Utah’s Title V Maternal & Child Health Block Grant is administered by the Bureau of Maternal and Child Health (MCH) and Children with Special Health Care Needs (CSHCN) Bureau in the Division of Family Health Preparedness (DFHP) of the Utah Department of Health (UDOH) and lead the work of this grant. Utah’s MCH/CSHCN programs collaborate with other statewide agencies, Local Health Departments, community partners and stakeholders to implement strategies to move the needle for women, infants, children, adolescents and children with special health care needs. The 2020-2025 Title V priorities were selected based on the findings of the 2020 comprehensive statewide needs assessment process. National and State Performance measures serve as long-term goals for each priority area.
Five-Year MCH/CSHCN Needs Assessment
The 2020 Utah MCH/CSHCN Needs Assessment used a community-engagement approach to gather information from stakeholders. Components of the comprehensive Needs Assessment included data collection via surveys, key informant interviews, tribal consultation, and focus groups. Regional and statewide stakeholder meetings were held both in person and virtually with activities culminating in a MCH/CSHCN Stakeholder Summit. Over 3,000 people participated in the assessment process and included stakeholders and partners who are parents, caregivers, health service professionals, community organizations, public health professionals, and mental health professionals. Data gathered from this process was used to select state health priorities to achieve the best health outcomes for mothers, children, and families in Utah.
The input provided by stakeholders and members of the MCH/CSHCN populations allowed many different perspectives on community health issues and needs. This input played a critical role in figuring out the most effective state priorities and performance measures.
The Needs Assessment Summit resulted in the selection of ten state MCH/CSHCN priorities as the focus for Title V activities; seven National Performance Measures (NPM), and three State Performance Measures (SPM).
Title V Block Grant Implementation
Each NPM and SPM developed through the 2020 needs assessment process are assigned to a “core writer” who oversees the implementation/coordination of the evidence-based strategies identified for each measure. The core writer identifies partners who can collaborate on activities, tracks progress, writes reports of achievements, and plans for the future year of work. The evidence-based measures are based on best practices and emerging evidence. Title V funds are leveraged with other federal grants and state funding.
Priorities and Progress
Routine preventive care is key to health across the lifespan. A yearly preventive checkup is a time for a person to develop a trusting relationship with their health care provider. The preventive visit is an opportunity for health care providers screen for early detection and treatment of disease and illness and counsel people on their specific healthcare needs. MCH Staff provide health education on the importance of the well-woman preventive visit at health fairs, when feasible, and through social media outlets. The MCH Bureau has formed a Well-Woman Coalition to bring together community partners to work on the development of a Well-Woman strategic plan for Utah.
Postpartum depression is the most common complication of pregnancy. When a mother's mental health complications go undiagnosed, there are serious implications for her and her family. The MCH Bureau has worked on providing training for healthcare providers, home visitors, and community health workers on perinatal mental health and referral resources. Education to raise awareness among pregnant and postpartum women is provided through in-person events and social media platforms.
A mother’s ability to begin and continue breastfeeding can be influenced by a host of factors. Mothers who receive help and support when they need it are more likely to reach their breastfeeding goals. Utah offers support to hospitals to implement breastfeeding friendly practices through the “Stepping Up for Utah Babies” program. The Utah WIC program supports a breastfeeding peer counseling program for its participants. Staff in the Healthy Living through Environment, Policy, and Improved Clinical Care (EPICC) program work with employers to establish worksite lactation accommodations and adopt policies that comply with federal and state lactation laws.
Developmental screening is a critical element of well-child care and an important opportunity to engage families in the process of developmental health promotion. The screening process is used to determine if development skills are progressing as expected or if there is a delay in development and further evaluation is necessary. MCH staff works with medical providers to provide education, ongoing training and access to data systems on developmental screening to increase the number of children who receive a developmental screen.
When people feel connected with their communities, they may feel more inclined to participate in actions that help the community. As an upstream factor, it impacts multiple levels of social ecology. Connectedness encompasses both family connection and support, as well as community violence. It is a shared protective factor. Family meals are a way to increase connectedness in families. This connectedness is a protective factor for youth and onset of risky behaviors. Connectedness is a protective factor for reducing suicide. MCH and EPICC staff work to provide parent-youth communication programs.
