Cross Cutting and Systems-Building

Report for the application year: Oct 2020 - Sept 2021

SPM 4: The percent of mothers of 3-year-old children whose family has an emergency plan in case of disaster.

SPM Strategy 4.1: Utilize existing platforms and capacity to contribute to rapid assessment of needs and dissemination of data and best practice information during emergencies.

The primary public health emergency during this reporting period continued to be the COVID-19 pandemic, with the first significant wave of cases occurring in Alaska in the late fall of 2020 and cases continuing to be high throughout most of the spring of 2021. In November-December 2020, the MCH Epi Unit conducted a fourth online public survey to assess the impact of the pandemic on Alaskans, receiving over 7,000 responses. Throughout the next year, the Unit Manager, Public Health Associate Program assignee, and other Unit staff created and disseminated publications and presentations to share the findings of the survey with others. These included a series of three fact sheets that were posted online and distributed to partners via email, presentations at the Alaska Public Health Summit and the Infant and Early Childhood Mental Health Institute / Child, Adolescent and Family Behavioral Health Conference, and a blog posting about mental health impacts of the pandemic on families with young children. The blog posting specifically included information on things health care providers, friends and communities could do to support and provide help for people in crisis.

WCFH provided support for school nurses by sharing information and resources for children and adolescents during the pandemic. During the reporting period, support continued to include assistance with protocols for school re-opening, collaboration with local providers on responding to positive cases and exposures, and targeted support for districts without a school nurse staff position. Information disseminated also included resources to support students and staff with health and social experiences related to the ongoing public health emergency, and to promote a return to accessing preventive health services.

Adolescent Health Unit staff and others working with the adolescent/young adult population were frustrated by the general lack of data available regarding the impact of the pandemic on people less than 18 years old. The MCH Epi Unit Manager met with the YRBS Coordinator regarding the possibility of surveying youth directly about the impacts of COVID, however these efforts were ultimately dropped due to challenges with conducting rapid assessments within this protected population.

The Section leveraged multiple listservs to disseminate best practice information, strategies and data related to COVID to providers and partners statewide, including the MCH Clinical listserv, the Home Visitors Resource Network Listserv, AKPQC listserv and Title X listserv. The Section continued to use the ECHO model for perinatal topics and received approval to use ARP funding to launch a home visiting ECHO with a focus on supporting the field as they work directly with families during crisis. The WIC Central Office was a partner in these efforts, as well as the Division of Behavior Health, Tribal programs, and Part C Early Intervention. WCFH also hosted pop-up calls with home visitors and other groups to provide support and information throughout the pandemic and communicated directly with providers to share information and recommendations.

MCH Epi unit staff were leveraged to support the ongoing COVID response, although with some decline in these efforts by the end of 2020. The Public Health Informaticist completed his support for the ArcGIS COVID Dashboards and the ABDR Epidemiologist assisted with building social network maps for contact tracers. The Unit Manager provided feedback and advisory services regarding other public surveys being conducted by other sections and the director’s office on topics such as vaccine hesitancy and masking.

SPM Strategy 4.2: Promote and disseminate information about community debrief/postvention response services following a significant traumatic event or emergency.

WCFH staff are often made aware of resources throughout the state which they can then relay to providers and partners through various mailing lists, including those mentioned above. During this reporting period, the most prominent emergency continued to be the COVID-19 pandemic, which, while no longer an acute emergency, continued to be a traumatic experience for many communities. This reporting period saw an increased recognition of the impact of the pandemic on youth. The Adolescent Health program in WCFH helped to develop a mental health infographic for youth that was disseminated to 4th R teachers. Additionally, the School Health Nurse Consultant provided support for school nurses who were working with youth.

The CYSHCN Program Manager helped with emergency management for CYSHCN through participation on the Vulnerable Children Task Force, a group of state and local agencies from across Alaska. This workgroup helped to develop on checklist for caregivers, including things to consider in case a caregiver became sick with COVID. This checklist was made available online and was translated into 9-10 different languages through collaborations with community-based organizations serving immigrant communities in Alaska.

SPM Strategy 4.3: Through partnerships, promote the continued use of reflective practice to support direct-service providers who conduct screening in non-clinical settings during public health emergencies.

Direct service providers face unique challenges in their work during a public health emergency. WCFH supports partner agencies who provide such services by offering information about reflective practice. Reflective practice involves facilitated, attuned, non-directive client interactions which are modeled during reflective supervision to facilitate supportive, empowering engagement that helps a person develop a sense of how they wish to move forward.

WCFH hosted a 2-day home visiting summit with a contractor from Futures Without Violence on IPV surveillance and support during COVID. One day of the summit was focused on self-care and attunement (breakout groups had practical activities) and was based on the facilitated attunement network (FAN) curriculum. DBH funding is helping to support development of additional FAN trainers. New funding for these activities has been identified through a CDC injury prevention grant awarded to the Section of CDPHP and the Mental Health Trust. A WCFH Perinatal Nurse Consultant was invited to be on the advisory committee for the UAA CHD Family Services Training Center which is looking at FAN as a foundational training to include in their curriculum.

The Adolescent Health Program provided staff time and materials to support development and dissemination of the trauma-informed school framework and helped recruit experts to speak on this topic at the February 2022 MCHI conference.

