Group: Health & Human Services - Department of Health

Agency: Health

Line Item: Community and Family Health Services

Function

The Division of Community and Family Health Services assures that women, infants, children, and their families have access to comprehensive, coordinated, affordable, community-based quality health care. Division services are available to all citizens of the State according to their ability to pay, but primary clients are women, infants, and children who have special health care needs and are low income. The Division coordinates efforts, identifies needs, prioritizes programs, and develops resources necessary to reduce illness, disability and death from:

• Adverse Pregnancy Outcomes
• Chronic Diseases
• Disabling Conditions
• Injury and Violence
• Vaccine-Preventable Infections

The Division is organized into a Director's Office and three functional bureaus. These bureaus are: Health Promotion; Maternal and Child Health; and Children with Special Health Care Needs.

Statutory Authority

The Division of Community and Family Health is governed by various chapters of the Utah Health Code in Title 26 of the Utah Code.

• UCA 26-5 defines chronic diseases and requires the Department to establish programs to prevent, delay, and detect the onset of such.
• UCA 26-7 authorizes the Department to create programs to promote good health practices and reduce major risk factors that contribute to injury, sickness, death, and disability.
• UCA 26-9f creates the Utah Digital Health Services Commission which deals with telehealth issues.
• UCA 26-10 establishes 'Family Health Services' including the metabolic testing of newborns.
• UCA 26-15 requires the Department to adopt rules to implement the Utah Indoor Clean Air Act, a function carried out by the Tobacco Prevention Program in the area of Health Promotion.
• UCA 26-21a requires the Department to create a program to reduce breast cancer mortality.
• UCA 26-38 is the Utah Indoor Clean Air Act, which restricts smoking in indoor public places, and establishes enforcement authority and penalties for noncompliance.
• UCA 26-42 establishes civil penalties for individuals and/or licensees that sell tobacco products to underage minors.
• UCA 26-43 requires the Department to obtain information regarding tobacco products and the level of detectable compounds in them.

Funding Detail

Program: Director's Office

Function

The Office of the Director of the Division of Community and Family Health Services (CFHS) leads and manages all the resources and programs of the Division. The office consists of the Director, the administrative secretary, the Center for Multicultural Health, Utah State Immunization Information System and the Financial Resources Program. The director oversees three bureaus, including Health Promotion, Maternal and Child Health, and Children with Special Health Care Needs.

The Center for Multicultural Health addresses health disparities among ethnic groups through health programs in the Department and in the community. The Center aims to foster accessible and high-quality programs and policies that help all racial and ethnic minorities in Utah achieve optimal health, dignity, and independence. The center will accomplish this by increasing public and health professional awareness of persistent racial/ethnic disparities and developing effective health policies and culturally competent programs that lead to better access to quality health care services and improved health status.

Utah State Immunization Information System (USIIS) is the immunization registry for Utah. This program collects and maintains current immunization records on children in Utah which health care providers use to keep their patients up to date on their immunizations. DOH uses this data to monitor the overall immunization rates in Utah.

The Financial Resources Program provides financial management for the Division by managing budgets, contracts and grants; ensuring compliance with financial policies and regulations; ensuring the accuracy of all financial transactions; and providing billing services for public services.

Funding Detail

Program: Health Promotion

Function

The Bureau of Health Promotion includes more than 90 public health professionals focused on reducing premature death and disability due to heart disease, stroke, cancer, diabetes, arthritis, asthma, tobacco, injuries and violence, and lack of prenatal care. The Bureau's programs systematically coordinate around common functions such as surveillance and information management, local health departments and other partner relations, media campaigns and related outreach, consumer research, and education of health care providers. Comprehensive population-based interventions are provided at the school, work, community and health care sites, and include primary, secondary, and tertiary prevention strategies.

Cancer Control Program

The mission of the Utah Cancer Control Program is to reduce cancer incidence and mortality in Utah through collaborative efforts that provide services and programs directed toward comprehensive cancer prevention and control through the following:

1. Implementation of the strategies of the 2006-2011 Utah Comprehensive Cancer Control Plan and initiate priority strategies annually along with the members, work groups, and committees of the Utah Cancer Action Network (UCAN).
2. Maintain UCAN, a group of over 107 people from 55 organizations including hospitals, private clinics, government and community agencies, nonprofit organizations and other groups who are working together to reduce cancer incidence and mortality for all Utahns.
3. Implement breast and cervical cancer media campaigns.
4. Sponsor and co-sponsor meetings for health care providers, practitioners and professionals.
5. Work closely with local health departments and other community providers statewide.

