integration project. A request for proposals (RFP) was released to integrate the newborn screening and newborn hearing program data systems and the work is now underway with the awarded bidder. Work on a RFP for integration of MCH related systems is underway. Current Activities Strategic leadership: Several staff members serve on AMCHP Committees. Through these roles, Iowa's Title V leadership will help influence decisions made on behalf of the Title V program. Partnerships across public and private sectors: Staff continues to follow progress being made related to the ACA to ensure Title V programs are integrated into the health home and with accountable care organizations (ACOs). QI: BFH and CHSC continue to work with local providers on integrating QI strategies into their work plans. Use of available resources: Utilizing the MCH Navigator training portal, State and local Title V staff will conduct the self assessment of the MCH Leadership Competencies to focus training and education opportunities. Iowa's Title V program will continue to seek out new funding opportunities, especially as they relate to integration into the ACA. Coordination of service delivery: IDPH staff will monitor of provision of services for special populations and care coordination services. CHSC will maintain service delivery improvements through telehealth. Data infrastructure: The RFP for integrating MCH data systems is being developed. BFH is awaiting the funding to be in place before releasing. As the system is developed, strategies to integrate with the IHIN and data systems within the Departments of Education and Human Services will be explored. SPM 1 SPM 2: The degree to which components of a coordinated statewide system of care for CYSHCN are implemented 2

3 Last Year s UI-DCCH surveyed families to elicit feedback on all services provided in CHSC Regional Centers for quality improvement. UI-DCCH implemented the Regional Autism Assistance Program teams at CHSC's 15 sites to assure a system of care for children with ASD and their families. UI-DCCH obtained a State Implementation Grant for Improving Services for Children and Youth with Autism Spectrum Disorder (ASD), a 2-year project funded by HRSA. UI-DCCH partnered with Iowa's 1st Five initiative to develop metrics to measure child, family, and provider outcomes. UI-DCCH trained employees in cultural competence and health literacy and examined ways to integrate the knowledge into service delivery. UI-DCCH reviewed UI-DCCH data dashboards to inform quality improvement efforts. UI-DCCH implemented the PIH program for children with Serious Emotional Disturbances (SED) in five sites and developed collaborative relationships with organizations implementing the PIH program in other counties. UI-DCCH and 1st Five sites piloted an enhanced care coordination algorithm to guide Title V practitioners in determining when a child could benefit by being served by a CHSC care coordinator. UI-DCCH contracted with a Family Medicine physician and a pediatrician to mentor 1st Five practice sites on the importance of early identification and referral of children at risk. UI-DCCH partnered with EPSDT to develop and pilot test tools to assist youth, families, care coordinators, and PCPs in planning for the transition to adulthood and examine barriers and best practices related to transition to adulthood. Current Activities UI-DCCH administers a MCHB funded Systems Implementation Grant to Enhance Systems Integration (SIG) for CYSHCN to increase the proportion of CYSHCN who receive integrated care through a medical or health home approach. SIG activities include: participating in a SIG Academy learning collaborative with other states to develop common aims, convening the SIG Advisory Council for quarterly meetings, developing Iowa s state plan and forming implementation resource teams to operationalize it, and developing a newsletter for the SIG Advisory Council and UI-DCCH Family Advisory Council. 3

4 UI-DCCH customizes the electronic medical record to include data on transition to adult health care and other key clinical components for CYSHCN. UI-DCCH collaborates with interagency partners to assure adequate services for screening and evaluating children suspected of being abused. UI-DCCH develops resources, including social media, to assist families and youth in building self-advocacy skills. UI-DCCH serves as a planning partner for the Iowa Governor's Conference on Public Health and other conferences by request, ensuring inclusion of topics related to CYSHCN. UI-DCCH maintains a Family Advisory Council to gain feedback on programs and the system of care for CYSHCN. UI-DCCH's advocacy team is training staff on how to address bullying of CYSHCN, monitoring legislative efforts, and advocating for meeting the needs of CYSHCN. UI-DCCH collaborates with the Iowa Chapter of the American Academy of Pediatrics to identify potential areas for collaboration with primary care providers (PCPs). UI-DCCH implements RAP teams to improve the system of care for children with ASD. RAP teams may include ARNPs, RNs and FNs. RAP teams provide care coordination, family-to-family support, and facilitate access to funding for ABA. RAP contacts service providers to maintain a directory of ASD resources and services and is developing a web portal with ASD resources. UI-DCCH implements the Regional Autism Assistance Program in one additional site (Des Moines) to assure a system of care for children with ASD and their families, bringing the number of RAP teams to 15. UI-DCCH regularly reviews UI-DCCH data dashboards to respond with quality improvement efforts and to communicate with stakeholders. UI-DCCH trains staff in health care transition and uses lessons learned from pilot project to revise and expand transition tools. UI-DCCH surveys referring PCPs and subspecialty providers referring on their perceptions of the care CHSC provides. Data is used for quality improvement. UI-DCCH surveys families to elicit feedback on all services provided in Regional Centers and improve all aspects of care. UI-DCCH offers standardized training for FNs and is developing a certification 4

