Strategies and Promising Practices to Address PHC Health Areas and Concerns

The following resources, practices, and interventions were identified by PHC partners during the virtual collaboration sessions as promising practices happening in their communities. Best practices listed are also those promoted by MCDPH, Arizona Department of Health Services, other county or state public health promotion organizations, and/or national government or nonprofit public health promotion entities.

Nutrition and Physical Activity

1. Increase access and consumption of affordable, healthy foods for children ages 0-5 and their families.

Current Practices in Healthy Food Retail: Small Stores This CDC document demonstrate ways to increase the availability of healthy foods and beverages by using public health strategies that focus on small stores.

Improving Retail Access for Fruits and Vegetables To increase fruit and vegetable consumption by community members, it is important to improve access to these venues and to increase the availability of high-quality, affordable fruits and vegetables sold at these locations. This CDC document highlights a few states' work in this area.

The MyPlate Daily Checklist (formerly Daily Food Plan) shows what and how much your child should eat to meet his or her needs. Checklists are based on average needs by age and activity level, so practitioners and caregivers should use the Checklist as a general guide.

The Arizona Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition education and breastfeeding support services, supplemental nutritious foods, and referrals to health and social services. WIC serves pregnant, breastfeeding, and postpartum women; infants; and children under the age of five who are determined to be at nutritional risk. The WIC Program is funded by the United States Department of Agriculture. The Arizona Farmers' Market Nutrition Program (AzFMNP) is administered by the ADHS Bureau of Nutrition and Physical Activity. WIC families and seniors in the Commodity Supplemental Food Program receive a Farmers' Market check (Cash Value Vouchers [CVVs] or vegetable and fruit checks) to spend on fresh, locally grown vegetables and fruits at approved Farmers' Markets. CVVs are issued every month to women and children who participate in WIC! See the AzFMNP Participant Guide for more information (bilingual).

Fresh Express by Discovery Triangle is a mobile produce market that provides access to high-quality, affordable produce to residents with little to no access to healthy food. Route stops include schools, senior centers, and other key community gathering places in underserved neighborhoods. Fresh Express accepts cash, credit/debit, and SNAP/EBT. Fresh Express will match SNAP/EBT benefits dollar-for-dollar up to $10 per day! View the Discovery Triangle Fresh Express Annual Report (2015).

Valley of the Sun United Way (UW) Summer Food Service Program (SFSP) Activity Resource Guide was produced by the US Department of Agriculture to ensure that low-income children continue to receive nutritious meals when school is not in session. The UW also has a WeekEnd Hunger Backpack program that gives children backpacks filled with food to take with them over the weeked.

UA Cooperative Extension provides a directory of Farmer’s Markets in Maricopa County, including those that accept SNAP as payment.

UA Cooperative Extension provides a directory of Community Gardens in Maricopa County.

The MCDPH provides a resource page for schools interested in starting or continuing a school garden program

Arizona Nutrition Network provides resources on nutrition and physical activities for families with young children.

The Arizona Chapter of the American Academy of Pediatrics (AzAAP) promotes the program 5-2-1-0 AZ Way To Go! 5-2-1-0 AZ Way To Go! is a nationally-recognized project and toolbox focused on dealing with the epidemic of childhood obesity. Developed by the AzAAP Childhood Obesity Committee, the program and its messaging for parents and their kids suggests the following: Eating 5 fruits and vegetables a day; limiting kids to 2 hours in front of the TV or other technology; participating in 1 or more hours of physical activity per day; and a focus on reducing the consumption of sugary drinks to close to 0.

2. Promote collaboration with early childhood education (ECE) programs to support healthy nutrition and physical activity of young children.

UW, Dairy Council of Arizona, and Arizona Department of Education (ADE) produced a Breakfast in the Classroom: Toolkit for Arizona Schools, which provides schools with ideas for launching a classroom breakfast program. Offering BIC in your school is a simple way to improve the school environment and ensure all children receive a nutritious breakfast. The toolkit is divided into easy-to-use sections that provide important information about the benefits of BIC, best practice tips, useful tools and much more. Also included are additional resources with links to sample menu ideas, media and marketing materials, financial planning tools and other helpful information.

The National School Lunch Program (NSLP) offers reimbursement to help Local Education Agencies (LEAs) serve snacks to children in Afterschool Care, or extended school day activities aimed at promoting the health and wellbeing of children and youth. The purpose of the Afterschool Care Snack Programs (ASCSP) is to provide snacks to children in afterschool settings or extended school day settings.