Heart Disease and Stroke Prevention Program (HDSPP)

The goal of the Heart Disease and Stroke Prevention Program (HDSPP) is to decrease premature death and disability due to heart disease and stroke through the following:

1. Develop and Coordinate State Partnerships: The Alliance for Cardiovascular Health in Utah (with over 100 partners) has been organized to strengthen health systems for the secondary and tertiary prevention of heart disease and stroke by advocating principles that are designed to promote, influence and assist the public in developing skills and making decisions for healthier choices.
2. Assist communities, worksites, schools and health care sites to develop polices, environmental supports and practices to promote heart health and prevent heart disease and stroke, such as worksite wellness programs focused on self-care for high blood pressure and high cholesterol, emergency medical services transport policies for stroke and heart attack, and increased physical activity time in elementary schools.
3. Increase school participation in the Gold Medal School Program, implementing healthier policies and environments in the schools to promote healthier nutrition, physical activity choices, and tobacco prevention for students and faculty.
4. Increase the knowledge and awareness base of Utahns about the importance of preventing heart disease and stroke for every age group, and the medical emergency signs of heart attack and stroke.
5. Maintain a surveillance and evaluation program to monitor heart health and risk status of Utahns, and evaluate effectiveness of program interventions and strategies.
6. Provide training and technical assistance to enhance knowledge, skills and resources of community partners to affect and sustain policy and environmental changes.

Diabetes Prevention and Control Program (DPCP)

The Diabetes Prevention and Control Program's (DPCP) mission is to work in partnerships to improve the quality of life of all Utahns at risk for, or affected by, diabetes. It is funded solely through federal monies.

Healthy Utah Program

Healthy Utah is a work site based employee health promotion and prevention program available to State and other public employees and spouses covered by Public Employees Health Program. Healthy Utah's mission is providing resources, incentives and skills: empowering people to achieve healthy lifestyles. Healthy Utah works in State agencies and with other public entities (local governments) to create healthy work environments that support healthy lifestyle behaviors. Healthy Utah offers physical assessments, personal health sessions, weight management and stress prevention classes. Seminars on a variety of health topics and group health promotion programs are also available free of charge. Healthy Utah also provides technical assistance to work sites interested in establishing wellness councils and integrating employee health promotion and prevention into daily business activities. Healthy Utah strives to increase employee productivity, decrease employee absenteeism, and reduce the rapid escalation of health care costs.

Arthritis Program

The Utah Arthritis Program (UAP) is focused on:

1. Increasing community awareness
2. Measuring arthritis trends
3. Increasing access and use of evidence based interventions designed for people with arthritis
4. Support policy and decision making to address arthritis

The mission of the Utah Arthritis Program is to improve the quality of life for people affected by arthritis. The Program received renewed and increased funding until 2012 and is fully funded by the Centers for Disease Control and Prevention.

All reports are available on the UAP website at http://health.utah.gov/arthritis/.

Evidence Based Interventions: The UAP has been working with partners to develop infrastructure and offer evidence based interventions to people with arthritis. Currently there are three categories of CDC-approved evidence based interventions:

1. Media Campaigns: Physical Activity the Arthritis Pain Reliever & Beunos Dias Artritis: The Spanish Media Campaign
2. Class Room Based Interventions: Arthritis Foundation Self Help Program, Spanish Arthritis Foundation Self Help Program, Chronic Disease Self Management Program & Active Living Every Day
3. Physical Activity Interventions: Arthritis Foundation Exercise Program & Enhanced Fitness

Asthma Program

The Utah Asthma Program was developed in 2002 and is fully funded by the CDC to address asthma from a public health perspective. The program provides a website used to facilitate partner communications and education about programs and policies affecting those with asthma.

Violence and Injury Prevention Program

To accomplish its mission, VIPP collaborates with many partners, including other DOH programs, State and local agencies, local health departments, private businesses, non-profit community based organizations, health care providers, and others.

The VIPP conducts and/or provides significant support to the following projects and activities: Teen Motor Vehicle Safety; Motor Vehicle Seat Belt, Child Safety Seat, and Child Booster Seat Campaigns; Domestic Violence Fatality Review; Child Fatality Review Committee; Utah Violent Death Reporting System; Rape and Sexual Assault Prevention Project; Traumatic Brain Injury Surveillance Project; Traumatic Brain Injury Fund and Contracts, Pedestrian Safety Project; Safe Kids Utah; and others. The VIPP contracts with all local health departments, providing funding and technical support for local injury prevention programs that address: teen motor vehicle safety; seat belt, booster seat, and child car seat use; bicycle safety; and pedestrian safety. VIPP also contracts with rape prevention non-profit community based organizations to provide primary prevention rape and sexual assault activities in their communities.

Additional information, reports, and data are available at http://health.utah.gov/vipp/.

Baby Your Baby Program (BYB)

The Baby Your Baby Outreach Program (BYB) strives to improve the health of families in Utah through outreach programs, telephone hotlines and education services. The Baby Your Baby Program provides a vehicle through which the Health Department can target audiences throughout the State with important health messages. The outreach program establishes public-private partnerships to promote healthy lifestyles, reduce health risks, and increase access to health care. This is accomplished through public service announcements and other television programs, radio and printed materials which address Department goals dealing with early prenatal care, folic acid, vaccine-preventable infections, injury, dental disease, obesity, and other important health issues.