SPM 3: Percent of people who recently delivered a live birth who have a strong social support system during the postpartum period.

Strategy 3.1: Provide staff training in responding to ACEs/trauma and strengths-based approaches.

All WCFH staff are encouraged to participate in webinars and trainings about trauma, ACEs and protective factors as the opportunities arise. One example is the Strengthening FamiliesTM training, which provides an Alaskan perspective on historical trauma and the impact of ACEs, as well as practical training on everyday actions to promote the five Protective Factors: (1) Parental Resilience, (2) Social Connections, (3) Concrete Supports, (4) Knowledge of Parenting and Child Development and (5) Social and Emotional Competence of Children. Additionally, staff who have experience working with traumatized populations provide guidance and support for other team members in the course of WCFH work and they help to ensure that key program activities are conducted in a way that is responsive to ACEs. Another excellent training, the AK Blanket Exercise training, provided by the Alaska Native Tribal Health Consortium, was unfortunately not available during this reporting period as it was being re-developed in a virtual format. This training covers the history of the Alaska Native people and the intergenerational trauma that has occurred in this population.

Motivational Interviewing training includes training informed approach and protective factors/resilience focus. Youth health literacy curriculum includes a component of self-efficacy/self-determination, for example knowledge of personal history for foster youth.

The MCDR program worked extensively with the Alaska State Hospital and Nursing Home Association on a publication on improving and understanding the impact of ACEs (attached as a supporting document), which was released in August 2021. The target audience of the publication was health care providers working in birthing people. A key information point shared in the publication was that Alaska Medicaid had authorized reimbursement for ACEs screening and maternal depression screening during pediatric appointments, up to one year postpartum as of April 1, 2021.

The Adult Health Unit supported a local Title X agency engaged in extensive trauma-informed care training in order to be considered a trauma-informed agency.

Strategy 3.2: Collect, analyze, and disseminate primary and secondary data through population-based surveillance systems and online dashboards.

The systems-building work of the MCH Epidemiology Unit provides the foundation for much of the programmatic work in WCFH to increase well-being and resilience among the Alaskan MCH population and reduce the impact of ACEs. The three traditional surveillance programs in the MCH Epi Unit, PRAMS, CUBS, and ABDR, provide population-based information about infancy and early childhood, a critical time period when many Alaskans are exposed to both positive and negative experiences that can have a lifelong impact on their health. The ALCANLink project brings together survey data with other administrative secondary data sources to measure longer term impacts of these early childhood events and experiences and look for prevention opportunities.

Much of the ongoing data collection and dissemination work of the population-based surveillance systems of the MCH Epi Unit are described in other Chapters of this report (specifically MCH Data Capacity Efforts and SSDI). During this reporting period, the Unit increased efforts to conduct qualitative data analysis and to more deliberately share comments made by PRAMS and CUBS respondents to help illustrate lived experiences of real Alaskans. While the Unit has been working towards designing new online data dashboards for many years, this work was initially stymied and then accelerated by the Cyber Attack on the DHSS website and servers in May 2021. The Unit’s response to the cyber attack and new data dashboards are described elsewhere in this narrative.

Priority Need: Increase or promote equitable access to medical and pediatric specialty care and family supports for CYSHCN.

Strategy P-1: Collaborate with Medicaid to improve reimbursement and/or increase access to services.

The purpose of this strategy is to recognize that WCFH’s many partnerships with the Medicaid program are a deliberate component of Alaska’s overall Title V Strategic Plan. However, most - if not all - of the work that WCFH does with Medicaid to improve reimbursement and/or increase access to services is also described in other sections of this report, specifically III.E.2.b.v.b Title V - Title XIX IAA, but also in several of the domain-specific reports. A few highlights of these work are described below.

During the COVID-19 pandemic, Alaska experienced a decrease in the rate of well-child visits and childhood immunizations. To help mitigate these challenges, WCFH, Medicaid, the state Immunization Program in the Section of Epidemiology, and the Public Information Team partnered on outreach strategies to promote preventive health visits for children. Title V dollars were used to create rack cards which were distributed to schools during 2021-2022, with priority placed on getting those materials to Title I schools. The Title V-funded school nurse consultant helped create the rack cards. One side of the cards had information about how to sign up for Denali KidCare and the other side was a list of the type of screenings by age. Additional work in this area included Title V CYSHCN staff participating in a workgroup with the Alaska Children’s Trust to discuss options for increasing Denali KidCare enrollment.

In partnership with Help Me Grow Alaska, the WCFH Early Childhood Program Manager continued to lead the Universal Developmental Screening Advisory Committee for the Alaska. This includes a separate workgroup with Medicaid specifically focused on billing for these screenings. Medicaid was an active partner in the development of the statewide developmental screening environmental scan and gap analysis. They added questions which will facilitate policy changes related to developmental screening reporting and reimbursement.

Other notable collaborations with Medicaid during the reporting period included participation by the Title V Director in a workgroup to promote the inclusion of LARC reimbursement in a new DRG methodology for hospital payments. Title V staff wrote a white paper which was submitted to the Office of Rate Review, the DRG contractor, and Medicaid on the health and financial reasons to do a carveout and incentivize this process. The Title V Director also began work during this period on a white paper on the topic of extending postpartum Medicaid coverage to 12 months.