The Summer Food Service Program (SFSP) is a US Department of Agriculture (USDA) Child Nutrition Program established to ensure that low-income children, ages 18 and younger, continue to receive nutritious meals when school is not in session. Free meals, that meet federal nutrition guidelines, are provided to all children at approved SFSP sites in areas with significant concentrations of low-income children by schools, private non-profits and local or county governments. The SFSP is administered at the by the ADE. http://www.eatwellbewell.org/summerfood provides an interactive map of SFSP locations in Maricopa County and Arizona.

Parents should be encouraged to join School Health Advisory Councils (SHAC) to advocate for nutrition and physical activity programs for preschool and in early childhood education. A (SHAC) is a group of individuals who represent both the school and the community to provide advice to the school system on aspects of school health policies and programs.

The ADE administers the USDA Fresh Fruit and Vegetable Program (FFVP) for the state of Arizona. The FFVP is a grant that provides funding for the purchase of a variety of fresh fruits and vegetables throughout the school day to all students in awarded schools. It is an effective and creative way of introducing fresh fruits and vegetables as healthy snack options to Arizona students.

Maricopa County’s Department of Public HealthOffice of Community Wellness and Health Promotion provides numerous resources for increasing physical activity of young children.

Ensure that ECE facilities and/or ECE jurisdictions serving 0 – 5 year olds, including preschools, child care centers, day care homes (also known as family child care), Head Start, and pre-kindergarten programs, meet national standards for physical activity. ECE Highlights focus on state health departments’ coordinated efforts to implement strategies that help support early care and education facilities in meeting national obesity prevention standards.

Let’s Move! Active Schools equips schools with the resources and tools to increase physical education and physical activity opportunities for students, and to cultivate an Active School environment.

Policy Regulations for Day Care in New York City were implemented to improve the physical activity and nutrition practices in NYC group day care facilities. They include specific guidelines for outdoor play and physical activity, limits on television viewing, and requirements for food.

Body Mass Index Measurements in Schools describes the purpose of school-based BMI surveillance and screening, examines current practices, summarizes the recommendations of experts, identifies concerns surrounding programs, and outlines needs for future research. Guidance is provided on specific safeguards that need to be addressed before schools decide to collect BMI information.

The AzAAP promotes the program 5-2-1-0 AZ Way To Go! This program provides schools and teachers with ideas for getting and keeping kids active during the day. Tips are provided at http://www.getfitazkids.org/Schools_Educators.html

3. Encourage a minimum of 60 minutes of daily physical activity for young children.

CDC Information and resources on physical activity for children.

Color Me Healthy was designed to increase physical activity and improve fruit and vegetable intake among 4- and 5-year-old children in child care and preschool settings. It focuses on increased opportunities for physical activity and exposure to nutrition education.

Eat Well Play Hard in Child Care Settings is a multi-component intervention focused on improving the nutrition and physical activity behaviors of pre-school age children and their parents/caregivers by using educational strategies and skill building activities to promote healthy behavior change.

ChooseMyPlate.gov has developed several resources for parents of preschool age children to encourage physical activity. Healthy Tips for Active Play and 10 Tips for becoming more active as a family (English) and (Spanish) provides parents with information and ideas for activities for preschool age children.

The Phoenix Children’s Hospital has partnered with Kohl’s Cares to provide Kohl’s F.I.T. (Families in Training) program, available onsite and online at http://www.kohlsfit.com/ (bilingual). Kohl's Fit is a comprehensive health and wellness program that targets children and their parents by encouraging active lifestyles (a minimum of 60 minutes of activity per day) and healthy eating through community outreach and education.

The AzAAP promotes the program 5-2-1-0 AZ Way To Go! 5-2-1-0 AZ Way To Go! is a nationally-recognized project and toolbox focused on dealing with the epidemic of childhood obesity. Developed by the AzAAP Childhood Obesity Committee, the program and its messaging for parents and their kids suggests the following: Eating 5 fruits and vegetables a day; limiting kids to 2 hours in front of the TV or other technology; 1 or more hours of physical activity per day; and a focus on reducing the consumption of sugary drinks to close to 0.