The Check Your Health Program (CYH), under the BYB umbrella, encourages all Utahns to eat healthy and be active. The Baby Your Baby Program started with the hotline service and now provides answering service to a number of other programs including the Asthma Program, the Diabetes Program, and the Immunization Program, among others.

Tobacco Prevention and Control Program (TPCP)

The Tobacco Prevention and Control Program (TPCP) provides technical expertise and coordination at State and community levels to prevent and reduce tobacco use in Utah. The goals of the TPCP are to promote quitting among young people and adults, prevent initiation of tobacco use among young people, eliminate nonsmokers' exposure to secondhand smoke and identify and eliminate disparities in tobacco use among populations groups.

Anti-Tobacco Projects Funded by Senate Bill 15, 2000 General Session

Anti-tobacco programs and services include:

Statewide and Community Based Services to Help Smokers Quit

Quitting smoking at any age provides health benefits and increases life expectancy for former smokers. To help Utah smokers quit, the TPCP offers the following quit services:

• The Utah Tobacco Quit Line, (888) 567-TRUTH and Utah QuitNet (www.utahquitnet.com)
• Medicaid coverage of tobacco cessation services for pregnant women and for the cessation medication Zyban.
• Local health departments tobacco quitting programs for pregnant women.
• Local school and community based teen cessation programs and community based adult cessation programs.

"The TRUTH" Public Awareness Campaign

The TRUTH media campaign is multi-pronged, targeting prevention and quitting among mainstream and high risk youth, adults, pregnant women, Native Americans, Hispanics and Latinos, rural populations, and work sites through a mix of media including radio, TV, and outdoor advertising. Most Utah residents are directly or indirectly impacted by the campaign. The TPCP evaluates the reach and impact of the media campaign with annual surveys of 1,200 randomly selected Utah teens, and adult smokers and non smokers. Some campaign components include:

• "Make Your Life Easier" quit smoking TV campaign to promote the Utah Tobacco Quit Line and QuitNet services.
• "Short-term Effects of Tobacco" youth ads.
• Advertisements addressing pregnant women and secondhand smoke.

Prevention Partnerships with Local Health Districts, Schools, and Communities

Evidence based school programs promote strong "no tobacco use" attitudes among students, increase students' knowledge of the dangers of tobacco, and teach students skills to resist peer influences. School programs are most effective when they are part of comprehensive school tobacco policies that include enforcement of rules against tobacco use, tobacco prevention education for students in all grades, access to cessation services, and involvement of families and communities in tobacco prevention. TPCP prevention services include:

• Collaboration with select school districts to strengthen and better enforce school tobacco policies.
• Evidence based anti-tobacco curricula for students in grades 4 to 8.
• The Truth from Youth Anti-Tobacco Advertising Contest for fourth and fifth grades, and Real Noise Contest for Middle and High schools.
• Anti-tobacco activities and presentations in schools and communities across Utah.
• Working with Utah's statewide youth anti-tobacco movement, the Phoenix Alliance, to ensure that youth play an important role in developing and spreading anti-tobacco messages.

Efforts to Reduce Exposure to Secondhand Smoke:

• Secondhand smoke (SHS) kills over 50,000 Americans annually by causing fatal diseases such as heart disease and cancer. Children exposed to SHS suffer from low birth weight, sudden infant death syndrome, asthma, pneumonia, ear infections, and bronchitis. To reduce Utahns' exposure to SHS, the TPCP and its partners work to enforce the provisions of the Utah Indoor Clean Air Act (UICAA), and encourage voluntary smoke-free policies in homes, worksites not covered by the UICAA, and outdoor venues.

Youth Access to Tobacco

Utah law prohibits tobacco sales to minors under the age of 19. Local health departments collaborate with retailers and law enforcement to ensure compliance with youth access laws through retailer education, retailer recognition, and compliance checks.

Utah Code requires that each of the State agencies that receive funding from the Tobacco Settlement funds provide an annual report on the program and activities funded to both the Health and Human Services Interim Committee and the Health and Human Services Joint Appropriations Subcommittee.

Funding Detail

Program: Maternal and Child Health

Function

The Bureau of Maternal and Child Health supports the Department's mission to reduce illness, disability and death among women of childbearing ages, children, and youth in the State. The Bureau identifies needs, prioritizes strategies to address needs, develops programs, coordinates efforts, and develops resources to address health issues for mothers and children.

The Bureau of Maternal and Child Health provides leadership for many maternal and child health efforts in the State through its programs, contracts with local health departments and other entities, federal grant opportunities and involvement at a national level to learn from other states' programs to apply in Utah. The Bureau is responsible for most maternal and child health issues, such as promotion of healthy women of childbearing ages, including planning for a healthy pregnancy before pregnancy, access to health care before pregnancy and during pregnancy, healthy weight and nutrition, mental health, oral health, and immunization status; and, promotion of healthy children and adolescents, including immunizations, oral health, mental health, healthy weight, and nutrition.

