The Alabama Department of Public Health (ADPH) is the primary state health agency for the state of Alabama, operating with the mission to promote, protect, and improve Alabama’s health. Public health functions are shared by state and local offices using a three-pronged system. Statewide programs are coordinated through the central office; the eight public health districts have the responsibility for delivering public health services and programs specific to the needs of their designated areas; and on the local level, the 66 county health departments (CHD) work to preserve, protect, and enhance the general health and environment of their individual communities. 

ADPH’s Bureau of Family Health Services (FHS), located in the central office, administers the Title V Maternal and Child Health Services Block Grant Program. ADPH contracts with Children’s Rehabilitation Service (CRS), a division of the Alabama Department of Rehabilitation Services (ADRS), to administer services to children and youth with special health care needs (CYSHCN). Other divisions and programs administered by FHS and ADRS include:

• Title X Family Planning Grant
• Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
• State Perinatal Program (SPP)
• Healthy Childcare Alabama Program
• Cancer Prevention and Control Division
• Pregnancy Risk Assessment Monitoring System (PRAMS) Program
• Oral Health Office (OHO)
• Alabama Childhood Lead Poisoning Prevention Program (ACLPPP)
• Adolescent Pregnancy Prevention Branch
• Alabama’s Early Intervention System
• Vocational Rehabilitation Service (VRS)
• State of Alabama Independent Living Service

FHS is also home to the MCH Epidemiology Branch which pairs an analytical staff member with programs within the bureau to provide data tracking and reporting support. Title V utilizes several epi staff to support the implementation, monitoring, and evaluation of Title V strategies. Furthermore, Alabama Title V program staff collaborate with other ADPH and ADRS staff and with a variety of local, state, and federal stakeholders in order to assess the magnitude of factors impacting the state of health of Alabama’s MCH population. Program staff rely on these partnerships to prioritize population health needs and create methods of addressing current and emerging needs.

MCH Needs

Needs Assessments for Alabama’s Title V program are collaboratively conducted by ADPH and ADRS, through FHS and CRS, respectively. The goals of the assessment and related key tasks comprised the framework for the statewide needs assessment. An analysis of quantitative and qualitative data gathered through paper and web-based surveys, focus groups, key informant interviews, and from select databases and national surveys yielded a variety of issues for the population health domains. After convening advisory committee meetings, national priority areas and state needs were identified. The operations and services of ADPH, ADRS, and their partners continued to be impacted by Coronavirus Disease 2019 (COVID-19) throughout 2021.

ADPH Highlights

The following information is a summary of 2021-2025 priority needs, strategies, and accomplishments. See section III.E.2.c. State Action Plan Narrative by Domain for additional information.

The Well Woman Program enrolled 268 new participants. Thirteen percent enrolled with a BMI >25 (overweight); 78% enrolled with a BMI >30 (obese); and 42% showed a decrease in BMI from enrollment to their second appointment.

ADPH’s Oral Health Coordinator acquired her certification as a Community Dental Health Coordinator (CDHC), becoming one of eight in the state. As a registered dental hygienist and CDHC, she is poised to hold a unique position where she will be allowed to perform certain teledentistry procedures according to protocol and guidelines currently being developed by the Board of Dental Examiners.

OHO conducted screenings for 7,478 children in Pre-K, Head Start, kindergarten, and third grade.

SPP continued to provide cribs. SPP staff and partners continued to review maternal, fetal, and infant mortality cases.

The number of children less than 18 years of age receiving at least one blood lead level (BLL) screening was 37,857 in 2020. Preliminary data from the year 2021 shows an upward trend (40,816) toward pre-COVID-19 numbers.

ADPH staff participated in Alabama’s first Remote Area Medical Clinic (RAM) event in April of 2022. The RAM event was originally scheduled for 2021 but had to be postponed due to COVID-19. A total of 612 unique patients were served, with many of those receiving two services during their visit, totaling $337,324 in free health care such as medical, vision, and dental services.

Public Health District Initiative

In November of 2019, Alabama Title V leadership initiated a plan to transform our population health efforts. Title V staff worked with the ADPH district administrators to identify and train district MCH coordinators, whose roles would be to manage the replication of evidence-based central office programs in their CHDs and local communities. ADPH also worked with program coordinators in the Jefferson County Department of Health (JCDH) and Mobile County Health Department (MCHD) to expand their community evidence-based programs. The projects were designed to focus on counties with adverse health outcomes in an effort to reduce the health disparities in our state. For FY21, the ADPH, MCHD, and JCDH coordinators designed projects that focused on access to oral health care, preconception and interconception care, safe sleep outreach and education, infant injury prevention, increasing EPSDT visits, and suicide prevention. In spite of numerous disruptions and delays due to COVID-19 and hiring difficulties, the coordinators found success.