Head Start’s I Am Moving, I Am Learning (IMIL) is a proactive approach for addressing childhood obesity in Head Start children. IMIL seeks to increase daily moderate to vigorous physical activity (MVPA), improve the quality of movement activities intentionally planned and facilitated by adults, and promote healthy food choices every day. Each month, HSBS creates new resources to help educators and parents promote MVPA and healthy lifestyles year-round.

The AzAAP recommends visiting https://www.healthychildren.org/ (bilingual) for information and resources on healthy living and fitness for the whole family.

4. Promote safe places for physical activity for children ages 0-5.

Kids in Parks turns existing, outdoor trails into kid-friendly hiking trails with the purpose of increasing access to, and the number of, places for physical activity.

Let’s Move Outside is a program of letsmove.gov and has online resources for parents to find local nature and outdoor events, forests and parks, and playgrounds.

MCDPH has produced a report, Finding Space to Play (2013), on community access to public facilities for recreational use. This report focuses on community use of school facilities at the 21 elementary school districts in the City of Phoenix as a way to promote physical activity and reduce the onset of chronic disease among residents, particularly in areas with limited public recreational spaces.

The AzAAP recommends visiting https://www.healthychildren.org/ (bilingual) for information and resources for creating a safe space at home for children to play.

Access to Care

1. Improve health literacy

The Nurse-Family Partnership program uses an evidence-based curriculum to provide parenting support and education during home visits for the first two years of a child’s life. The specially-trained nurses can also provide referrals for healthcare and support services in the community.

Healthy Start provides families with supportive home visits, small group perinatal health classes, health checkups, and developmental screenings. The program will also provide referrals for services and expedited AHCCCS services.

Maricopa Integrated Health Systems Family Learning Centers provide literacy education and health information for parents and their children. This program provides educational classes for parents on parenting, nutrition, safety, and development as well as community referrals.

2. Increase utilization of preventative care

Bright Futures guidelines, developed by the American Academy of Pediatrics, provide tools and tips that health care providers can implement to increase family involvement and engagement in preventative healthcare.

Many states and counties are increasing their focus on providing culturally responsive care by offering training and education for health care providers on promoting health and health equity in a meaningful way for their patients. The Office of Minority Health in the U.S. Department of Health & Human Services provides a number of free online trainings for providers around cultural responsive practice.

School-based health centers provide age-appropriate health care services in a child’s school. The health centers typically can provide preventative screenings and early intervention services, as well as health counseling and treatment for some acute illnesses and chronic conditions.

Text4Baby is a free program that provides text messages timed to a mother’s due date and up through year 1 of a baby’s life. Topics include nutrition for mother and baby, safe sleep tips, baby's milestones, signs and symptoms of labor, doctor visit and appointment reminders for mother and baby, breastfeeding advice, car seat safety, information on health insurance, urgent health alerts, and resource hotlines and websites.

3. Increasing access to healthcare for uninsured families with children 0-5.

Abrazo Health School-based Health Centers, in conjunction with the Phoenix Baptist Hospital Family Medicine Center Residency Program, operate a bi-monthly evening and after-hours clinic. Staffed by volunteers and located at the Legacy Foundation Chris-Town YMCA, the clinic provides free medical services to uninsured and uninsurable community members. For more information or an opportunity to volunteer, please call 602.246.5597.

ADHS provides online resources regarding Sliding Fee Schedule (SFS) clinics throughout Arizona that provide free or low-cost primary, mental, and dental health services to persons without health insurance. This website provides information on location of clinics and information for providers on developing and implementing SFS and policies.

4. Reduce number of people without health insurance

South Phoenix Healthy Start provides families with supportive home visits, small group perinatal health classes, health checkups, and developmental screenings. The program will also provide referrals for services and expedited AHCCCS services.

Health Care for Homeless (HCH) provides health care services for families in Maricopa County in primary care, mental healthcare, and nutritional health. HCH also provides referrals, housing support, and employment assistance.

Arizona’s Children’s Health Insurance Program (CHIP) Kids Care offers health insurance for children under the age of 19 who are not eligible for other AHCCCS insurance. There are income limits associated with qualifying.

Health-e-Arizona PLUS is a resource for children and families to help them apply for public programs including AHCCCS insurance. This program also provides Community Assistors throughout the state to support individuals and their families as they navigate applying for and using public assistance.