The Bureau includes a staff of public health professionals who work to improve the health of Utah mothers, children and their families in Utah through a variety of public health functions. The Bureau conducts surveillance and analysis of data related to pregnancy and factors associated with poor pregnancy outcomes, such as prematurity; and review of maternal, fetal, and infant deaths. This information is used to identify factors that are related to prevention of future deaths. The Bureau conducts surveillance and analysis of data related to children's health, such as dental screenings for young school-aged children to determine the degree of dental disease, or parents' experiences with health care for their children. Staff also promotes access to health care services, such as family planning, prenatal and well child care, outreach to disadvantaged populations, and education of the general public and health care providers. Staff help facilitate collaborative efforts with local health departments, community health centers and the private provider community, as well as community-based organizations, health care professional organizations, hospitals, and schools. The Bureau includes six programs that work to achieve the Bureau's goal of healthy mothers and children: Reproductive Health; Child, Adolescent and School Health; Data Resources; Immunizations; Oral Health; and the Women, Infants and Children Programs (WIC). The Bureau is responsible for the State Title V Maternal and Child Health Block Grant Application and Annual Report, the CDC-funded Immunization Program, and the USDA-funded WIC Program. The Bureau reviews and analyses numerous data sources to determine priorities and to establish program plans to improve the health of mothers and children. The Bureau is responsible for oversight of the funding sources, including Title V, CDC Immunization and PRAMS, USDA WIC and a small amount of General Funds that meet the federal match requirements.

Reproductive Health Program (RHP)

The mission of the Reproductive Health Program (RHP) is to improve the health of women of childbearing age and their infants by reducing preventable illness, disability and death related to pregnancy, birth and infancy through the promotion of healthy lifestyles and optimal health care. The various components of the RHP include Prenatal/Family Planning, WeeCare, Pregnancy Risk Assessment Monitoring System (PRAMS) , and the Perinatal Mortality Review (PMR) component. The program creates and disseminates pertinent health education messages that are identified through the program's various data collection resources. These messages are distributed via presentations at schools, churches, health fairs, etc. as well as their Internet website (www.health.utah.gov/rhp), brochures, television and radio messages, and poster displays.

The prenatal component of the Program improves access to prenatal care through expedited eligibility to Medicaid, enhanced prenatal and delivery services within Medicaid, and by covering prenatal care for uninsured women. The family planning component assures access to family planning services in underserved areas of the State, and also assures reproductive health services through technical assistance to local health departments, community health centers, and other providers. Contracts are maintained with these agencies for prenatal and family planning services. The program, in partnership with other DOH programs contracts with Dynamic Screening Services to develop and maintain the online web-based application program, Utah Clicks, that enables low income families to be screened for presumptive eligibility for Medicaid and other services. The WeeCare component offers nurse case management of moderate and high-risk PEHP pregnant participants throughout the State via telephone. Women are provided information that can help them reduce the risk of premature delivery and other pregnancy complications. They also enjoy follow-up contact throughout the pregnancy to assure that everything is going well, and that mother and infant have optimal healthy outcomes.

The Pregnancy Risk Assessment Monitoring System (PRAMS) is a Centers for Disease Control and Prevention-developed, population-based surveillance system that queries a sample of Utah mothers about their experiences before, during and after pregnancy. Utah is among 39 states throughout the country who implement the survey. PRAMS is intended to help answer questions that birth certificate data alone cannot answer. Data are used to provide important information that can guide policy interventions, and other efforts to improve care and outcomes for pregnant women and infants in Utah. An example of how PRAMS data are being used is to educate prenatal care providers about the effects of overweight/obesity on pregnancy outcomes.

The Perinatal Mortality Review (PMR) component of the program is a process aimed at identifying and examining the factors that contribute to perinatal deaths (fetal, infant, and maternal) through the systematic evaluation of individual cases. Through individual case review, the PMR coordinator, in conjunction with a committee of perinatal professionals, identifies contributing factors that may have led to the death. Information is obtained through medical records, public health records, autopsy reports, birth/death certificates and health care provider records. Committee members make recommendations based on findings that may lead to public health recommendations for changes that could improve the outcome of future cases.

The program is guided by a strategic plan that includes nine outcome objectives:

1. Reduce the number of unintended pregnancies
2. Increase percentage of women accessing quality early and adequate prenatal care.
3. Decrease maternal death rates and morbidity
4. Reduce percentage of infants born before the 37th week of pregnancy and/or weighing less than 5 pounds and 9 ounces.
5. Decrease fetal and neonatal deaths.
6. Increase the percentage of women who initiate and continue to breast-feed their infants through the first year of life.
7. Increase the recognition and treatment of depression among women of childbearing age in Utah.
8. Increase the proportion of women who practice healthy behaviors before becoming pregnant.
9. Decrease the prevalence of intimate partner violence during the perinatal time period.

Child, Adolescent and School Health Program (CASH)

The Child, Adolescent and School Health Program (CASH) provides a broad range of services related to child health and development, from birth through adolescence. The CASH Program administers several grants that seek to improve the system of services for children and promote health behaviors.

