Overview and context

In addition to the State Action Plan (SAP) strategies outlined throughout the population domain narratives, Louisiana Title V has invested in strategies that aim to improve the state’s maternal and child health (MCH) capacities through investment in core infrastructure and capacity-building strategies focusing on health equity, family engagement, communications, and public policy engagement. Louisiana Title V has significantly contributed to improving BFH’s effectiveness as the public health system for women, children, and families in the state.

 

During the FFY 2016-2020 strategic period, BFH completed an organizational strategic planning process that led to a structural reorganization which included creation of the Strategy, Policy, Alignment, Communications, and Equity (SPACE) team to facilitate the development of systematic processes for strategy development and program quality improvement across the Bureau.

 

Cross-cutting / systems building priority needs and performance measures

Priority needs:

The 2020 Needs Assessment identified key issues including promotion of health equity, engagement with families and communities, and improvement of evidence-based strategic development as cross-cutting priorities for Title V programming in the state of Louisiana. To strengthen the systems and supports that shape these factors, Louisiana Title V continues to execute strategies that align with the following systems priorities:

• Boldly work to undo systemic drivers of disparities and institutionalize equitable policies and practices
• Partner with families, youth, and communities at all levels of systems change
• Ensure Title V strategies are outcomes focused and rooted in essential public health services

 

Performance measures:

Throughout the FFY 2021-2025 strategic period, Title V investments in cross-cutting and systems strengthening initiatives in Louisiana will contribute to improvement of the following state-level performance measures (SPM):

• Percent of recommended actions resulting from externally assessed equity audit that have been successfully implemented (SPM 1)
• Organizational commitment to family engagement in systems change (SPM 2)
• Percentage of programs using and implementing audience tested message frames (SPM 3)

 

In FFY2022, LA Title V aimed to achieve the following objective(s) in relation to cross-cutting and systems strengthening:

• By June 2022, develop BFH improvement and accountability plan based on external equity audit recommendations
• By January 2022, engage 100% of BFH staff in the Conscious Roots Diversity, Equity, and Inclusion training series
• By January 2022, support the hiring and onboarding of the Project SOAR manager of family engagement
• Host quarterly individual quality improvement meetings with facilitators of BFH-supported boards and commissions

 

Summary of cross-cutting / systems-building interventions supported by Title V in FFY2022

 

Systems Priority: Boldly work to undo systemic drivers of disparities and institutionalize equitable policies and practices

Institutionalize equity within BFH by establishing or amending existing policies and practices to ensure BFH operates with equity, consistently incorporating a social justice and anti-racism lens:  Reducing health disparities, particularly racial health disparities, has been a priority for BFH since 2010. In the previous Title V strategic cycle (FFY 2016-2020), BFH created a Health Equity Action team (HEAT), which was guided by a formal steering committee and aimed to build organizational capacity for promoting health equity. HEAT has since evolved to include a HEAT Advisory Committee and four workgroups (Staff Development and Internal Processes; Data Collection, Analysis, and Distribution; Communications; and Policy Response and Development).

 

As part of the 2020 Needs Assessment and in preparation for the new five-year strategic cycle (FFY 2021-2025), a BFH outlined a five-year health equity vision. As part of this five-year vision, BFH aims to:

• Acknowledge the historical and ongoing systems of oppression that have resulted in present health inequities.
• Approach all organizational and programmatic goals with a social justice and equity lens to work toward health equity for all.
• Develop and maintain routine analyses of current BFH practices to work towards quality improvement with an equity lens.
• Through restorative practices, establish and maintain a work culture in which staff are empowered to identify and address (including but not limited to) racism, ableism, heterosexism, and classism.
• Elevate and support community and family leaders and partnerships, utilizing a “nothing about me without me” approach.
• Ensure that BFH lifts and centers the voices of our state’s populations by going beyond existing data sources and analyses. We will develop and leverage fully engaged community partnerships to accomplish this.
• Regularly examine the health landscape through a health equity and social justice lens and identify partnerships that can influence and change systems of inequity.