Prenatal and Newborn Health

1. Encourage women to engage in prenatal health care during their first trimester.

The Integrated Healthcare Association has produced an Issue Brief #12, Maternity Care Patient Engagement Strategies (Lally & Lewis, September 2014) that focuses on patient engagement in maternity care and the strategies that enable pregnant women to make informed decisions to improve their care, their health, and the health of their babies.

Mobile health (mHealth) is a relatively new patient engagement strategy that many researchers contend has the potential to reach the large, diverse populations that use cell phones. Studies reveal that individuals are increasingly searching for and receiving health information on their cell phones. Studies also report that patients, including young pregnant women, are amenable to receiving health related text messages.

The National Healthy Mothers, Healthy Babies Coalition’s Text4Baby is a free program that provides text messages timed to a mother’s due date and up through year 1 of a baby’s life. Topics include: nutrition for you and your baby; safe sleep tips; baby's milestones; signs and symptoms of labor; doctor visit and appointment reminders for you and your baby; breastfeeding advice; car seat safety; information on health insurance; urgent health alerts; and resource hotlines and websites.

In 2008, Childbirth Connection convened a Vision Team of innovators in maternity care delivery and health systems design to define the fundamental values, principles, and goals for a high-quality, high-value maternity care system. The resulting consensus document, 2020 Vision for a High-Quality, High-Value Maternity Care System serves as a focal point to inspire improvement strategies, and formed the basis for the Blueprint for Action. A high-quality, high-value maternity care system means care is consistently and reliably woman-centered, safe, effective, timely, efficient and equitable. The Blueprint for Action manuscript published in Women’s Health Issues (2010) is available for download.

Centering Healthcare Institute’s CenteringPregnancy is group prenatal care bringing 8 to10 women due at the same time together for their care. Providing care in this way allows moms and providers to relax and get to know each other on a much deeper and meaningful level. Members of the group form lasting friendships and are connected in ways not possible in traditional care. Centering groups comprised of women of different ages, races, and socio-economic backgrounds see those differences diminish in importance as they share the common experience of pregnancy, birth, and family care. Many continue on for family centered well-child care through the first two years in CenteringParenting.

California Department of Public Health’s Black Infant Health Program (BIH) aims to improve health among African American mothers and babies and to reduce the Black: White disparities by empowering pregnant and mothering African American women to make healthy choices for themselves, their families, and their communities. BIH clients participate in weekly group sessions (10 prenatal and 10 postpartum) designed to help them access their own strengths and set health-promoting goals for themselves and their babies. View the BIH Program Profile for more information.

The Birth Center model uses midwives and teams of health professionals, including peer counselors and doulas, working in collaboration to provide comprehensive prenatal care at birth center sites. Key components of this model are engaging mothers as partners in their care; using evidence-based, coordinated care; and providing health education and emotional support. The American Association of Birth Centers (AABC) is a multi-disciplinary membership organization comprised of birth centers, and individuals and organizations that support the birth center concept including certified nurse midwives (CNMs), certified professional midwives (CPMs), physicians, nurses, women and their families. AABC publishes materials on birth centers, sets national standards for birth center operation, and promotes state regulations for licensure and national accreditation by the Commission for the Accreditation of Birth Centers.

Patient decision aids (PDAs) can be used to facilitate the shared decision making process. Many different types of PDAs are used to educate patients and help them understand their choices. They range from printed patient questionnaires, fact sheets, and brochures describing conditions, treatment options, and risks to DVDs, computer programs, and interactive web sites that include filmed interviews with patients and health professionals. Studies suggest that decision aids improve patients’ knowledge; in turn, evidence-based knowledge helps pregnant women make more informed decisions regarding their maternity care. Read the full text of Say, Robson, & Thomson, 2011 article on PDAs published in Reproductive Medicine, Obstetrics, and Gynecology.

PregnantMe is piloting their decision aids in California through a project funded by the California Health Care Foundation (CHCF), a national maternity care shared decision-making initiative launched in 2013 by the Informed Medical Decisions Foundation and Childbirth Connection National Partnership. The initiative aims to improve health outcomes and patient experiences during pregnancy by helping pregnant women access the information they need to work with their providers and make informed decisions about their care. The decision aids are designed to be appropriate for use by women with low health literacy skills, and selected aids are translated into Spanish.

2. Promote nutrition education for mothers and their babies

The Nurse-Family Partnership (NFP) program uses an evidence-based curriculum to provide parenting support and education during home visits for the first two years of a child’s life. The specially-trained nurses can also provide referrals for healthcare and support services in the community. NFP brings measuring cups and other tools during home visits to educate mothers on portion control and health nutrition. NFP also provides resources from Choose My Plate.