5 process. UI-DCCH Registered Dieticians provide technical assistance to primary care providers of CYSHCN who are overweight/obese and direct clinical nutrition services to CYSHCN in the Early ACCESS program. UI-DCCH implements the PIH program for children with SED in five sites. UI-DCCH creates CYSHCN specific job aids regarding health literacy. UI-DCCH s article titled Developing a Statewide Electronic Public Health Care Coordination Tracking System was published in the March edition of the Journal of Pediatric Nursing. UI-DCCH Community Circle of Care/PIH sites implement care plans for all patients, which address family strengths, needs, and monitors ongoing progress. UI-DCCH s goal is to implement this model of care plan for all patients served, regardless of funding source. UI-DCCH received technical assistance to train Family Navigators and additional staff in Shared Decision Making through Missouri Family to Family. UI-DCCH FNs are regularly represented as Association of Maternal and Child Health Programs (AMCHP) Family Scholars, Mentors, and Delegates. A FN serves as Vice Chair of the AMCHP Family and Youth Leadership Committee, which is a national effort to promote family leadership. FNs presented at AMCHP on Iowa s Family Navigator Training Program and assisted other states in developing their programs. UI-DCCH FNs participate in the Region 4 Midwest Genetics Collaborative to provide the training Care Coordination: Empowering Families. The purpose of the training is to provide families with the skills, knowledge and resources needed to coordinate care for CYSHCN with a genetic condition in partnership with medical homes. UI-DCCH develops lists of community resources for families of CYSHCN who experience bullying and trains community partners in recognizing and responding to bullying. UI-DCCH uses a web-based program known as CultureVision to provide frontline health care professionals with information needed to provide culturally competent patient care. UI-DCCH requires materials for families to be written at 6th grade level or below 5

6 and uses a software program to review documents and assure they meet this standard. They are tested by the Family Advisory Council for readability. A UI-DCCH Family Navigator is a family faculty member for the Iowa Leadership Education in Neurodevelopmental and other Related Disabilities (ILEND) program, and other UI-DCCH leaders serve as MCH Title V faculty. UI-DCCH RAP partners with 1st Five to promote knowledge of ASD and related screening/assessment tools and resources within primary care offices. UI-DCCH Leadership participates in state level planning for Iowa s Medicaid Modernization efforts. UI-DCCH is developing a new model of care in northwest Iowa that does not include a UI-DCCH employed ARNP on the care team. UI-DCCH collaborated with statewide partners and families to develop the Brain Care Guide to provide information on services that children and families may need after a traumatic brain injury. Enabling and Direct Care Services: UI-DCCH assists families of CYSHCN in making behavioral and/or emergency care plans. SPM 2 UI-DCCH ARNPs and RNs provide nutrition education and health assessments for young children in Early ACCESS, which are shared with the children s medical homes. SPM 3: The degree to which Iowa s state MCH Title V program addresses health equity in MCH programs measured through the MCH Title V index Last Year s Provided a minimum of 40 continuing education and trainings at MCH conferences and workshops to provide awareness and education of the CLAS Standards (Culturally and Linguistically Appropriate Services) in our efforts to infuse this blueprint and the incorporation of these standards to advance health equity, improve quality and help eliminate health care disparities. 6 The Office of Minority and Multicultural Health works in collaboration with child health, maternal health and adolescent health teams to provide inclusion of health equity and health disparities issues and concerns that may be relevant to minority, immigrant, refugee targeted populations within Iowa's changing