 

Since FFY2021, the below strategies have been undertaken to contribute to the realization of BFH’s health equity system priority.

 

Institutionalizing equity within BFH policies and practice: The 2020 Needs Assessment highlighted a growing and urgent need to maintain a health equity strategy beyond BFH HEAT. To promote accountability around implementing the above vision and institutionalize equity within BFH policies and practices, BFH contracted Conscious Roots, LLC, to conduct a diversity, equity, and inclusion audit of BFH. The audit was conducted during spring 2021 and consisted of an anonymous survey and optional follow-up interviews with staff. Nearly a third of BFH staff completed the survey, and thirteen follow-up interviews were conducted. In June 2021, Conscious Roots provided BFH leadership with a comprehensive summary report of key findings. Findings were organized around the themes of Leadership, Access and Equity, Promotion and Retention, and Climate.  The external equity audit resulted in nine recommended actions, which form the foundation of BHF’s State Performance Measure (SPM) 1.

 

In FFY2022, BFH HEAT created a monitoring framework, including scoring procedure and timeline, to respond to the recommendations received from Conscious Roots. A baseline score was established in August 2022 and annual progress targets have been set for FFY2023 - FFY2025. An implementation plan was also created to prioritize which recommendations could be implemented first and to determine which recommendations were in BFH, LDH, and OPH’s scope of work.  Progress against the nine recommended actions are summarized below:

• Recommendation 1. Creation of an (a) anti-racism statement and strategies to ensure this statement is lived out as part of BFH’s foundation. Creation of a (b) EDI statement and strategies to ensure this statement is lived out as part of BFH’s foundation. Select staff and partners began the development of BFH’s EDI and anti-racist statements. Between January and March 2022, select staff (bureau director, BFH Advisory Board, and Dr. Gillespie-Bell) came together and developed BFH’s EDI statement. After the final draft was written, it was presented to all staff who had the option to respond. Following staff feedback, the EDI statement was made final and shared with all staff and partners via email, an all staff meeting, and was added to BFH’s Learning Management System (LMS), Moodle and the Partners for Family Health page on the LDH website. Once the EDI statement was created, work began on the development of the anti-racist statement. The initial drafts were again written with guidance and feedback from bureau director, BFH Advisory Board, and Dr. Gillespie-Bell. Many considerations were taken into account due to the sensitive nature of racism. Several drafts of the statement were written between March and July 2022. After the HEAT Advisory group met in July, it was decided to develop an anti-oppression statement in lieu of an antii-racist statement to expand the scope of BFH’s equity commitment to include consideration of race/ethnicity, disability, and genderism. The next steps are to present the statement to OPH leadership for approval.

 

• Recommendation 2. Examination of the evaluation, promotion, and pay structures through an equity, diversity, and inclusion (EDI) lens as this is a major pain point contributing negatively to the employee experience and retention of talent. The OPH HEAT developed (October 2021 - September 2022) EDI recommendations that span the entire employee life cycle. This Employee Life Cycle Recommendations document aims to guide OPH leadership and human resources in creating and maintaining an affirming, inclusive, and welcoming work environment, and support the LDH Business Plan. The recommendations are divided into eight areas: Attract, Recruit, Interview, Hire, Onboard, Develop, Retain, and Separate; and includes three recommendations with 92 accompanying strategies or actions.

 

• Recommendation 3. Put additional resources into building out a more representative and diverse pipeline of candidates for leadership positions, and create the necessary structures and systems to grow, develop, and promote people from within teams and the institution broadly. There was no significant progress made against this recommendation in FFY2022. 

 

• Recommendation 4. Examination of current policies, procedures, and systems through an EDI lens. There was no significant progress made against this recommendation in FFY2022. 

 

• Recommendation 5. Ensure that EDI is integrated into all of BFH’s strategic plans with timelines and accountability measures for leadership team members. There was no significant progress made against this recommendation in FFY2022. 