• A total of 245 youth and adults participated in suicide prevention trainings.
• A total of 7,467 WIC participants were screened for oral health needs. Of those screened, 3,852 were referred for dental services and a total of 760 children received dental exams.
• Between October 2020 and September 2021, From Day One enrolled 46 new pregnant women and hosted four baby safety showers providing 54 maternity clients with injury prevention education and infant supplies and safety items. 
• Under the guidance of the Office of Performance Management within ADPH’s Bureau of Prevention, Promotion, and Support (BPPS), district MCH coordinators began Quality Improvement (QI) training and initiated QI projects to improve the implementation of their district MCH projects.  

CRS

CRS’ mission embodies the principles of comprehensive, community-based, and family-centered care. The mission of CRS is to enable CYSHCN and adults with hemophilia to achieve their maximum potential within a community-based, culturally competent, family-centered, comprehensive, coordinated system of services.

CRS continues to operate seven programs to serve CYSHCN and their families. Services provided in each of these programs are funded in full or in part by Title V funds. The seven programs are: Clinical Medical; Clinical Evaluation; Hemophilia; Care Coordination; Information and Referral; Parent Connection; and Youth Connection. Family engagement is supported in partnership with Family Voices of Alabama (FVA) and the Family to Family Health Information Center (F2F HIC). Coordinated health services are delivered via 14 community-based offices across eight service districts. Through statewide partnerships with various entities and agreements with the state's two tertiary-level pediatric hospitals, CRS continues to bridge gaps in the system of care for CYSHCN and their families. These partnerships increase the state's capacity to address the health, social, and educational needs of CYSHCN.

CRS Highlights

The following information is a summary of 2021-2025 priority needs, strategies, and accomplishments. See section III.E.2.c. State Action Plan Narrative by Domain for additional information. The performance measures to address the CSHCN priority needs are outlined below:

CRS is committed to creating a culture of continuous quality improvement to improve service delivery for CYSHCN and their families and has incorporated quality improvement throughout the activities and approaches in the Children with Special Health Care Needs (CSHCN) State Action Plan.

CRS, in collaboration with the University of Alabama at Birmingham (UAB) School of Public Health (SOPH), Department of Health Care Organization and Policy, Applied Evaluation and Assessment Collaborative (AEAC), designed a Transition Survey and a Care Coordination Family Survey. AEAC will provide CRS with detailed reports from the survey data and CRS will utilize the data to identify areas for improving service delivery.

CRS continued to strengthen its partnership with the UAB Staging Transition for Every Patient (STEP) Medical Clinic. STEP clinic facilitates transition of care for patients with chronic/complex diseases of childhood as they are preparing to exit the Children’s of Alabama system for the adult model of care at UAB. CRS staff participate in the STEP clinic providing a link between UAB physicians and ADRS programs across the state, supporting a continuation of care for transitioning young adults with complex medical needs previously unavailable for this population.

Utilizing the National Family Voices Family Engagement in Systems Assessment Tool (FESAT), all CRS district offices implemented a Family Engagement Quality Improvement Initiative to strengthen family engagement. In addition, the CRS State Parent Consultant (SPC) and local parent consultants collaborated with Family Voices of Alabama (FVA) to offer Family Connections webinars designed for families to learn about topics related to caring for CYSHCN.

Coronavirus Disease 2019

Due to COVID-19, many public and private offices and businesses transitioned to providing services through virtual applications, the state experienced staff shortages, meeting, training and program cancellations, closures of healthcare clinics, and postponed medical, mental, behavioral, and dental services. Alabama Title V continued to seek guidance from our funders and partners, discover new best practices implemented by our fellow HRSA grantees, and implement new policies and protocols as the pandemic and the response evolved.

CRS staff members continued to ensure CYSHCN, and their families receive high quality services in their local communities while identifying resources for families to address the ongoing impacts of COVID-19. These impacts included compromised learning as a result of virtual school and challenges related to returning to in person learning, disruption to health care due to hesitancy to seek in person care, along with social and economic impacts. CRS care coordinators continue to link CYSHCN and their families to resources that may mitigate some of the long-term effects of the pandemic. CRS staff continue safety practices including wearing Personal Protective Equipment (PPE), utilizing screening procedures, managing waiting areas, and limiting the number of individuals that could accompany the child to clinic. Parents and caregivers provided feedback that these continued measures increase their confidence in bringing their CYSHCN to CRS offices.