7 demographic. We insure that the social determinants of health are included with strategic plans and processes of our contracted MCH agencies through attendance at meetings, webinars, conference calls and staff development training sessions. We have provided six in-service workshops for professional and new employee training utilizing the City MatCH Life Course Model game to ensure enhanced awareness of the social determinates of health that impact our MCH clientele. Provide technical assistance to the Maternal and Child Health contractors and their partners to insure that health equity is part of professional development, ongoing education of staff and team building for quality improvement. We provide assistance in reviewing marketing materials, and provide visual and media resources for diverse populations. Current Activities The Office of Minority and Multicultural Health (OMMH) has provided CLAS (Culturally and Linguistically Appropriate Services) training and staff development to the management team of the Division of Health Promotion and Chronic Disease Prevention. OMMH has co-presented at the April Governor s Health Conference regarding the work that has been done with the West African community, especially regarding mobilization and partnership building in time of crisis. In June OMMH will present a one hour workshop using the City MatCH Life Course Model game for the 2015 statewide annual WIC conference. We continue to serve on the DHHS OMH Regional Health Equity team for the state of Iowa, and will continue to infuse the CLAS standards awareness and education model especially in addressing Title VI of the Civil Rights Act, Affirmation Action policies and procedures, financial connections that these standards will have with federal funding streams, and ongoing MCH program activities in addressing targeted communities. It is the intent that 45 workshops and trainings to address this performance goal will take place in SPM 3 SPM 4: Percent of family planning clients (women and men) who are counseled about developing a reproductive life plan Last Year s 7 IDPH has a network of seven sub-recipient (SR) agencies to provide Title X services. A new sub-contractor was identified in Primary Health Care, Inc. is providing services in Polk County. The FQHC began seeing clients in May, 2014.

8 Issues to be resolved included FQHC enrollment into Iowa's Family Planning Waiver (this had never been done before and required the assistance of Iowa Medicaid Enterprise), billing and coding training for family planning services, staff training, and contracts. Changes needed to occur at the FQHC to encourage/enable them to keep contraceptive methods in the clinic, work with their internal 340B pharmacy, create new documentation templates in their EHR system and work with our Community Based Screening Program for STIs. Five of seven (71%) of SR have successfully transitioned to EHR. IDPH staff has conducted interim and post transition chart audits and provided technical assistance where needed. One SR has been given information about the availability of open access EHR systems. One SR has indicated a plan to move forward Spring All seven SRs are participating with the insurers that are on Iowa's shared Marketplace. All are participating with both Medicaid and the Medicaid managed care payer. All seven SR are participating with Iowa's Medicaid expansion - the Iowa Health and Wellness Plan. All seven SRs also provide on site enrollment into the Iowa Family Planning Network Waiver. Three SRs have successfully completed training to become a Certified Application Counselor entity (CAC). One SR that initially decided not to pursue training when their Board of Directors expressed concerns about liability is reconsidering. The FQHC provides navigators for enrollment as well. Quality improvement projects include working with the CDC on contraceptive performance measures and the evaluation of denied Medicaid claims to provide training to SRs. IDPH has raised awareness and introduced SRs to the importance of quality measures and, specifically, family planning performance measures in health care delivery. SRs were provided information on the performance measure of proportion of users initiating or continuing a most or moderately effective method of birth control. The information was presented at a FP Directors meeting by the MCH Epidemiologist. The FP Directors overwhelmingly asked to continue to receive feedback on this measure at least annually. According to preliminary FPAR 2014 reporting, IDPH SR agencies continue to provide care to primarily low income individuals. Ninety-six percent of clients had incomes below 250 percent federal poverty level (FPL) in 2014 as well as FPAR In 2014, 70.9 percent of clients had incomes below 100 percent FPL compared to 69.9 percent in In this reporting period, 669 clients with limited English proficiency (LEP) were served, compared to 447 in This represents almost 5 percent of total clients. According to FPAR 2014 data 52% of clients were under 24 years of age, while the largest number of clients were between years of age. Six (6) percent of clients were African American; eleven (11) percent of clients were Hispanic or Latino while three (3) percent were other minority declarations. In the fall of 2013, the MCH Epidemiologist and Title X coordinator worked with the Medical Director at Iowa Medicaid Enterprise (IME) on an initiative to promote Medicaid coverage for immediate postpartum insertion of LARCs. In February 8