 

• Recommendation 6. Provide professional development sessions for all system members that include understanding of EDI, identity and self-awareness, and ways in which this learning can be made tangible through application to daily work. After the Conscious Root’s Equity, Diversity, and Inclusion (EDI) series concluded, the recorded sessions were made available to all staff via BFH’s learning management system (LMS), Moodle. Although this training series has already occurred, learning opportunities are continuously being shared with staff to further their learning until we can proceed with future training.

 

• Recommendation 7. Offer formalized departmental/team/organizational mentoring programs where departments pair an experienced team member with a new team member; this can also be effectively implemented in a cross-departmental manner. BFH’s health equity coordinator did an environmental scan to learn what is happening around this recommendation. The coordinator found that OPH offers a mentoring program that pairs mentors and mentees based on strengths of mentor, interests of mentee, and desired outcomes. Both mentors and mentees have to apply. If anyone is not selected, they can reapply the following year.  

 

BFH currently uses an informal “buddy” system where new staff are matched with more tenured staff to support new staff during their onboarding process. Some managers pair new staff with tenured staff who share the same contract, who are on the same team, but different programs, different teams completely – staff selection depends on who the manager believes can best support the new staff member as they orient to BFH.

 

• Recommendation 8. Develop funding models that reallocate significant resources to support widespread organizational transformation. For example, every unit should allocate a percentage of total operating budget to a central fund that will be used to develop diversity programs and initiatives. There was no significant progress made against this recommendation in FFY2022. 

 

• Recommendation 9. Create a cohesive, consistent, and streamlined communication system where information is disseminated in a way that feels clear and accessible, and where all system employees feel informed. In May 2021, LDH purchased Monday.com as a project management software for staff to improve communication and information flow with projects and work plans. Licenses have been provided to staff members where it is relevant to their work.

 

A debrief session was also held for staff to provide feedback on their experience and what they would like to see in future training/workshops, as well as an internal communication survey was sent out to staff to understand how BFH can work to streamline its communication system. Questions centered around learning what information staff knew, what information staff find difficult to find, what staff think about current communication platforms, and what staff would like to know regarding health equity. Survey results will be used to guide future communication system work and will be used in the next health equity intern project.

 

Build workforce and partner capacity to promote health equity, anti-racism, and social justice: In FFY2022, BFH continued to invest in building workforce and partner capacity to promote health equity, anti-racism, and social justice. BFH’s approach to building a workforce dedicated to health equity and anti-racism is grounded in the promotion of Health and Racial Equity Core Competencies, which were initially defined in FFY2019 and reviewed in FFY2021. BFH facilitates a health equity orientation for staff bimonthly. At the end of orientation and via a follow-up email, staff are asked to complete a short survey for quality improvement. The orientation was updated in May of 2022 to reflect feedback provided by staff. BFH also has a HEAT newsletter that provides status updates on HEAT activities and information about particular health equity concepts. This newsletter was redesigned to also include updates from LDH health equity work and OPH HEAT.

 

The Communications team also facilitated presentations on equitable communications  for staff and partners. This presentation examined written and spoken language used to describe identity markers (age, gender, race/ethnicity, etc.) to share which words and sayings should be used and which ones should not be used due to negative connotations. The presentations were presented to BFH staff, and at the Women, Infants, and Children (WIC) virtual conference (May 2022) and the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Annual Education Event (March 2022).

Integrate health equity into legislative policy processes: BFH has increasingly been called upon by the legislature for subject-matter expertise, both during legislative sessions through testimony and talking points, and between sessions for policy development and implementation. To better prepare for time-sensitive requests received during legislative sessions, BFH began to proactively track relevant bills and legislative proceedings in 2016. The initial effort was spearheaded by the Title V coordinator and health systems strategy manager, whow were joined by the health equity coordinator in 2017. In 2018, the core team identified an opportunity to integrate the legislative tracking work into the HEAT policy action plan. This integration into the HEAT policy action plan had the mutual benefit of expanding the tracking capacity of the BFH team and increased bureau staff understanding of health equity legislation that was outside of the scope of BFH operations.  In the 2023 legislative session, nearly 20% of legislation tracked was health equity related. (See also the below report strategy: Provide high-level support to the legislatively-mandated commissions and action bodies under the purview of BFH to ensure compliance with their mandated requirements and maximize impact.)

