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 Maternal and Child Health Services Title V 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
- State Dental Program
- Alabama Childhood Lead Poisoning Prevention Program
- Adolescent Pregnancy Prevention Branch
- Alabama’s Early Intervention System
- Vocational Rehabilitation Service
- 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.
Coronavirus Disease 2019 (COVID-19)
The operations and services of ADPH, ADRS, and their partners continued to be greatly impacted by COVID-19 throughout 2020. While many public and private offices and businesses transitioned to proving services through virtual applications, the state has experienced staff shortages, and meeting, training, and program cancellations, closure of healthcare clinics, and postponed medical, mental, behavioral, and dental services. Alabama Title V continues 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 worldwide response evolve.
COVID-19 presented unanticipated challenges for CRS. In response to the Governor’s mandates, CRS operated most of the second quarter of FY 2020 with a hybrid of on-site service delivery, teleworking, and telemedicine. CRS’ priority was ensuring that families with CYSHCN and staff were staying safe and healthy. On May 1, 2020, CRS District Office and State Office staff returned to on site work. On May 4, 2020, CRS clinics resumed operations per guidance provided through the CRS Re-Open Task Force and CDC.
CRS staff members continue to ensure CYSHCN and their families receive high quality services in their local communities while identifying resources for families to address issues created by the impacts of COVID-19. Our mission has always been to provide quality clinical services to CYSHCN and their families and we were able to continue meeting their needs even during a time of extreme limitations.
Needs Assessments for Alabama’s Title V program are collaboratively conducted by ADPH and ADRS, through FHS and CRS, respectively. FHS’ tasks pertained to assessing needs of infants, children and youth, women of childbearing age, and their families. CRS’ activities focused on assessing needs of CYSHCN and their families. 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.
ADPH Highlights
The following information is a summary of 2015-2020 priority needs, strategies and accomplishments. See section III.E.2.c. State Action Plan Narrative by Domain for additional information.
Accomplishments
The Well Woman Program enrolled 371 participants in the program and 361 patients were seen in the colposcopy clinic, despite delays and complications due to COVID-19.
The State Dental Program’s FY2019 FY fluoridation awards went to 109 wells and plants per CDC standards and guidelines—a 21% increase over the previous year. The FY2020 FY fluoridation awards will go to 121 wells and plants per CDC standards and guidelines—a 10% increase over 2019. The program partnered with the City of Troy (Alabama) and the Alabama Department of Emergency (ADEM) Management to host its first ever Oral Health and Community Water Fluoridation Conference. The conference was held in October 2020 using a virtual platform and provided four free CE hours to 187 water plant operators. State dental directors and college instructors were also among the diverse group of attendees. Representatives from CDC, the National Fluoridation Society, City of Troy, and Hand Aqua Products presented at the conference.
SPP continued to provide cribs. SPP staff and partners continued to review maternal, fetal and infant mortality cases, and implement plans of action to address identified needs. SPP was a member of the core leadership team on the Project Harnessing, Opportunity for Positive, Equitable early childhood development (Project HOPE), which provided aid to children and families in Montgomery and Macon counties through the purchase of cloth masks, bottles of hand sanitizer, Chromebooks, Amazon Fire tablets, and Teach My Learning kits.
County Health Departments
In November of 2019 Alabama Title V leadership worked with the ADPH district administrators to identify and train six district MCH coordinators, whose roles would be to manage the replication of evidence-based central office programs in their local communities. ADPH also worked with program coordinators at the Jefferson County Department of Health (JCDH) and Mobile County Health Department (MCHD) to expand their community evidence-based programs. District projects were designed to focus on counties with adverse health outcomes in an effort to reduce the health disparities in our state. For FY20 the ADPH, MCHD, and JCDH coordinators designed projects that focused on access to oral health care, expansion of the Well Woman services, safe sleep outreach and education, infant injury prevention, increasing EPSDT visits, and suicide prevention. COVID-19 caused numerous disruptions and delays during FY 2020.
CRS
CRS’ mission embodies the principles of comprehensive, community-based, and family-centered care. The mission of CRS is to enable children and youth with special health care needs 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 service 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 (FVA/F2F HIC). Coordinated health services are delivered via 14 community-based clinics across eight service districts.
CSHCN Needs
The state priority needs, selected for 2021-2025, are as follows: lack of or inadequate supports for transition to all aspects of adulthood; lack of or inadequate access to health and related services, especially in rural areas and for services identified as difficult to obtain; and increases in family and youth involvement and participation in advisory groups, program development, policy-making, and system-building activities. Public/private partnerships, including agreements with the state's two tertiary-level pediatric hospitals, will enable CRS to bridge gaps in the system of care, thereby increasing the state's capacity to address the health, social, and educational needs of Children with Special Health Care Needs (CSHCN).
CRS Highlights
The following information is a summary of 2015-2020 priority needs, strategies, and accomplishments. See section III.E.2.c. State Action Plan Narrative by Domain CSHCN Annual Report for additional information.
The CRS State Care Coordination Program Specialist convened a group of CRS staff members that included Care Coordinators, Social Work Specialists, Physical Therapists, Computer Services, Nurses, and State Office Staff including the State Parent Consultant to focus on improving the Comprehensive Plan of Care (CPoC). Major changes that resulted from the workgroup include allowing a multidisciplinary team to document in the CPoC and automatically send the plan of care to the child’s medical home.
CRS had 54 YSHCN participate in Teen Transition Clinic (TTC). This number was a 29 percent increase from FY 2019. The increase is attributed to more CRS clients and their families being educated about TTC, consistent use of transition readiness assessments, development of transition plans of care, and access to additional evaluation resources. TTC is a specialized clinic that helps YSHCN make the transition to adult life. There are five TTCs located throughout the state.
CRS collaborated with Family Voices of Alabama (FVA) as part of the Collaborative Improvement and Innovation Network to Advance Care for Children with Medical Complexity (CMC CoIIN) project to provide individuals participating in the CMC CoIIN a FVA Care Notebook. Recognizing the importance of empowering families to communicate with healthcare providers and health related professionals FVA developed the Care Notebook. It is designed to help parents/caregivers maintain an ongoing record of a child's care, services, providers, and notes.
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