The Utah Oral Health Program promotes oral health education and prevention, increases community awareness of the oral health needs in the state, and improves access to oral health care services. The Oral Health Program works with the Utah Medicaid program to increase the percentage of children enrolled in Medicaid who have preventive dental visits.
Bullying is the unwanted, aggressive behavior among school-aged children that involves a real or perceived power imbalance. Staff in MCH and the Violence and Injury Prevention Program (VIPP) collaborate to address the risk factors for bullying. These include family connectedness, evidence-based programs for mental health promotion/suicide prevention and economic stability. They work to offer parent education through a parent-youth communications program, provide bystander training to youth, positive youth development programs, and to encourage physical activity, which benefits adolescent mental health.
Students who participate in the school meal programs consume more milk, fruits, and vegetables during meal times and have better intake of certain nutrients, such as calcium and fiber, than nonparticipants. And, eating breakfast at school is associated with better attendance rates, fewer missed school days, and better test scores. School lunch is a proxy for economic stability. EPICC staff work to support education agencies with advancing the quality of school meals by participating in programs such as Farm to Fork, and educate families on how to receive free or reduced price breakfast/lunch in schools.
Children with Special Health Care Needs
The medical home model promotes high quality primary care that promotes coordination and partnership between the family, the patient, and health care and other service providers. Providers who understand and promote the medical home concept mark a well-functioning and coordinated system of care for CSHCN. CSHCN staff work to educate providers on the importance of providing care coordination as a component of the medical home and provide direct care coordination support to provider offices, their patients, and any CSHCN family who contacts us when needed.
Our goal related to youth to adulthood transition (12-18 years old) growing from adolescence to young adulthood is to support parents, guardians and empower adolescents during this period in life and educate them on the responsibilities of becoming an adult. Having a transition plan is critical in ensuring seamless transition to adult service providers and daily living responsibilities.
Utah CSHCN employees and stakeholders work on these educational activities to support our adolescents in the following ways: becoming independent and developing one’s self-identity; communicating in difficult relationships; determining if higher education (college or trade schools) is a personal goal; developing a safety net for the future (trusts, wills, banking accounts); housing and rent; and identifying the questions to ask and skills needed to transition to adult health care providers and physicians.
In Utah we have formed a collaborative effort with several major stakeholders to address these activities and share information in a uniform and or universal manner to facilitate learning and ease the system navigation process for the public we serve. We have four active strategy groups: curriculum; referral and follow-up; marketing; and quality assurance/improvement, which includes surveying providers and families to meet NPM 12.
Assuring Comprehensive, Coordinated, Family Centered Services
Utah places a high value on family centered partnerships, family feedback, and collaboration. An example includes the CSHCN Bureau’s partnership with Utah Family Voices. Utah Family Voices supports statewide family-centered care for all children and youth with special health care needs and/or disabilities.
The CSHCN Bureau has a CSHCN Advisory Committee composed of family members and individuals with special health care needs. This committee advises the Bureau on the family/parent perspective regarding issues, needs, and services, influences the direction of policies, contributes to program improvement, and ensures a voice for families and individuals with special health care needs to improve the system of care. CSHCN programs incorporate surveys to gather feedback from families to identify specific needs and future directions for meaningful services.
Title V Partnerships
The strength of MCH/CSHCN lies in the established and new partnerships that help expand the work of reaching women, infants, children, and families. Federal and non-federal funds are leveraged to deliver programs, services and create a statewide system of collaboration. Utah Title V partnerships include: health care systems (University of Utah, Intermountain Healthcare, Community Health Centers), non-profit agencies (YWCA, Utah Family Voices, Help Me Grow, Utah Parent Center, Utah Maternal Mental Health Policy Group), advisory groups (Newborn Screening, Utah Autism Initiative, CSHCN Advisory Committee, Newborn Hearing Screening and Transition/Medical Home stakeholder groups), and other public health systems and programs (Local Health Departments, Utah Indian Health Advisory Board, Home Visiting-MIECHV, Child Development).
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