 

In recent years, several high-profile incidents involving discrimination based on hairstyles and hair textures historically associated with race have prompted legislative action at both the state and federal levels. In the wake of increased national dialogue on the issue, legislation was proposed to protect persons from discrimination based on natural, protective, or cultural hairstyle. The BFH legislative tracking team monitored the proposed legislation. Through legislative updates that occurred on a weekly basis, the legislative policy coordinator presented updates on the progress of the legislation and its content. House Bill 1083, signed into law by the governor as Act 529, of the 2022 Regular Legislative Session of the Louisiana Legislature added “natural, protective, or cultural hairstyle” as a trait protected against discrimination in Louisiana. The integration of this topic into the list of BFH-tracked legislation prompted increased awareness amongst staff within the Bureau that the trait of "natural, protective, or cultural hairstyle" has been just one piece of a pattern of harassment for Black, Indigenous, People of Color (BIPOC) and contributed to larger conversations on systemic racism.

 

 

System Priority: Partner with families, youth, and communities at all levels of systems change

The 2020 Title V Needs Assessment highlighted the need to improve family and community engagement at all levels of systems change, regardless of the population of focus, and that a robust collaborative effort is needed to build BFH organizational capacity to support ethical, meaningful engagement. To promote accountability as BFH works to institutionalize family partnership as a foundational component of all systems change initiatives, Title V  introduced SPM 2: Organizational Commitment to Family Engagement in Systems Change for the FFY 2021-2025 cycle. SPM 2 utilizes the scoring criteria in the "Commitment" Domain of the Family Engagement in Systems Assessment Tool (FESAT) developed by Family Voices. Baseline and original targets for this measure were set by a group of Title V staff and family and youth partners from Families Helping Families (FHF) organizations.

 

Naming an Association of Maternal and Child Health Programs (AMCHP) family delegate:  After several gap years, BFH was pleased to identify a new AMCHP family delegate in FFY2022. The delegate has been an active member of multiple Bureau supported boards, commissions, and working groups and expressed interest to take a more formalized role to support the overall mission of the Bureau.  The delegate participated in the 2022 AMCHP Annual Conference.

 

Strengthening relationships with community based organizations: BFH worked to strengthen family partnership strategies through the collaborative project with the state’s family peer support organization, FHF. FHF organizations are independent non-profit, family-driven resource centers, located in every region of the state. The BFH-FHF project was launched during the COVID-19 pandemic to support expansion of FHFs capacity to serve all CYSHCN in their area, to ensure CYSHCN in the state had access to community level resource and referral services, and to build BFH’s capacity to engage and partner with community families to guide public health initiatives. Several successful initiatives have resulted from this partnership since its inception.  The FHF-BFH project supported both phases of the BFH Specialty Provider Landscape Assessment which surveyed pediatric specialty providers statewide. Lessons learned from this work continue to support Title V strategies. The BFH-FHF partnership also resulted in establishment of coordinated referral pathways between FHF and the Family Resource Center (FRC). Additionally, this partnership supported annual provider capacity building education workshops, which reached over 470 providers in FFY2022. As family engagement experts, FHF was also a valued thought partner as the Project SOAR (Screen Often and Accurately and Refer) team worked to operationalize the SOAR work plan. BFH looks forward to ongoing collaborative work with the FHF statewide network.

