- Improve preterm, low-birthweight, and pregnancy outcomes
- Promote breastfeeding to ensure better health for infants and children
- Promote safe and healthy infant sleep behaviors and environments, including improving support systems and daily living conditions
- Increase the percent of infants and children receiving a developmental screening
- Reduce the burden of injury among children
- Decrease the prevalence of childhood and adolescent obesity
- Improve access to health care for women, specifically women who face significant barriers to better health, to improve preconception health
- Increase the number of adolescents with and without special health care needs who successfully transition to adult health care
The ADH conducted needs assessments for Title V and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) grant programs during 2019 and 2020. Findings from those assessments informed the selection of priority needs, strategies, objectives, and measures in the state’s 2021-2025 Title V action plan. Arkansas used a mixed-methods approach, which allowed the state to gather information from local, state, and national sources as well as internal colleagues and external partners. In-person stakeholder meetings, surveys, and virtual domain meetings comprised the methods of assessment strategies. These strategies also ensured continued engagement of stakeholders in the planning, implementation, and evaluation processes. Arkansas’s MCH epidemiologist worked with Arkansas State Systems Development Initiative (SSDI) staff to provide data to measure progress and inform decision making around program objectives and measures. In 2020, the Arkansas Title V staff established domain-specific working groups. Each group is made up of stakeholders with lived experience, professional expertise, and/or community leadership and engagement skills who serve in an advisory capacity to the Arkansas Title V team.
Arkansas identified 15 areas of concern, 11 of which align with national performance measures. The national priorities are well woman care, neonatal care for low birthweight infants, breastfeeding, infant safe sleep, developmental screening, child injury, physical activity among children and adolescents, bullying, transition to adult care for children with and without special health care needs, and oral health during pregnancy. The state-specific priorities are newborn hearing screening, adolescent nicotine use, the health care system for children with special health care needs, and implicit bias in public health systems. An overview of Arkansas’s Title V MCH needs, including emerging needs, gaps in services, program capacity, and internal and external partners for each domain is outlined below.
Women/Maternal Health. Mental health was a constant survey theme for this group. Among 53 participants responding to this question, nearly half (49%) cited mental health services as one of the three most important gaps in women’s health. Mental health disorders were listed as fourth most important for Arkansas women. Other important gaps in services for women were the availability of health care providers (32%), transportation (30%), and illicit or other drug abuse prevention programs (30%).
Perinatal/Infant Health Domain. Almost half (47%) of the 49 participants responding said availability of transportation was an important gap in the state for perinatal and infant health. Almost two-thirds (60%) of respondents said they would like to see new strategies or interventions for making transportation more available. A lack of health care providers and specialty care compounds the problem, particularly in rural areas. Survey participants offered the following suggestions for improving access to breastfeeding support and care: provide more access to lactation experts in communities, provide additional access to lactation experts beyond telephone services, provide special group clinics with a nutritionist to assist new mothers in breastfeeding, provide more support and incentives to breastfeeding mothers, expand the ADH’s breastfeeding program, provide better outreach for breastfeeding programs with local providers and hospitals, and educate hospital nurses on how to encourage new mothers to breastfeed.
Child Health Domain. Developmental and behavior disorders (57%) ranked as the most important public health problem by respondents. Almost half (48%) of respondents reported that an existing strategy or intervention was in place for the children they serve, yet one-fifth (21%) of respondents indicated that developmental monitoring and screening was one of the top three areas where gaps existed. Childhood obesity and overweight (52%) and related risk factors such as physical inactivity (34%) and poor nutrition (32%) ranked as the second, third, and fourth most important public health problems among Arkansas children. Partners included the Arkansas School Health Team, with members from the ADH and the Division of Elementary and Secondary Education (DESE) of the Arkansas Department of Education (ADE). This team provides training, programs, and resources to reduce childhood obesity and address behavioral health needs.
Adolescent Health Domain. Overweight and obesity was recognized as the most important public health problem facing adolescents (55%). Compared to children, fewer respondents believed that key strategies or interventions existed for physical health education (32.6%) and nutrition education (27.9%). Tobacco use including vaping (48%) ranked second most important. Use of electronic vapor products has been on the rise in Arkansas and across the nation. Partners include the Arkansas School Health Team and the ADH Tobacco Prevention and Cessation Program (TPCP).
Children with Special Health Care Needs (CSHCN) Domain. For CSHCN, availability of transportation was cited as the most important public health need (50%). One-fourth (24.4%) of respondents said key strategies or interventions were in place. Families have difficulty understanding, accessing, and navigating the health system for CSHCN, including Medicaid and other financial assistance, technological issues including internet access, accessing available specialists and services, and finding respite care.