The CASH Program provides oversight, training and technical assistance for two home visiting nurse programs provided by public health nurses through the twelve local health departments. The CASH Program oversees the Title V-funded Prenatal-5 Nurse Home Visiting Program that provides nurse home visiting for pregnant women and at-risk children from birth to five years of age. The program provides coordination, oversight and technical assistance for the Title V-funded Sudden Infant Death Syndrome (SIDS) Program for families that need grief and local services support after the unexpected loss of an infant. SIDS prevention materials and training are provided to local hospitals, community organizations, child care providers, and professional preparation programs.

The program administers the State Early Childhood Comprehensive Systems grant, funded with federal Title V funds, to improve the system of services for children from birth to age eight by coordinating efforts of statewide agencies and organizations to ensure children are ready to enter school healthy and ready to learn.

The Head Start-State Collaboration Office grant is designed to meet the increasingly complex and difficult challenges of improving long-term health outcomes for low-income children and their families and is funded with federal and State-match funds. The overall goal of this grant is to create and promote a statewide focus of interagency partnerships and linkages between Head Start and other early childhood service providers.

The CASH Program provides oversight, with federal Title V funds, for the Abstinence Education Grant, Section 510 of Title V, to provide technical assistance, training, and consultation to the agencies that implement the Abstinence Education Only programs for youth from ages nine to fourteen. The goal of this grant is to promote abstinence from sexual activity before marriage.

Immunization Program (IMM)

The Immunization Program (IMM) promotes immunization as part of comprehensive health care across the life span - infants, children, adolescent, and adult. It provides services through technical assistance to local health departments (LHD), community health centers (CHC), managed care organizations (MCO), schools (public and private) and early childhood programs (licensed day cares, head start, etc), and public and private providers. The program contracts with LHDs and CHCs to support infrastructure for outreach activities to at-risk and eligible populations. Special emphasis is placed on efforts to improve the immunization coverage of pre school-age children, especially those under two years of age.

The Vaccines for Children Program (VFC) provides vaccines at no cost to eligible children ages 0-18 years who are uninsured, covered by Medicaid, under-insured, or American Indian. The vaccine is provided to over 300 enrolled public and private medical providers statewide. An essential part of this program is technical assistance for vaccine management and accountability including: doses administered, quality assurance, assessment, storage and handling, and audits. The VFC distribution system is used, through an MOA with CHIP, to provide vaccine to children enrolled in CHIP which provides a substantial cost savings to the CHIP program and provides the same services related to vaccine management and accountability

The Disease Surveillance and Outbreak Control activities monitor the incidence of vaccine-preventable diseases and assist in addressing disease outbreaks. A full-time employee is supported in the Division of Epidemiology and Laboratory Services to monitor morbidity and mortality data.

The Population Based Assessment component provides technical assistance to school staff, school nurses, and school administrators. It further provides retrospective school entrance surveys and validation audits of all schools and early childhood programs. Additionally, it monitors second MMR levels of all school children kindergarten through grade 12. There is a strong collaboration with Utah State Office of Education.

The Vaccine Adverse Event Reports System (VARES) component provides for a reporting system for adverse events following receipt of any U.S. licensed vaccine.

The Public and Professional Information and Education component involves activities and efforts to provide current immunization information, education, and training to the public and medical providers. It also supports the Every Child by Two public/private partnership, four local coalitions, and the Immunize It's Up Two You media campaign working to increase immunization rates for children under two. This component maintains the Immunization Hotline and mobile immunization services through Care-A-Van.

The Immunization Registry provides support of aspects of the development and maintenance of a population based immunization registry. This includes responsibilities of provider enrollment, education, training, and technical assistance to increase provider utilization of Utah Statewide Immunization Information System (USIIS).

The Perinatal Hepatitis B Prevention Program promotes Hepatitis B vaccine to prevent perinatal transmission. The program offers technical assistance and oversight of case management, provided through local health departments, as well as Hepatitis B immunization for infants and household contacts. It also provides technical assistance, information, and education resources on other forms of hepatitis.

The Adolescent Immunization component supports activities to prevent vaccine preventable diseases in adolescents ages 11-21. This is accomplished through providing technical assistance, current information, and education to the public and medical providers. College entrance immunization recommendations are in place and a collaboration with Juvenile Justice Services.

The Adult Immunization component promotes the prevention of vaccine preventable diseases among adults with an emphasis on influenza and pneumococcal disease. It also supports the Utah Adult Immunization Coalition working to increase immunization rates for adults.

The WIC linkage component promotes increased rates of immunization and the prevention of vaccine preventable diseases among WIC participants.

The Preparedness component provides support for Utah to achieve appropriate pandemic preparedness and response to bioterriorism agents statewide. Technical assistance and vaccine management are provided to local health departments and communities statewide.

The IMM Program provides vaccine to eligible children through a federal grant awarded credit line at the Centers for Disease Control and Prevention. It also provides educational information and technical assistance to the entire population through grant awarded CDC funds.