 

Piloting an innovative family engagement strategy through Project SOAR: To help build forward momentum, the decision was made to focus on piloting an innovative family partnership strategy within one BFH program. In FFY2022, Title V began testing a different approach to supporting family engagement, partnership, and leadership within the scope of a newly-funded Early Childhood Comprehensive Systems (ECCS) project entitled Project SOAR. Given the grant requirements to incorporate family partnership throughout the project, this grant presented an opportunity to operationalize and evaluate family partnership strategies within the scope of the early childhood systems project. SOAR keenly focuses on creating pathways for family participation and partnership within systems strengthening work.

 

Throughout FFY2022 the team focused on operationalizing work plans and putting processes and structures in place to implement SOAR using the Targeted Universalism (TU) equity framework. As part of initial project implementation, the team worked through the first step of TU and developed an aspirational, universal goal for SOAR. Goal setting was informed by the YCWC and grant TA providers. The Louisiana goal for Project SOAR reads, all children receive equitable, timely and accurate developmental screenings and follow-up; all pregnant and parenting caregivers receive equitable, timely and accurate perinatal depression screening and follow-up. 

 

Additional SOAR efforts focused on the core team and Young Child Wellness Collaborative (YCWC) learning and understanding the TU framework, resetting and building the capacity of the cross sector YCWC to serve as the advisory body for SOAR, and exploring best practices for engaging family partners and building family leaders. As part of the best practice exploration, the team completed key-informant interviews with internal and external partners that have content expertise in family engagement strategies. 

 

 

System Priority: Ensure Title V strategies are outcomes focused and rooted in essential public health services

This revised priority need builds off of the previous progress and work related to the 2015-2020 priority to ensure high performing essential MCH screening and surveillance systems. As described when introduced in the 2015 Needs Assessment Summary, the original priority need was intended to ensure Louisiana maintains robust screening and epidemiology capacity to monitor health and well-being, ensure timely individual and system-level follow up as needed, guide programs, and inform public policy that affect women, mothers, children inclusive of those with special health care needs, and families. The original priority need was rooted in the Essential Public Health Services of monitoring health, diagnosing and investigating health concerns, and evaluating the effectiveness, accessibility and quality of health services, and the revised version of this priority need is likewise rooted in the following proposed updated Essential Public Health Services:

• Assess and monitor health status, factors that influence health, needs, and assets to understand and improve population health and wellbeing;
• Diagnose, investigate, and address health problems and hazards affecting the population, including the identification of root causes.
• Communicate effectively to inform and educate people about health, including factors that influence it and how to improve it.
• Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement.

 

This revised priority captures the need for Title V strategies and investments to be outcomes-focused and able to demonstrate effectiveness. This has been an expressed need for several years, and it was one of the themes that inspired the reorganization and strategic planning overhaul of BFH. This theme was also at the center of the needs assessment process.

 

Ensure effective Title V communication strategies through the implementation of the Frameworks Institute approach to develop, test and use thematic frames and core stories:

Building internal communications capacity: At the time of the 2015 Needs Assessment, Title V had two dedicated communications staff to manage topic-specific health communications projects, web presence, and the mandated Title V resource hotline. Communications strategies were primarily focused on delivering messages to families to reduce infant mortality and were related to specific topics such as early prenatal care, preconception health, and safe infant sleep.

 

With LDH reorganization in 2016 and the subsequent merger of several programs into BFH, the capacity of the communications team was built out to support communications across all BFH teams. As the role of the BFH continued to evolve and focus turned towards reaching provider influencers and impacting systems and policy, communication strategies were subsequently designed to target providers, community stakeholders, and policy makers. In 2017, a new umbrella website, PartnersforFamilyHealth.org was built to reflect that shift. The Communications team began to support policy work, including writing policy briefs, talking points and legislatively mandated reports. The team also provided leadership in the development of select operational processes for the BFH, such as processes for working with the media, developing new communications products, and adding topics into a workflow for boards and commissions.