9 2014, IME began paying practitioners and hospitals for postpartum insertion of intrauterine systems and hormone implants. IDPH is working to provide outreach to educate providers about the coverage and updated billing procedures. It is too early to report data from this change. Current Activities Title X continues to implement the work plan submitted to OPA in Work includes supporting the national Title X priorities of maintaining quality family planning services to low income men and women in need of publicly funded family planning services, including providing a broad range of contraceptive methods; addressing the comprehensive family planning and other health needs of individuals by helping local agencies partner with other community-based health and social services providers that provide needed services; addressing clinical sustainability through coding and billing trainings; assuring workforce response to emerging issues; conducting community outreach and education to make priority populations aware of the availability of family planning services and inform the public about Title X services and assuring that all men and women receiving Title X services receive preconception care services as well as Reproductive Life Planning (RLP) to enable them to freely plan and space pregnancy, avoid unintended pregnancy and/or enter pregnancy in optimal health. A RLP toolkit is in development for use in birthing hospitals to encourage providers to discuss reproductive planning with new parents. It will be piloted in February in four (4) of the Title X communities. SPM 4 SPM 5: The degree to which the health care system implements evidence based prenatal and perinatal care Last Year s Strategic leadership: Statewide Obstetrical Task-force released its strategic plan. Their mission is to guide, monitor and improve obstetrical care in Iowa. The vision statement is by 2018, to improve obstetrical and neonatal outcomes in quality, patient safety and cost. Their goals are as follows: 1. To deploy evidence-based best practices (reduce early elective deliveries, standardized progesterone treatment, tobacco cessation, avoid adverse OB events) 2. Ensure access to care 3. Increase providers and consumer awareness of available resources 4. Promote use of common metrics to measure our performance. 9 Partnerships: The Medicaid Maternal Health Task Force will continued to partner with IDPH. They have been exploring methods to improve quality of care for pregnant Medicaid eligible women. Needs are identified through a matched data set that included Medicaid claims data and birth certificate data. IDPH has been

10 working on strategies to link hospital discharge data to birth file to improve data tracking of elective deliveries prior to 39 weeks gestation. QI: BFH staff has continued to provide technical assistance to MCH programs on QI methodology and to promote QI guidelines through the Perinatal Newsletter and the BFH Update. Use of available resources: BFH staff has collaborated with IME to advance evidence- based strategies into provider requirements and recommendations IDPH provided training and plan to implement therapeutic listening home visits. Current Activities Strategic leadership: Statewide Obstetrical Task-force has started to define activities to meet the goals in their work plan 1. To deploy evidence-based best practices (reduce early elective deliveries, standardized progesterone treatment, tobacco cessation, avoid adverse OB events) 2. Ensure access to care 3. Increase providers and consumer awareness of available resources 4. Promote use of common metrics to measure our performance. Partnerships: The Medicaid Maternal Health Task Force continues to partner with IDPH. They are exploring methods to improve quality of care for pregnant Medicaid eligible women. IDPH is working on strategies to link hospital discharge data to birth file to improve data tracking of elective deliveries prior to 39 weeks gestation. Identify new partnerships to collaborate on the Infant Mortality collaborative Improvement and Innovation Network (CoIIN) QI: BFH staff continues to provide technical assistance to MCH programs on QI methodology and to promote QI guidelines through the Perinatal Newsletter and the BFH Update. Use of available resources: BFH staff is collaborating with IME to advance evidence- based strategies into provider requirements and recommendations. IDPH provided training in 2014 in therapeutic listening home visits this will continue to be implemented in our Title V MH agencies. SPM 5 SPM 6: Percent of Medicaid enrolled women receiving preventive dental health services during pregnancy Last Year s 10 OHC continued working toward building systems that address the oral health needs of MH clients and linking with the existing I-Smile initiative for children.