Arkansas selected the following eight priorities that align with the Title V purpose and legislative mandate:
1. Coordinated, comprehensive preventive care and services for women age 18-44
2. Perinatal services and programs that support optimal birth outcomes and infant health
3. Developmental and mental for children
4. Prevention of maltreatment among children ages 0 through 9
5. Reduction of obesity among children and adolescents
6. Access to care for adolescents and children with special health care needs
7. Transition to adult health care for transition-aged children (ages 12 through 17) with and without special health care needs
8. Preventive oral health care for pregnant women
Arkansas selected the following 11 National Performance Measures (NPM) that most closely align with the priorities:
- NPM 1: Percent of women, ages 18 through 44, with a preventive medical visit in the past year
- NPM 3: Percent of very low birthweight infants born in a hospital with a Level III+ neonatal intensive care unit
- NPM 4: a) Percent of infants ever breastfed and b) Percent of infants breastfed exclusively through six months
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NPM 5: a) Percent of infants placed to sleep on their backs, b) Percent of infants placed to sleep on a separate approved sleep surface, and
c) Percent of infants placed to sleep without soft objects or loose bedding - NPM 6: Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year
- NPM 7.1: Rate of hospitalization for non-fatal injury per 100,000 children, ages 0 through 9
- NPM 8.1: Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day
- NPM 8.2: Percent of adolescents, ages 12 through 17, who are physically active at least 60 minutes per day
- NPM 9: Percent of adolescents, ages 12 through 17, who were bullied
- NPM 12: Percent of adolescents with and without special health care needs, ages 12 through 17, who received services necessary to make transitions to adult health care
- NPM 13.1: Percent of women who had a preventive dental visit during pregnancy
Arkansas also selected the following four State Performance Measures (SPM) to monitor progress with state priority needs not specifically addressed by an NPM:
- SPM 1: Percent of newborns with timely follow-up of a filed hearing screening
- SPM 2: Percent of youth, grades 9 through 12, who report using nicotine products
- SPM 3: Percent of families with children with special health care needs served by Title V CSHCN who report that their child received the health care services needed
- SPM 4: Percent of Family Health Branch, Arkansas Home Visiting Program, and Title V CSHCN staff who complete an equity training
The MCH program is supported by a variety of state and federal funding sources. The federal-state Title V partnership budget totals $28,032,881 for fiscal year 2022 (federal funds: $6,961,610 and state funds: $21,071,271). Maternal and Child Health Block Grant (MCHBG) funds contribute to portions of program management positions responsible for planning, oversight, and strategic work to improve public health systems. These programs strive to ensure women and children receive the health benefits they are entitled to, including preventive health services and screening, to promote the importance of coordinated care, and to address issues of health equity. As a quality improvement initiative, Title V staff are currently analyzing the effort, effectiveness, and impact of work to improve public health policies and processes.
KEY STRATEGIES
Women/Maternal Health
- Review medical record data reports for rates of preventive health services for women, ages 18 through 44, provided in local health units
- Provide education and counseling on dental health to all women attending ADH maternity clinics
Perinatal/Infant Health
- Encourage hospitals to voluntarily participate in surveys to determine the level of nursery/neonatal intensive care unit they provide
- Provide breastfeeding education and support to women enrolled in Arkansas’s Women, Infants, and Children (WIC) Program
Child Health
- Increase awareness of the importance of developmental screening through an education campaign to promote use of the Learn the Signs, Act Early Program
- Identify and teach parenting skills to parents in home visiting programs
- Identify and teach physical activity standards to school personnel to improve health norms in student populations
- Increase community collaborations statewide by providing professional development about physical activity to schools
- Provide bullying/suicide prevention presentations statewide
- Implement Student Wellness Advocacy Groups (SWAG) to engage youth in student-led activities that improve health norms in student populations, their families, and their communities
- Conduct health care transition training for public school personnel and use pre- and post-test results to improve training and evaluate increases in knowledge
CSHCN
- Partner with key stakeholders and referral sources to encourage understanding and use of a planned, structured approach to health care transition
- Prepare youth, age 12 through 17, and their families for health care transition
- Work with families to use formal and informal resources and supports to identify needs and to achieve family-identified goals for children
The Title V Program’s nurse care coordinators work with families to develop family-centered plans to reach priority goals for CSHCN and their families. Nurse care coordinators coordinate support and services for eligible families through collaborative partnerships with programs and related agencies. In a current statewide initiative, the program partners with Arkansas Part C (the state’s birth-to-3 early intervention program) and Following Baby Back Home (a MIECHV program for at-risk infants and toddlers) to assist families to help their children learn, grow, and develop. In a birth-to-age-5 pilot initiative, the program partners with Arkansas Part C, Early Head Start and Head Start, and the local education agencies to support transitions from early intervention to early childhood special education. This initiative ensures that school personnel and preschool home visitors know how and when to refer CSHCN and their families who might benefit from care coordination and other support through Title V. Partnerships with related agencies around common goals ensure coordinated, comprehensive services to assist families in reaching their goals for their children.
Arkansas continues to refine the focus of objectives and strategies to shape organized, logical, evidence-based approaches to achieve outcomes. Progress on each priority is outlined in the annual update section of the MCHBG application by MCH population domain. CSHCN is in the early stages of implementation of evidence-based strategies and can be identified as an ongoing challenge in improved outcomes. The Title V nurse care coordination program has identified promising strategies to include in the plan revision.
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