Healthier Food Retail: An Action Guide for Public Health Practitioners provides guidance for public health practitioners on how to develop, implement, and partner on initiatives and activities around food retail to improve access, availability, and affordability of healthier foods and beverages. With this guide, public health practitioners can begin or enhance their work in healthier food retail.

Text4Baby is a free program that provides text messages timed to a mother’s due date and up through year 1 of a baby’s life. Topics include: nutrition for you and your baby; safe sleep tips; baby's milestones; signs and symptoms of labor; doctor visit and appointment reminders for you and your baby; breastfeeding advice; car seat safety; information on health insurance; urgent health alerts; and resource hotlines and websites.

3. Promote breastfeeding for a minimum of 6 months.

The WHO/UNICEF Baby-Friendly Hospital Initiative is the global standard for hospital care to support breastfeeding, with the Ten Steps to Successful Breastfeeding at its core.

Baby-Friendly Hospital Initiative at Boston Medical Center was designed to implement hospital policies and procedures that support optimal breastfeeding practices.

The Connecticut Breastfeeding Initiative was designed to promote practices in maternity facilities that support the initiation and continuation of breastfeeding.

Ensuring workplace compliance with federal lactation accommodation law is part of the Patient Protection and Affordable Care Act ("Affordable Care Act").

Support for Breastfeeding in the Workplace includes several types of employee benefits and services, such as developing corporate policies to support breastfeeding women, educating all employees about workplace support for breastfeeding, and providing time and designated private space that is not a bathroom for breastfeeding or expressing milk.

State Health Departments Provide Community-Based Breastfeeding Support fact sheet outlines program successes and lessons learned from the CDC Breastfeeding Supplement grant. CDC grantees and breastfeeding practitioners can use this document when implementing community-based breastfeeding programs or strategies.

CDC Guide to Strategies to Support Breastfeeding Mothers and Babies provides state and local community members with information to choose the breastfeeding intervention strategy that best meets their needs.

HealthyChildren.org of the American Academy of Pediatrics provides numerous resources on breastfeeding for families.

Breastfeeding Peer and Professional Support Highlights focus on state health departments’ coordinated efforts to implement strategies that increase access to breastfeeding support in communities.

The Academy of Breastfeeding Medicine published a Model Breastfeeding Policy (2010). The purpose of this protocol is to promote a philosophy and practice of maternal–infant care that advocates breastfeeding. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. This policy is based on recommendations from breastfeeding policy statements published by the Office on Women’s Health of the U.S. Department of Health and Human Services, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the World Health Organization, the Academy of Breastfeeding Medicine, and the UNICEF/World Health Organization evidence-based Ten Steps to Successful Breastfeeding.

A New Hampshire WIC initiative supports several programs to promote breastfeeding, including peer counseling support groups, education and NH department of health effort that encourages its state-funded community health centers, prenatal programs, and home visiting programs to educate expecting families on the health and nutrition benefits of breastfeeding, and support new mothers in continuing breastfeeding through the first year.

Baby Friendly USA provides information about the Baby-Friendly designation process and requirements, and a list of all Baby- Friendly facilities in the United States.

The Colorado Can Do 5! Initiative promotes five steps that have been shown to affect breastfeeding duration. This initiative is supported by a collaboration between the Colorado Department of Public Health and Environment and the California Breastfeeding Coalition.

4. Reduce preterm birth rates and low birth rates/5. Reduce Infant Mortality Rates

The March of Dimes and the Johnson & Johnson Pediatric Institute collaborated with the Kentucky Department for Public Health to launch an innovative, community-based preterm birth prevention initiative called Healthy Babies are Worth the Wait. The program promoted forming partnerships within a local community; educating providers regarding evidence-based practices to prevent preterm births; support¬ing patients by providing prenatal education and other community services; engaging the community; and measuring the progress and effectiveness of the program. To help organizations initiate HBWW programs with the March of Dimes chapters in their areas, they have created HBWW: Preventing Preterm Births through Community-based Interventions: An Implementation Manual to provide tools and resources for program implementation in new sites. Download a free copy of the toolkit from prematurityprevention.org.

The Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) promotes their “Don’t Rush Me...Go the Full 40™” campaign in support of spontaneous labor and normal birth by encouraging pregnant mothers to wait until labor begins spontaneously around 40 weeks. AWHONN has a login specific for nurses to access resources. AWHONN provides a toolkit to implement the Go The Full 40™, including handouts (English and Spanish), ways to share the campaign, sample social media posts, and more.

The Strong Start for Mothers and Newborns initiative, an effort by the Department of Health and Human Services, aims to reduce preterm births and improve outcomes for newborns and pregnant women. The first initiative is a public-private partnership and awareness campaign to reduce the rate of early elective deliveries prior to 39 weeks for all populations. The other component is a funding opportunity to test the effectiveness of specific enhanced prenatal care approaches to reduce the frequency of premature births among pregnant Medicaid or Children’s Health Insurance Program (CHIP) beneficiaries at high risk for preterm births. Fact sheets, and Tool Kits for providers and consumers are available online.

Developmental and Mental Health

1. Increase early screenings, detection, diagnosis, and interventions

HealthMap Vaccine Finder provides location and clinic information for clinics providing vaccination services.

Maricopa County Department of Public Health operates three immunization clinics for children ages 0 to 19 which provide immunizations free of charge, regardless of insurance status.

Quality First child care ratings provide a detailed assessment of child care settings in the areas of health and safety, staff experience, interactions, learning environment, lessons, group sizes, and child assessment. Highly-rated childcare programs provide an ideal developmental climate for a child.

The Nurse-Family Partnership program uses an evidence-based curriculum to provide parenting support and education during home visits for the first two years of a child’s life. The specially-trained nurses can also provide referrals for healthcare and support services in the community.

South Phoenix Healthy Start provides families with supportive home visits, small group perinatal health classes, health checkups, and developmental screenings. The program will also provide referrals for services and expedited AHCCCS services.

2. Increase access to and quality of developmental disabilities programs.

Arizona Early Intervention Program provides support for infants and toddlers with developmental delays or disabilities.

AZ FIND provides resources and information to parents regarding the identification and evaluation of disabilities within an educational setting.

South Phoenix Healthy Start provides families with supportive home visits, small group perinatal health classes, health checkups, and developmental screenings for families in South Phoenix and Maryvale. The program will also provide referrals for services and expedited AHCCCS services.

Quality First child care ratings provide a detailed assessment of child care settings in the areas of health and safety, staff experience, interactions, learning environment, lessons, group sizes, and child assessment. Highly-rated childcare programs provide an ideal developmental climate for a child.

Early Head Start provides focused and individualized development services to infants and toddlers through home visits and site-visits at Early Head Start centers. Early Head Start also provides referrals and connects services for parents and children to ensure child development throughout an individual’s early years.

3. Promote education for parents of children ages 0-5 with developmental delays, disabilities, and/or mental health issues.

Early Head Start provides focused and individualized development services to infants and toddlers through home visits and site-visits at Early Head Start centers. Early Head Start also provides education and support to parents of infants and toddlers with disabilities.

Raising Special Kids program provides training and education to parents of children with disabilities on a variety of skills to ensure their child’s development is supported.

AZ FIND provides resources and information to parents regarding the identification and evaluation of disabilities within an educational setting.

Maricopa Integrated Health Systems Family Learning Centers provide literacy education and health information for parents and their children. This program provides educational classes for parents on parenting, nutrition, safety, and development as well as community referrals.

The Alliance for Children and Youth with Unique Challenges—description and link

4. Promote positive parenting behaviors to promote healthy parent-child relationships.

Healthy Families focuses on teaching pregnant parents and parents of newborns skills to support healthy and positive parenting.

The Nurse-Family Partnership program uses an evidence-based curriculum to provide parenting support and education during home visits for the first two years of a child’s life.

South Phoenix Healthy Start provides families in South Phoenix and Maryvale with supportive home visits, small group perinatal health classes, health checkups, and developmental screenings. The program will also provide referrals for services and expedited AHCCCS services.

Text4Baby is a free program that provides text messages timed to a mother’s due date and up through year 1 of a baby’s life. Topics include: nutrition for you and your baby; safe sleep tips; baby's milestones; signs and symptoms of labor; doctor visit and appointment reminders for you and your baby; breastfeeding advice; car seat safety; information on health insurance; urgent health alerts; and resource hotlines and websites.

