PROGRAM OVERVIEW:

The American Samoa Maternal and Child Health (ASMCH) Program under the Department of Health receives funding from the federal Health Resources and Services Administration (HRSA) Title V Block Grant, towards improving the lives and overall health of women and children, including children and youth with special health care needs in the territory. ASMCH is currently under the leadership of the Deputy Director, who reports to the Director of Public Health. An organizational chart is displayed in Figure 1.

Figure 1: American Samoa MCH Program Organizational Chart:

Needs Assessment Findings:

The ASMCH Title V Program continues to use the block grant logic model to guide the development of the 5-year program plan. From the initial year of the 5-year cycle, the needs assessment process is strategically done to gather information leading to priority needs on all MCH populations.  Throughout the year 2020, Title V program staff have been involved in various meetings, training, and informational discussions on issues that directly impact the health and wellness of women and children in the territory.  These opportunities provide a means for Title V to continue monitoring changes, progress, and challenges that occur throughout the year on selected priorities.  Stakeholders were given opportunities to provide feedback on selected program goals and objectives with reassurance of a continued process for annual review and revisions.

ASMCH Priority Needs and Emerging Needs:

The MCH Team and stakeholders identifies priority needs that are specific to American Samoa with distinct variations directly related to cultural, economic, and geographical challenges and expectations, but are very similar to the needs of women and children across the vast United States These needs range from improving healthcare early in a young woman’s life, before, during, and after pregnancy, to ensuring best health outcomes for children from newborn to adulthood. 

The Title V Program State Action Plan overall will generally remain as determined from the 2020 Needs Assessment process, with a few revisions due to the recent COVID-19 pandemic and its overall continued effect on the community and the healthcare system.  Although American Samoa has been successful so far in remaining COVID free since the pandemic started, there are still numerous significant matters that have prompted some minor reconsiderations to the Action Plan for the remaining four years of this cycle.  The State Action Plan will be revised accordingly to correspond with changes and challenges brought about with the COVID pandemic, as well as the input from Title V partners. 

Some of these adjustments will address challenges women and children, as well as children and youth with special needs, have had to endure throughout the year and onward due to the pandemic. These challenges include access to preventive healthcare during “shut-down” mode among the entire community, having an appropriate system in place for families to access necessary services during a pandemic or an island-wide emergency evacuation plan that is adopted by the community as a whole. Due to COVID-19, ASMCH has also begun initiating concepts that will teach clients how to engage in utilizing telehealth as an option during these challenging times to ensure continuity in care and wellness.

The ASMCH team has reviewed its Strategic Plan and has made revisions to accommodate changes brought about with the current pandemic. These revisions were made possible to enable the program to attain “low hanging fruits” and continue to sustain a momentum in improving health for pregnant women and women in general, as well as all children, adolescents, and those with special needs. These “low hanging fruits” are such things like strengthening partnerships with other existing programs in the community to address priority concerns in our strategic plan.  For example, while the territory was diligent in keeping its borders closed to COVID infection during 2020, the rate of teen suicide in the island was becoming a crisis.

In the course of one month, a total of eight suicides among young teenagers was recorded.  ASMCH sought for an AMCHP grant and applied, receiving funds to address suicide among teens and young adults in the territory.  These funds afforded equipment to set up a suicide hotline that is now housed and operated under DOH.  ASMCH also was able to purchase telehealth equipment for all high schools in the islands, both private and public, to connect at-risk students directly to available mental health professionals for counseling services.  This has also engaged non-profit organizations who work with this age group to collaborate with the local Department of Education and Department of Health to improve mental & behavioral services across the island for young people contemplating suicide.  To this day, all of ASMCH staff have been trained as operators for the suicide hotline and are confident to use this skill also in our daily work with our program clients. 

At the start of COVID-19 vaccine efforts, help was needed to make reminder phone calls to folks who were due for their second dose, and the ASMCH team stayed after hours to assist in making these calls.  While schedules for health centers were uncertain during a lengthy period in 2020, our family center partnered with another nonprofit, Parents of Children with Special Needs (PCSN), to provide computer courses for families of children with special needs so they can learn to create an email, use social media to connect and learn how to use zoom.  These classes lasted for almost an entire year, and ASMCH was able to support these efforts as they were presented.

Majority of the MCH services occur within the community health centers (Prenatal, Well Child, Primary Care Clinics). With Title V funds, some clinicians who are nurses, dental assistants, health educators are fully funded by the MCH Program to provide services and support at these health centers. MCH client navigators and case managers often visit families at their homes or in the community to further determine how the program can support their health needs. The local health agency influences and supports Title V priorities by integrating existing programmatic goals and objectives into existing services, influencing larger outcomes and more successful results. An example would be having a family access both well child and prenatal services at the community health center. These services are supported by not only ASMCH, but clients also have access from other DOH programs such as Tobacco/Diabetes Program, Breast & Cervical Cancer Program, other NCD programs and of course FQHC overall.  Each program targeting their own agenda and task while the family is able to access comprehensive care, a win-win situation for everyone involved.

Program Evaluation:  

ASMCH gathers input from stakeholders and community participants on the work that is provided and supported for women and children, as well as children with special needs and their families. Quarterly reports are submitted to the DOH office for leadership to review and provide feedback on the progress of the program and how the public is served through our objectives and efforts. There is a strong connection between the ASMCH program and its non-profit organization partners in the community, where consistent discussions and meetings occur to evaluate efforts that target our specific populations. ASMCH also attends various meetings and training where primary healthcare providers are present and can share their feedback, request for specific support, and provide valuable insight into healthcare improvements for our women and children. These are various ways that the ASMCH use to evaluate the work we are tasked to do throughout the year.