Data Resources Program

The Data Resources Program (DRP) provides health data and information support to staff within MCH and CSHCN programs, local health departments, community-based health organizations, and citizens. The program is two-pronged in its approach as it aims to (1) increase access to health information and data, and (2) provide analytic consultation, data training, and web services.

DRP acts as a resource for MCH programs in identifying data sources and status of certain health indicators. The program also facilitates the coordination of multi-program projects and reports. The program also plays an active role in designing web site and web-based applications for CFHS and ensures that they are in compliance with Department and State web standards.

DRP provides the necessary activities related to all the MCH Bureau programs which deal with the documentation of data reporting by local health departments as part of the contract process. The DRP serves as the data resource component for all MCH Bureau and CSHCN Bureau programs, rather than hire an epidemiologist or data analyst for each individual program. An important responsibility of DRP is to assist MCH/CSHCN programs in the measurement of progress towards Healthy People 2010 goals by tracking and monitoring a broad range of health status indicators.

Women, Infants and Children (WIC)

Women, Infants and Children (WIC) is a federally funded program designed to provide supplemental food and nutritional education to pregnant, breast-feeding or postpartum women, infants and children up to five years of age. Included are individuals from low income families who are determined to be at nutritional risk because of inadequate nutrition, health care, or both. WIC is specifically designed to serve as an adjunct to good health care during critical periods of human growth and development.

Applicants must meet the following criteria to be certified and eligible for WIC authorized foods:

• A resident of the area or member of the population served by the 49 local clinics.
• Income at or below 185 percent of the Federal Poverty Level.
• Certified to be at nutritional need through a medical and/or nutritional assessment.

Oral Health Program (OHP)

The Oral Health Program (OHP) improves the oral health status of Utah residents by developing, implementing, and promoting prevention and dental access programs at both the State and local health department levels. OHP dental caries prevention methods include community water fluoridation, fluoride mouth rinse programs, tooth sealant programs, and early childhood interventions. The evaluation and dissemination of statewide dental health surveys, Head Start data and other Utah specific dental health information by OHP provides needs assessment information for the State and local health departments.

In collaboration with the Utah Oral Health Coalition, the OHP has developed and maintains the Utah Oral Health Action Plan which emphasizes implementation of appropriate prevention and access strategies for target populations and promotes development of policies for better oral health and improved oral health systems statewide. Additionally, the OHP encourages and facilitates the formation of local oral health coalitions by conducting needs assessments and oral health surveys, providing technical consultation and reporting progress toward Healthy People (HP) 2010 oral health objectives. The OHP collaborates with local health departments and community health centers and partners with many community public health and private practice dental and health professionals, stakeholders, and advocates to implement programs which serve the needs of local communities. The OHP has developed and maintains an oral health website that provides educational and resource information for public and private partners as well as the general population of the State.

Funding Detail

Program: Children with Special Health Care Needs

Function

The Bureau of Children with Special Health Care Needs (CSHCN) encompasses ten programs serving special needs children. CSHCN programs reduce preventable death, disability, and illness due to chronic and disabling conditions by providing access to affordable high-quality health screening, specialty health care, and coordination of health services. Bureau programs try to improve the system of care for Utah children with special needs through direct or population based services and the promotion of system infrastructure building. These services are provided by Bureau staff or through contractual agreement with community providers.

Specialty Services

Specialty Services provides statewide screening, evaluation, and referral of infants and children with hearing, speech, vision, motor, movement, and transition problems. Target populations are newborns, infants and preschoolers, children at risk, children in areas lacking alternative care, children whose parents request financial assistance, and children with special health care needs. Specialty Services works with local resources to provide referral to appropriate intervention services. Children identified with these disorders in early life have a much lower rate of subsequent chronic disability.

The goal of this Program is to help assure optimal development in Utah special needs children, through a collaborative statewide system of education, prevention, early identification, early intervention, and care coordination.

Families are charged according to ability to pay, utilizing a sliding fee schedule. No services are denied due to a families' inability to pay. Specialty Services maintains clinical facilities in Salt Lake City, Cedar City, and Price. Clinics are staffed by licensed and nationally certified speech-language pathologists and/or audiologists, physical therapists and occupational therapists. Services are also provided in many rural areas of the state through traveling and clinics held in cooperation with local health departments. Once a problem is identified, children are referred to appropriate local resources for continued management. Public education, professional education, consultation and technical assistance are also available.

Specialty Services also oversees the legislatively mandated hearing screening of all Utah newborns and provides technical assistance to hospital programs. The Early Hearing Detection and Intervention (EHDI) centralized database is also managed and maintained through this program. Tracking and follow up of infants that require additional testing is provided for hospital screening programs and audiologists.

Neonatal Follow-up Program (NFP)

The Neonatal Follow-up Program (NFP) provides statewide multi-disciplinary screening services for the very low birth weight graduates of Utah newborn intensive care units. The services are offered through three satellites in Salt Lake City, Ogden, and Provo.