Injury Prevention

1. Reduce rates of children struck by or against injuries.

Child-Parent Centers (CPCs) provide comprehensive educational and family support to economically disadvantaged children (beginning at age 3 and thru the third grade) and their parents. In a matched control trial, children participating in these centers had a 52 percent reduction in child maltreatment. See Reynolds, A.J., & Robertson, D.L. (2003). School-based early intervention and later child maltreatment in the Chicago Longitudinal Study. Child Development, 74(1), 3–26.

Durham Family Initiative works to improve family well-being and reduce child maltreatment by coordinating services for high-risk families. Children who are at risk for maltreatment are identified through home visits after birth or through referrals from pre-kindergarten, schools, and clinics. In a randomized controlled trial, this model resulted in a 57% reduction in child maltreatment in Durham county compared to control counties. See Daro, D., & Dodge, K.A. (2009). Creating Community responsibility for child protection: Possibilities and challenges. Future of Children, 19, 67-93.

Nurse-Family Partnership is a nurse home visitation program for low-income, first-time parents and their children that encourages healthy behaviors during and after pregnancy. A randomized controlled trial documented a 48 percent reduction in child maltreatment at the 15-year follow-up. See Olds, D.L., Eckenrode, J., Henderson, C.R., Kitzman, H., Powers, J., Cole, R., et al. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect: Fifteen-year follow-up of a randomized trial. JAMA, 278(8), 637–643.

Triple P is a multi-level system of parenting interventions based on need, usually delivered through health care. In the U.S. Triple P System Trial, funded by the CDC, researchers found a 28% reduction in substantiated abuse cases, a 44% reduction in child out-of-home placements, and a 35% reduction in hospitalizations and emergency room visits for child injuries in nine study counties in South Carolina where parenting interventions were implemented. See Prinz, R.J., Sanders, M.R., Shapiro, C.J., Whitaker, D.J., & Lutzker, J.R. (2009). Population-based prevention of child maltreatment: The U.S. Triple P System Population Trial. Prevention Science,10(1),1–12.

The Safe Environment for Every Kid (SEEK) program screens parents of children ages 0-5 in pediatric primary care settings to identify parental exposure to partner violence, mental illness, or substance abuse and provide appropriate referrals. A randomized controlled trial showed significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment non-adherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. See Dubowitz, H., Lane, W.G., Semiatin, J.N., Magder, L.S., Venepally, M., & Jans, M. (2011). The Safe Environment for Every Kid Model: Impact on Pediatric Primary Care Professionals. Pediatrics, 127(4), 962-970

Safe Kids of Maricopa County—description and link

2. Reduce motor vehicle traffic injuries

The Kids Ride Safe Program reaches out to parents about the importance and correct use of car seats, booster seats and restraints. Phoenix Children's partners with Safe Kids, as well as local fire and police departments to host community car seat checks. Trained technicians check car seat installations, train parents and, in some cases, distribute donated car seats.

Safe Kids of Maricopa County—description and link

3. Reduce rates of suffocation and drowning

The Phoenix Children’s Hospital provides numerous water safety resources for professionals and parents.

4. Promote safe home environments

The Association for Supportive Childcare’s Child Care Injury Prevention Program (CCIPP) offers a comprehensive program that provides child care professionals and parents with education, materials and resources needed to decrease the unintentional injury and death rate in children ages 14 and under.

Safe Kids of Maricopa County—description and link

Oral Health

1. Increase rate of dental screenings and dental varnishes.

Maricopa County’s Office of Oral Health administers First Teeth First, a First Things First-funded program. Basic oral screenings, education and referrals are provided at no cost to pregnant women and children 0 through 5 years of age. The First Teeth First program provides services throughout Maricopa County at Women, Infant and Children (WIC) clinics, Immunization clinics, childcare centers, preschools and community events. Locations interested in services can call Jan Kalina at 602.506.6282 or email at JanKalina@mail.maricopa.gov

The Arizona School-based Sealant Program is a public health service provided by the Arizona Department of Health Services in partnership with Maricopa County Department of Public Health's Office of Oral Health.

2. Increase access to healthy foods for children ages 0-5 and their families.

Fresh Express by Discovery Triangle is a mobile produce market that provides access to high-quality, affordable produce to residents with little to no access to healthy food.

UA Cooperative Extension Directory of Farmer’s Markets in Maricopa County, including those that accept SNAP as payment.