11 Oral health data was not yet available from PRAMS and the Barriers to Prenatal Care Survey, but the Medicaid/birth certificate match data allowed for some measure of program impacts and considerations for future program directions. In response to contractors, OHC staff and BFH staff developed policy to allow an oral health only maternal health client, to enable providing preventive dental services and care coordination for pregnant women in need of that assistance. The changes are taking effect during the current fiscal year. Population-based Services: OHC staff offered preventive messages to moms on the I-Smile Facebook page. Other family health issues were also incorporated. Funding for I-Smile health promotion was offered to MH contractors, as well as CH contractors. Enabling and Direct Care Services: OHC staff encouraged contractors to assist MH clients to become enrolled on Medicaid or to find another payment source for dental care. IOHC monitored dental care coordination services provided to MH clients as part of quality assurance reviews. Gap-filling preventive services were provided by contractors as indicated by local need. Twelve local MH agencies had action plans related to dental care for pregnant women. Activities include discussing the importance of dental care and good oral health at each prenatal and postpartum visit, providing education to dispel the myth that dental care during pregnancy must be avoided. Current Activities OHC staff is working on a data portal, part of Iowa's data warehouse project. A new epidemiologist has begun identifying data system needs and considerations for further evaluation of program impact on pregnant women. OHC staff is working with BFH staff to on a new policy to incorporate OH only MH client services. OHC staff makes annual site visits to each MH contractor and participates in direct care chart audits to assure quality record-keeping and appropriate referral documentation. An oral health state plan is begin developed as part of a CDC grant activity, and includes ways to better integrate oral health within health reform. Population-based Services: I-Smile health promotion activities continue at the state level as well as through local contractors. Funding was provided to MH contractors to conduct oral health promotion initiatives. Enabling and Direct Care Services: OHC staff offer technical assistance and monitoring of dental care coordination services. 11

12 MH contractors who identify gaps in care for low income pregnant women offer direct dental services of screenings, counseling, and fluoride application. This is particularly important due to the lack of a requirement to have dental insurance as part of Iowa's health insurance reform. SPM 6 SPM 7: Percent of Medicaid-enrolled children ages 0-5 years who receive a dental service Last Year s The bulk of activities targeting this performance measure are accomplished within the I-Smile project. A capacity-building CDC grant allowed OHC to add epidemiological support, assisting with data monitoring, program evaluation, and surveillance. Four I-Smile Coordinator trainings were held, including topic areas of core public health functions, care coordination, communication and being a spokesperson, and how to use data effectively. OHC staff participated on the Community of Practice Care Coordination meetings, discussing strategies for expansion of 1st Five, MIECHV, and other health programs for children. Current Activities 12 Population-based Services: OHC health promotion activities included several National Children's Dental Health Month activities such as I-Smile sponsorship of public television shows and a legislative postcard; maintaining a Facebook page; and radio spots promoting "first visit by first birthday". I-Smile display banners were provided to all 24 coordinators to be used at community functions and funding for I-Smile health promotion activities was provided to MCH contractors. Enabling and Direct Care Services: OHC and Family Health Bureau staff worked with local contractors to determine care coordination policy needs, then worked with IME to address those needs. OHC consultants provided technical assistance to MCH contractors through trainings, site visits, and phone/ communication. Gap-filling preventive services continued through local contractors. All were required to ensure that children ages 0-2 at WIC are served. OHC staff oversee the I-Smile dental home initiative, including professional development and training for state coordinators, site visits, and policy development as needed. New OHC staff, hired as part of a CDC capacitybuilding grant will consider ways to create a consistent approach to oral health coalitions and partnerships statewide. OHC staff are incorporating

13 improvements to the auditing process for the state's school screening requirement, managed by local I-Smile coordinators. OHC staff also continue to work to better integrate oral health within medical health reform. Population-based Services: Open mouth surveillance is planned for children at Head Start. OHC staff work with I-Smile coordinators on statewide and local health promotion opportunities. Enabling and Direct Care Services: I-Smile coordinators and CH contractors continue to offer care coordination, supported by OHC staff technical assistance. Coordinators advocate for selecting dental insurance for families enrolling with new health coverage via the marketplace. CH contractors will continue to be required to ensure that children ages 0-2 are provided preventive care at WIC, due to data indicating a gap in care for this age group. Since dental insurance is not required as part of the health insurance marketplace, additional gap-filling care will also continue in other locations such as Head Start, based on need. SPM 7 SPM 8: Rate of hospitalizations due to unintentional injuries among children ages 0-14 Last Year s BFH staff worked with the IDPH Bureau of Disability and Violence Prevention to conduct annual surveillance of statewide injury trends. Data and best practice information on injury prevention for children were distributed to local Title V contractors, including resources from the Children's Safety Network (CSN) and the Safe States Alliance. BFH staff promoted the Annual Iowa Child and Youth Injury Prevention Conference and the Love Our Kids Grant, designed to provide funding to rural areas to implement injury prevention initiatives for children. Five Child Health (CH) agencies developed specific action plans related to preventing unintentional injuries. Activities included creating public awareness campaigns, car seat safety and motor vehicle safety initiatives, and providing health and safety education for families. Nineteen of 22 CH contract agencies employed Child Care Nurse Consultants (CCNC) and implemented activities related to promoting health and safety in child care settings. New education resources were developed. A Safe Sleep training and 13