Undesirable long term outcome remains high in spite of advances in technology, pharmacology and better understanding of fetal and newborn physiology. Risk for poor outcome rises as birth weight and gestational age decrease. Of the extremely low birth weight babies, 20% will have cerebral palsy, 25-30% will test in mentally retarded range, and 45% will need special education resources.

The Neonatal Follow-up Program provides:

• two and one half (2½) year follow-up for the very low birth weight babies;
• four and one half (4½ ) year follow-up for the extremely low birth weight babies.

The Neonatal Follow-up Program offers:

• periodic screening by multiple providers (neurologist, ophthalmologist, pediatrician, audiologist, speech pathologist, dietitian, psychologist, occupational/physical therapist, social worker and nurses).

Neonatal Follow-up Program's objectives are to:

• Improve long-term outcome by identifying and treating significant findings in a timely fashion
• Coordinate services with existing resources and partner in long term care
• Provide feedback to Utah newborn intensive care units and allow for reassessment of treatment practices
• Ultimately reduce cost of family stress, health care and educational resources

Developmental Consultative Services (DCS)

The Developmental Consultative Services (DCS) Program provides multi-disciplinary medical and developmental assessment services for children birth to 18 years of age who have developmental disabilities or chronic illness associated with developmental delay. These services are offered in the Salt Lake, Ogden/Logan and Provo areas as well as State wide at the following sites: Blanding/Montezuma Creek, Moab, Price, Richfield, St. George and Vernal. Services include access to pediatric, genetic, neurological, psychological, speech, occupational/physical therapy (OT/PT), audio and social work/case management evaluations and support. These itinerant clinic sites are coordinated through the local health departments and provide access to these needed services in the underserved, rural areas of the State. Services are designed to:

• Recognize the need for early diagnosis and treatment
• Provide timely detection of sensory, cognitive, and emotional disorders
• Assist the family in identifying their child's strengths and weaknesses
• Develop and monitor a written plan of services
• Provide parents with support and information
• Coordinate the delivery of services with local agencies
• Promote and develop appropriate community wide services for the prevention of disabilities

Technology Dependent Waiver/Family Involvement

The Division of Health Care Finance shares the responsibility for the day-to-day administrative activities for Utah's Waiver for Technology Dependent, Medically Fragile Individuals with the Technology Dependent Waiver Program. The waiver program tries to prevent institutionalization and to facilitate transition from an institutional setting to a home and community-based setting for technology dependent, medically fragile individuals with complex medical conditions.

The Family Involvement Program/Family Voices provides information, training and support regarding health care and community services to families of children and youth with special health care needs. Family Voices facilitates partnerships between families and professionals on behalf of children and youth with special health care needs.

Fostering Healthy Children

The mission of the Fostering Healthy Children Program is to ensure that the health care needs of children in the Utah Child Welfare System are met in a timely manner. The program was implemented in response to the settlement agreement the State made with the National Center for Youth Law in 1994. The settlement agreement requires the State to provide medical, dental, and mental health care to all children in foster care custody on an on going basis. Additionally, the State must make sure they receive any follow up care deemed necessary by their medical providers. The Division of Child and Family Services (DCFS) in the Department of Human Services contracts this service with the Department of Health to provide coordination of Medicaid services for all children entering Foster Care across the State. Registered nurses are utilized to:

• Manage the health, dental, and mental health care needs of children in Foster Care
• Assist the caseworker in addressing physical, dental, and mental health concerns for a child in DCFS custody
• Provide input to DCFS on the placement of a child with special health care needs
• Provide education and training to foster parents, families, and caseworkers on medical topics
• Provide hospital, home and/or office visits for children with special needs with one-on-one health care education and training
• Identify and recruit Medicaid providers to assist in meeting the needs of this population
• Refer children with developmental delays noted on the Ages and Stages to Early Intervention

Pregnancy RiskLine

The Pregnancy RiskLine (PRL) provides information regarding exposure to drugs, chemicals, and infections in pregnancy and lactation and the possible effect on the developing fetus, breast-fed infant and mother. The Pregnancy RiskLine was established to provide health care practitioners and consumers with accurate, up-to-date information regarding potential risks to a fetus or breast-fed infant in order to prevent unjustified anxiety leading to unnecessary abortions, costly prenatal and postnatal screening, diagnostics, and testing of an exposed fetus or infant.

Major goals of the Division of Community and Family Health Services are aimed at prevention of poor pregnancy outcomes and adverse health effects in children. The desired outcomes are intended to prevent low birth weight, infant mortality, and birth defects.

By offering accurate and current information about fetal effects of maternal exposure to medications, drugs, chemicals, infections and diseases, the PRL may prevent untoward effects of some of these agents on a developing fetus, resulting in a decreased incidence of low birth weight, infant mortality and birth defects.