 

Shift towards strategic and effective health communications: As Title V grew its communications capacity over the past few years, BFH programs began to leverage communications strategies and products (webpages, fact sheets, one-pagers, postcards, talking points, reports, etc.) more frequently to motivate, empower, or persuade parents or providers to do something, or to do something differently. To accommodate demand, the communications team typically works with programs separately, on a project-by-project basis. Within programs, communications products build on one another. Across programs, however, messaging and distribution channels are not aligned, even when communication products are targeting the same audience and have similar communication objectives. Therefore, across BFH, agency communications can be fragmented and inconsistent, and may be confusing, overwhelming, or forgettable to users.

 

Despite increasing Title V investment in communications expertise, BFH does not have an evaluation mechanism in place to determine whether or not BFH communications products are effective in achieving their intended outcomes. BFH communications products are grounded in communications best practices to the fullest extent possible, but time, capacity, and resource restraints have limited BFH’s ability to consistently conduct audience-testing during and after product development.

 

In FFY2021, BFH Communications team began laying the groundwork to design a new strategic communications approach internally to ensure more effective Title V communication strategies and set the stage for robust communications evaluation. The proposed strategic communications strategy was based, in part, on the Frameworks Institute approach to develop, test and use thematic “frames'' and “core stories.” Through this evidence-based approach, core stories embed frame elements (values, metaphors, and explanatory chains) in a coherent narrative that reorients and restructures how Americans think about a complex issue. Developing and repeating frames and core stories will help establish messaging consistency across BFH. When organizations repeat messages to external audiences with a unified voice, these messages are amplified and more likely to reach a message saturation point. In FFY 2021, the communications team developed a step-by-step roadmap to transitioning BFH’s current processes to the new overarching communications strategy, outlining the specific workflow changes that would have to occur across the bureau.

 

FFY2022 brought many staff changes with the BFH Communications team. A new communications, strategy, and operations manager was hired and the team structure changed to assign one communications specialist to each of the three teams (data, clinical, and family) to help tie the messaging within each team more closely together. The team began creating a standardized process for how each member will be involved in working with programs to create materials from performing a needs assessment when communications needs arise through the final approval and distribution process. 

 

MCH toll-free hotline: In FFY2022, BFH hosted two interns through the Title V MCH Internship program. The intern project revolved around resource management and coordination across BFH with a specific focus on the mandated toll-free telephone number and website. At its core, the project was intended to support BFH’s continued responsible, effective stewardship of Title V funding. This project was directly related to two of our cross-cutting Title V priority needs for the FFY 2021-2025 strategic period: 1) Ensure equitable access to high-quality and coordinated clinical and support services and 2) Ensure Title V strategies are outcomes focused and rooted in essential public health services.

 

The internship was broken up into two phases. In the first phase, the interns documented and evaluated all of BFH’s current resources and referral activities. Interns conducted a SWOT analysis, interviewed staff, inventoried and reviewed documents, estimated effectiveness of resources, and synthesized major themes. In the second phase, interns researched best practices for resource management and referral. Interns reviewed what other states used, what other Louisiana entities used, and what was available overall. They synthesized the information and presented a summary of approaches that could improve the way BFH manages resources and referrals.

 

Based on their findings, the interns recommended transferring oversight of the current helpline contract with APA to WIC since the majority of calls are about WIC services. For BFH related work, they recommended using the FRC as a general helpline. The mandate does not require for the helpline to be 24/7 as initially believed, so the FRC can serve as the helpline during their hours of operation. Finally, they recommended using a centralized resource referral platform and provided research on FindHelp, UniteUs, Exceptional Lives, IRIS, VIA Link 211 and United Way 211.