14 factsheet for child care providers were presented by local CCNCs to child care center staff and development home providers throughout the state. A new Using Chemicals Wisely factsheet was distributed to CCNCs and child care consultants which provides information on how to select disinfectants/sanitizers that are safe for use in child care. It also addresses safe storage, dwell times, the importance of carefully reading labels, and personal protective equipment that may be needed by staff. ALICE (armed intruder) training was provided at the CCNC state meeting. IDPH participated in the CSN and Traumatic Brain Injury (TBI) Technical Assistance Center's collaborative Community of Practice on the prevention of TBI. The Iowa Team included staff from the IDPH Bureau of Family Health (BFH), Office of Disability, Injury & Violence Prevention, Bureau of EMS, and Division of Behavioral Health, the Advisory Council on Brain Injuries, the Brain Injury Alliance of Iowa, and the University of Iowa College of Medicine. This involved monthly educational webinars with the national group and monthly conference calls or meetings of the Iowa Team. Iowa's project focused on development of an assessment for coordination of care and supports for children/families that have experienced mild and moderate to severe traumatic brain injury. BFH staff continued participation on the Prevent Iowa Shaken Baby Syndrome (SBS) Team. The team, comprised of representatives from IDPH, Prevent Child Abuse Iowa, Iowa Department of Management, and Blank Children's Hospital, continued to implement Iowa's statewide initiative. SBS prevention training was provided to hospital staff at St. Luke's Hospital in Cedar Rapids and to early care, health, family support, and education providers at the Annual Iowa Child Abuse Prevention Conference. At the Annual Iowa Conference on Perinatal Medicine on Prevention of SBS, Early Childhood Iowa supported two national speakers who addressed `Latest Developments on the Research, Program Components and Delivery of the Period of PURPLE Crying' and `The Financial Impact of Abusive Head Trauma: Why We Need to be Investing in Prevention'. Population Based Services: The Period of Purple Crying is the educational program which helps parents and caregivers understand the features of crying in normal infants that can lead to shaking or abuse. It promotes a foundation for good parenting through instruction that it is never okay to shake or otherwise harm a baby. Period of PURPLE Crying DVDs and booklets for families in English and Spanish were distributed to birthing hospitals. They emphasize the serious nature of SBS, as well as techniques to prevent it. Iowa continued the public awareness campaign `Click for Babies' coordinated by the National Center for SBS. Volunteers were solicited to knit purple hats for newborns with a note to reinforce key points of SBS prevention. `Knit-ins' were held in Des Moines and Cedar Rapids. Approximately 7,796 caps were distributed to birthing hospitals across the state. The International Conference on 14

15 SBS/Abusive Head Trauma featured an Iowa Prevent Team presentation on the Iowa `Click for Babies' campaign, and the National Center sponsored an educational webinar on the Iowa project. Current Activities BFH continues to track statewide data trends, monitor key legislation, and distribute educational resources to local CH agencies. Healthy Child Care Iowa (HCCI) is beginning work on the state plan for the Child Care Development Block Grant. Child Care Nurse Consultants (CCNC) are an important part of consultation, on-site assessment, and support in child care health and safety practices; health and safety provider training; and improving access for under-served populations by assisting with care planning, training, and coordination for inclusive care for children with special health needs. Population-based Services: In the first six months of FFY 2015, local CCNCs provided trainings to over 375 child care providers statewide which included Safe Sleep, Emergency Preparedness, Medication Administration, Injury Prevention, Period of PURPLE Crying, and Save a Baby - Needle a Provider (influenza & pertussis prevention). ALICE (armed intruder) information was added to the Emergency Preparedness training for child care providers. HCCI staff also developed a Fall Surfacing Factsheet. Shaken Baby Syndrome prevention education is provided to hospital emergency department staff in Iowa's ten most populous counties. The Period of Purple Crying DVDs and booklets are distributed to birthing hospitals upon request. Education will be provided to family support workers and other professionals at Iowa's Area Education Agencies. Participation in `Click for Babies' continues with `Knit-Ins' at four scheduled events. SPM 8 General Comments 15