Utah Birth Defect Network (UBDN)

The Utah Birth Defect Network (UBDN) is a statewide surveillance system monitoring the occurrence of major structural birth defects in Utah. The UBDN uses this information to assess the prevalence of birth defects occurring in Utah; conduct epidemiological studies to determine risk factors that may contribute to birth defects; educate women and health care providers about these risk factors; evaluate whether education has decreased specific birth defects; and identify whether clusters of birth defects are occurring. Birth defects are the leading cause of infant mortality. Birth defects also contribute to premature births and are the major reason for hospitalizations during the first year of life. There are economic costs to families and society for children born with birth defects and the costs extend beyond medical and surgical care to behavioral and educational service issues. The cause of most birth defects remains unknown. Utah's UBDN is one of ten centers selected nationally to participate in an ongoing federal study of birth defects with no known cause.

The UBDN's efforts are directed toward primary prevention of birth defects by monitoring occurrence, conducting educational outreach, and participating in collaborative epidemiologic studies. Evaluation of the UBDN epidemiologic data provides information in order to assess risk factors for birth defects and develop primary prevention activities directed at reducing these risk factors. Implementation of primary prevention activities targeted at high risk populations in the State will reduce the occurrence of birth defects, which must be evaluated through the continuous tracking of all major birth defects statewide. The UBDN serves as a resource and referral system for families and physicians.

UBDN measures: (1) accurate and timely tracking of birth defects statewide; (2) folic acid educational campaign and evaluation of neural tube prevalence over time to evaluate effectiveness of prevention activities; and (3) estimated number of individuals reached through general education and outreach activities.

Newborn Screening Program (NS)

The Newborn Screening Program (NS) provides a statewide system for early identification and referral of newborns with certain metabolic, endocrine, or hematologic disorders that can produce long-term mental or physical disabilities or death if not treated early. The disorders are: congenital hypothyroidism, galactosemia, and hemoglobinopathy, biotinidase, congenital adrenal hyperplasia, amino acid disorders, fatty acid disorders, and organic acid disorders. Testing for cystic fibrosis will begin in January 2009. The testing kit fee is $75.00. The fee revenue is split between the Public Health Lab and CSHCN.

Statewide services are designed to:

• Administer newborn screening by:
  1. Developing and dispersing newborn screening kits
  2. Training and educating institutions of birth (hospitals, birthing centers, midwives) on the importance of screening, screening practices, proper collection techniques and submission parameters.
• Provide the framework for early diagnosis and treatment by:
  1. Developing and instituting a unified computer system between the state lab and the Newborn Screening Follow-up Program.
  2. Providing identification of all screening test results, which in most cases is within 24 to 72 hours.
  3. Coordinating any necessary testing beyond the screening test to identify a possible disease.
  4. Reporting abnormal screening results to medical home (provider) and providing education/direction on follow up needs for each specific disorder.
  5. Providing education and counseling to families of an affected newborn.

Baby Watch Early Intervention Program (BW/EI)

The Baby Watch Early Intervention Program (BW/EI) provides early intervention and developmental interventions statewide for young children with developmental delays and/or disabilities from birth to age three. Services include multi-disciplinary evaluation and assessment; service coordination; specialty and therapy services such as nursing, physical therapy, occupational therapy, speech therapy, special instruction, family support and other related services that build on family strengths and child potential. Services are available statewide through local service delivery personnel.

Parents pay a sliding scale fee for their children to receive services. The BW/EI program bills Medicaid and CHIP for eligible children.

Child Health Advanced Records Management (CHARM)

Currently, data exists in an array of public and private health sectors and each database serves its own users and data is not shared across organizations or health programs. Services are often not coordinated and typically do not provide a network of care for families. As a result, many children do not receive critical follow-up. The Child Health Advanced Records Management (CHARM) Project is a coordinated, Department-wide effort to create an electronic virtual health profile for every child in Utah that allows real-time digital access and data sharing among appropriate health care programs and partners. The CHARM vision is to become a shareable repository of child-specific public health information with secure role-based confidential access to a comprehensive set of integrated public health data accessible by people with a need to know, that promotes timely and efficient access to needed services, and supports program planning and evaluation. Integrating the State's health care databases provides for immediate access to information that is stored in specific databases to track and monitor health status for children and their families.

In the last 2 years, CHARM has linked the databases from Vital Records, (Birth and Death Certificates), Utah Statewide Immunization Information System (USIIS), Early Hearing Detection and Intervention (EHDI), and the Office of Recovery Services. The Newborn Screening (heelstick) Program and the Baby Watch Early Intervention Program will be integrated next. Following the integration of those programs, the UBDN and clinical information from the Neonatal Follow-up Program (NFP) will also be linked to CHARM. Through data-sharing and tracking between integrated programs, CHARM's goal is to reduce the number of children lost to follow up statewide by 50% and ultimately to provide more accurate and timely information to the child's medical home through a web access.

Funding for this project has come from braiding multiple funding streams including HRSA grants, CDC grants, and the MCH Block Grant. Management of the funds is performed by an oversight committee (CHARM Governing Board) to ensure accountability and coordinated use. The CHARM Project is managed by a 'hands on' work group consisting of a program manager, an operations manager, and technical data services and support.

Funding Detail