 

Provide high-level support to the legislatively-mandated commissions and action bodies under the purview of BFH to ensure compliance with their mandated requirements and maximize impact:

Policy and governmental relations: As BFH elevated the quality of its data and communications products and strengthened relationships with boards and commissions, BFH has increasingly been called upon by the legislature for subject-matter expertise, both during legislative sessions through testimony and talking points, and between sessions for policy development and implementation. To better prepare for time-sensitive requests received during legislative sessions, BFH began to proactively track relevant bills and legislative proceedings in 2016. In addition to tracking legislation, the team coordinates responses to requests for talking points and helps prepare staff asked to testify as subject matter experts. To keep staff informed about relevant legislation that could impact MCH and CYSHCN populations, the team hosts regular legislative huddles and maintains a shareable tracking spreadsheet. In preparation for the 2020 legislative session, BFH established a new position, the legislative policy coordinator. Since then, the legislative policy coordinator has continued to define the protocols, procedures, and staff responsibilities during the legislative session and promoted the coordination of legislative and strategic policy initiatives whether during or between legislative sessions.

 

In FFY2022, BFH continued to increase staff capacity to administer Title V policy work by establishing a new position, the legislative and policy lead. As the manager of the Policy, Research, and Development section, the legislative and policy lead will oversee policy and legislative operations to ensure that BFH policy initiatives, legislative responses, and legislatively-required public bodies and other action bodies are guided by rigorous policy planning and evaluation methods, from research to partner engagement, review, approval, and implementation. BFH began the search to recruit and attract the legislative and policy lead in late FFY2022, with selection of the candidate anticipated in early FFY2023.

 

Boards and commissions support: In FFY2018, Title V began investing in a boards and commissions coordinator position to provide high-level support for ensuring that the legislatively mandated commissions and action bodies under the purview of BFH are cultivated to reach their potential. At the time the position was created, some of the boards and commissions had active membership with a defined scope and were actively engaged with meaningful systems-level change, but many did not. Since then, the boards and commissions coordinator has continued to define and support baseline standards for the bodies under the purview of BFH. This included an initial assessment of each body in accordance with mandated requirements, identification of areas requiring additional support to maintain compliance, and definition of individualized roadmaps for each group to achieve their optimum success.

 

In FFY2022, BFH continued to support 16 statewide public bodies (i.e., boards, commissions, councils) and two internally created action bodies serving as workgroups to make systems-level changes and propose policy changes. BFH staff provided technical expertise and a variety of administrative support functions, such as meeting facilitation and coordination of meeting logistics and minutes, communication with appointed members, and supporting the implementation of recommendations. While each board, commission, and council has a unique charge and responsibility, the boards and commissions coordinator has promoted the creation and implementation of uniform operating guidelines, streamlining robust processes to yield quality recommendations, and tracking significant accomplishments in a centralized hub in order to measure growth over time. Through identifying roadblocks and solidifying processes of quality improvement, these commission and action bodies are supported and encouraged to serve as effective change agents from cross-cutting angles.

 

A continued challenge in providing boards and commission support has been to fully equip staff in understanding and appropriately implementing public meetings to most effectively leverage the boards, commissions, and councils under BFH’s purview. In FFY2022, the boards and commissions coordinator established standard operating procedures for internal staff working closely with boards, commissions, and councils. Standard operating procedures, as well as additional resources regarding maintaining and storing public records and documents, were shared as part of the initial creation of a toolkit of information, processes, procedures, best practices, templates, and tools that will be continued to be developed through FFY2023 for staff working closely with boards, commissions, and councils. The goal of this toolkit is to have a centralized repository of information to provide staff with robust resources to optimize involvement and support the charges and goals of the 16 boards, commissions, and councils under BFH purview.

 

Legislative policy support: In preparation for the 2020 legislative session, BFH established a new position, the legislative policy coordinator. In FFY2022, the legislative policy coordinator served as a liaison between the legislative offices of the state and BFH to ensure that the programs within BFH had the opportunity to put forth legislation and provide expertise on legislation related to the work of BFH. A large part of the work included navigating politically-sensitive work, including but not limited to: newborn screening, sickle cell disease, policy monitoring, programmatic and population impact resulting from policies related to abortion and medical futility, economic policies for women and families, maternal mental health, maternal mortality,perinatal systems of care regulations (maternal levels of care, neonatal intensive care unit (NICU) levels of care, and free-standing birth centers), pregnancy and postpartum support (doulas, home visiting programs), and care coordination for children and youth with special healthcare needs and special populations.