UA Cooperative Extension Directory of Community Gardens in Maricopa County connects community members to opportunities to grow their own food. The MCDPH School Gardens Resource Page provides resources for schools interested in beginning a school garden program that can be connected to nutrition education, physical activity, sciences, math, and more.

Arizona Nutrition Network provides nutrition and physical activity resources for parents, kids, and partners.

Current Practices in Healthy Food Retail: Small Stores The practices highlighted in this document demonstrate ways to increase the availability of healthy foods and beverages by using public health strategies that focus on small stores.

Improving Retail Access for Fruits and Vegetables Food can be sold at a variety of retail venues in a community. To increase fruit and vegetable consumption by community members, it is important to improve access to these venues and to increase the availability of high-quality, affordable fruits and vegetables sold at these locations. This document highlights a few states' work in this area.

The MyPlate Daily Checklist (formerly Daily Food Plan) shows what and how much a child should eat to meet his or her needs. Each child's needs may differ from the average, and appetites can vary from day to day. Try to balance the amounts over a few days or a week.

3. Increase oral health education at pediatrician’s offices and early child care centers.

The Massachusetts Department of Public Health developed a guide, Growing Health Smiles in Child Care Settings, (2009) to teach child care workers how to implement a tooth-brushing program.

The University of Iowa’s Department of Pediatric Dentistry has produced a tooth brushing protocol for preschool and child care settings serving children 3-5 years of age. The protocol instructs child care providers on when to brush children’s teeth, how often to brush, where to brush, hygiene and storage of toothbrushes, and how to dispense toothpaste.

Head Start’s Early Childhood Learning and Knowledge Center provides resources for Head Start and other early child care providers on oral health of young children. This website provides information for Head Start staff and others to help ensure that children receive oral health assessments, follow-up, and treatment. Resource materials provided online will also help Head Start staff and others provide oral health education to children, pregnant women, and families. Additionally, Head Start provides information for Head Start staff and others on oral health policies and procedures for early child care centers, oral diseases, and injury prevention.

Bright Futures is a national disease prevention and health promotion initiative funded by the Maternal and Child Health Bureau. This toolbox contains resources for promoting and improving the oral health of infants, children and adolescents, and includes information on how to develop and implement oral health programs.

This Guide to Pediatric Oral Health Management from the National Maternal and Child Health Oral Health Resource Center assists health professionals in performing oral screenings to identify infants and children at increased risk for oral health problems, as well as in offering referrals and providing parents with anticipatory guidance.

Open Wide: Oral Health Training for Health Professionals is a series of four online modules designed to help health and early childhood professionals working in community settings promote oral health. Topics include tooth decay, risk factors for tooth decay, and prevention of tooth decay; oral health risk assessment and oral health screening; and anticipatory guidance for parents. The modules were prepared by the National Maternal and Child Oral Health Resource Center and the Center for the Advancement of Distance Education at the University of Illinois at Chicago.

The purpose of WIC‘s Early Entry into Dental Care is to increase the number of at-risk young children who receive preventive dental services and access early dental care, and to ensure that families have information about diet and proper brushing practices. The program, run by the Center for Oral Health, uses WIC centers as the service delivery point. (WIC provides food and nutrition education to low-income pregnant and parenting woman and their children.)

4. Develop a list of dental offices that are family friendly in Maricopa County.

MCDPH Oral Health provides a dental treatment referral list of dental treatment providers in Maricopa County that treat children who have AHCCCS (bilingual).

MCDPH Oral Health provides a list of reduced fee and community dental clinics in Maricopa County (bilingual).

5. Encourage families to reduce consumption of sugary drinks and foods through educational campaigns.

The CDC has produced The CDC Guide to Strategies for Reducing the Consumption of Sugar-Sweetened Beverages (SSB). This document provides guidance for program managers, policy makers, and others seeking to identify strategies to reduce SSB consumption.

http://www.kickthecan.info/ provides trustworthy and up-to-date information about the negative health effects of soda and other sugary drinks. Advocates wishing to see reduced sugary beverage consumption in their communities can get equipped with health facts and statistics, and be prepared to counter beverage industry tactics. The site also contains useful information on sugary drink policy, legislative activities around the country, and links to toolkits, key reports, studies and media coverage.

Fry’s Food Stores announced that as of May 2016, each Fry’s store has ‘Free Fruit for Kids’ cart in their produce departments! This program offers children free fruit while their family is shopping.