 

Moreover, the legislative policy coordinator worked with BFH subject-matter experts, legislators, other policymakers, and community partners to produce legislative study commission reports assigned to BFH in FFY2022. House Concurrent Resolution (HCR) 94 of the 2022 Regular Legislative Sessions of the Louisiana Legislature, also known as the “Baby Bonds'' Study, requested that LDH and Department of Children and Family Services (DCFS) conduct a study regarding the potential establishment of a program to provide children born to low-to moderate- income parents with a trust that, at maturity, can be used for postsecondary education, the purchase of a home, or formation of a business. Senate Resolution 131 of the 2022 Regular Legislative Sessions of the Louisiana Legislature established the Study Commission on Maternal Health and Wellbeing, which was facilitated by the legislative policy coordinator. The purpose of this study commission was to identify findings and recommendations, together with specific proposals for legislation from the study commission that (1) identify and assess the functions and activities of existing state efforts and service systems focused on the health and wellbeing of individuals before, during, and after childbirth; and (2) seek ways to address a reduction of adverse maternal-health behaviors during pregnancy, dysfunctional infant caregiving, and stressful environmental conditions that interfere with parental and family functioning. Both reports will be due for submission to the respective entities and/or individuals named in the legislation in the second quarter of FFY2023. In addition to these mandatory reports, the legislative policy coordinator supported Title V initiatives through the monitoring of implementation for all other reports that BFH-affiliated boards, commissions, and councils are responsible for producing on an annual basis.

 

Develop and operationalize processes and templates to support BFH policy recommendations:

Advancing Title V health systems strategy: After significant advancement of its health systems strategy between FFY 2015-2019, BFH recognized the need to extend its strategy beyond a liaison and coordination role.  After the original health systems strategy (HSS) manager resigned, BFH onboarded a new HSS manager in FFY2020 who had previously worked in the private insurance sector and brought deep technical knowledge of insurance coding processes, financing structures and policies, and research practices. The new HSS manager utilized this skill set and experience to support the Bureau in creating a stronger integration between public health practices and research and health systems and services policy and research. In FFY2021, the HSS manager spearheaded several in-depth health systems research projects to help inform decision-making in high-priority areas, including reviews of Title V/Title XIX interagency agreements and MIECHV Medicaid financing structures across the country.

 

Another key charge of the HSS  anager position was to build Title V workforce capacity to understand and navigate health systems. In FFY2020, the HSS manager initiated a health systems strategy technical assistance (TA) workgroup. The new TA workgroup was designed to increase Title V workforce capacity to research, propose, and implement health systems strengthening initiatives. The TA workgroup supported BFH's transition from knowledge and understanding of health systems to having the capacity to act. In FFY2021, the HSS manager created strategy support toolkits, including frameworks for Medicaid research, health systems and services research, systems-level thinking and policy decision-making. These efforts have led to programs taking more ownership over their respective health systems initiatives.

 

In FFY2022, the HSS manager position transitioned to a new staff member and BFH leadership redeveloped the position again to expand the scope of BFH’s health systems strategy beyond the Title V/Title XIX partnership. Oversight of the HSS manager position also shifted from the SPACE team to the Clinical Services and Systems team. The new HSS manager focused on defining Louisiana Title V’s current and future role in supporting the overall health care delivery system. Based on their background in public health as well as health economics, their contributions have expanded into data-driven analyses and recommendations with the goal of increasing the efficiency and sustainability of Title V services. This work has been used to inform the strategic direction of the Title V clinical services within each level of the MCH pyramid. In FFY2022, the HSS manager conducted the third phase of the pediatric subspecialty landscape analysis (described in the CYSHCN narrative), and has contributed to other special studies in collaboration with programs and BFH leadership.