Georgia’s Title V Maternal and Child Health (MCH) Program, in partnership with the US Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA), is responsible for promoting the health of all mothers and children, including children with special health care needs and their families. The Georgia Department of Public Health (DPH) MCH Section located in the Division of Health Promotion (HP) administers the MCH Services Title V Block Grant. HP includes the MCH Section, the Supplemental Program for Women, Infants, and Children (WIC), and the Georgia Oral Health Program. The Title V Program serves as the backbone of maternal and child health policy and program administration, providing the core public health system for women, children, children and youth with special health care needs (CYSHCN), and families serving the state’s 18 public health districts comprised of 159 counties.

The 2021 Application/2019 Annual Report provides an overview of MCH’s recent successes and achievements, as well as a summary of the Five-Year Needs Assessment. The needs assessment resulted in identifying priority areas and a five-year plan with objectives and strategies designed to meet those needs. MCH activities will continue to be coordinated across funding sources, state agencies, and local providers relying on partnerships, shared measurement, and data to track the impact and effectiveness of services, activities, and strategies. MCH will continue to address the goal of establishing a foundation of health early in life by investing in and fulfilling its commitment to improve the health of women, infants, and children, including those with special health care needs. In addition, DPH will continue to address social determinants of health and improve health equity.

In 2019, DPH achieved national accreditation through the Public Health Accreditation Board. The national accreditation program works to improve and protect the health of the public by advancing and transforming the quality and performance of health departments. Under the leadership of DPH Commissioner Dr. Kathleen Toomey, DPH continues its mission to prevent disease, injury and disability, promote health and well-being, and prepare for and respond to disasters.

MCH Advisory Council

During the reporting year, MCH assembled the MCH Advisory Council to provide support and guidance to the Title V program for the purpose of promoting and improving maternal and child health in Georgia. The Council convenes quarterly and brings together several organizations and groups with a broad range of expertise to address and improve health outcomes for women, infants, children, and families. The Council serves as a conduit for the exchange of information and advises on progress, facilitates private and public sector support for improving health outcomes and helps focus efforts among partners, recommends collaborative initiatives, and reviews existing and proposed Title V projects. Council members include representatives from state, local, non-profit, academic, health care, and professional organizations who have expertise in areas related to MCH, such as nursing, nutrition, parenting, pediatrics, family practice, child protection, family development, district and state health departments, and a parent/family member representative.

COVID-19

With the emergence of the COVID-19 pandemic, DPH is working closely with the Center for Disease Control (CDC) and state partners to respond to the outbreak. The goal is to quickly identify cases of COVID-19 and take the appropriate public health action to reduce its spread and protect the general public. MCH programs have developed responses to ensure continued and appropriate services.

Population needs and priorities

Across all MCH programs, implementation efforts include activities specific to health equity, community engagement, performance management, quality improvement and evaluation. Title V efforts are focused on health equity and are integral in assuring that populations experiencing the greatest health disparities receive equitable and needed services. Progress on each priority is outlined below:

Women/Maternal Health: Due to the critical need to reduce maternal mortality, MCH focused on efforts to impact this need. In 2011, the maternal mortality rate (MMR) was 28.7, which on average was four times higher in Black, non-Hispanic women (39.1 deaths per 100,000 live births) than White, non-Hispanic women (9.6 deaths per 100,000 live births). These staggering rates and the underlying racial and ethnic disparities served as the impetus for the creation of a statewide Maternal Mortality Review Committee (MMRC) in 2012. Coordinated by the Georgia Obstetrical and Gynecology Society (GaOBGYN) with funding provided by MCH, the committee reviews cases to determine causes of death, and provides recommendations for maternal mortality reduction. As of 2019, the MMRC has reviewed 349 maternal deaths in Georgia from 2012 to 2015. Of the 349 maternal deaths reviewed, 145 were determined to be pregnancy-related deaths. There were 28 pregnancy-related deaths per 100,000 live births. Two-thirds of pregnancy related deaths were determined to be preventable.

Perinatal/Infant Health: Infant mortality is the single leading indicator of the overall health and well-being of a population. In 2018, Georgia’s infant mortality rate (IMR), per 1,000 live births, was 7.1, compared to the national rate of 5.8. In the 2015 needs assessment, stakeholders identified infant mortality and the need to reduce maternal substance use as a state priority. The major evidence-based strategies recommended nationally for addressing infant mortality were regionalized perinatal care, safe sleep initiatives, and improving breastfeeding rates. In 2018, DPH launched an initiative to designate hospitals according to the appropriate level of maternal and neonatal care provided. DPH continues to develop strong partnerships around the coordination of Regional Perinatal Centers (RPC) by providing information and education to delivering facilities, staff, and women to ensure they deliver at the appropriate facility in instances where mother and baby may require specialized care. In 2018, the Neonatal Subcommittee of the Georgia Perinatal Quality Collaborative (GaPQC) developed a baseline survey for birthing hospitals to determine current practices around Neonatal Abstinence Syndrome (NAS) diagnosis and treatment and to explore gaps and opportunities for maternal interventions. Increasing breastfeeding rates and eliminating Sudden Unexplained Infant Deaths (SUID) are ongoing MCH initiatives which are integral parts of Georgia’s strategic plan to reduce infant mortality. Georgia has 16 baby-friendly designated birthing hospitals commited to creating a culture of breastfeeding. The Georgia Safe to Sleep initiative has 100 percent of the 77 birthing hospitals providing parents with safe infant sleep education prior to hospital discharge and 100 percent of hospitals reported having a safe infant sleep policy in place or in progress. To strengthen community awareness and involvement in reducing infant mortality, MCH developed the Improving Birth Outcomes Initiative to develop strategies to reduce premature births and infant mortality among all infants, and specifically black infants, by addressing the correlations between race, equity, infant mortality and pre-term birth.

Child Health: Promoting developmental screenings and physical activity were priorities for Child Health in the 2015 needs assessment. The Children 1st program facilitated trainings for the Ages and Stages Questionnaire (ASQ) developmental screening tool, developmental milestones, and Child Health Referral System to more than 2,300 staff from hospitals, public health programs, community organizations, daycare centers, head start programs and primary care offices. Addressing obesity requires a multi-level approach, involving both policies and activities in schools. In a partnership with the Georgia Department of Education (DOE), MCH works intensively on obesity prevention in elementary and early learning school settings. These efforts include the Georgia School Health and Physical Education (SHAPE) Network, which provides trainings and resources for school district staff and administrators on incorporating physical activity into daily school activities.

Adolescent Health: The Adolescent Health program addresses risk and protective factors for children ages 8-17 at the local, regional, and state levels and provides evidence-based and informed interventions and strategies to impact health outcomes. The Adolescent Health and Youth Development (AHYD) program aims to empower youth with the knowledge and skills to strengthen relationships, increase community awareness and engagement to solve adolescent related issues. SHAPE implements the Power Up for 30 (PU30) program in middle schools to increase physical activity.

Children and Youth with Special Health Care Needs (CYSHCN): CYSHCN priorities are to improve systems of care for CYSHCN with an emphasis on educating providers, families, and adolescents on the health care transition from pediatric to the adult care process as well as the expansion of DPH’s Telehealth infrastructure to support specialty clinic services. The Children’s Medical Services (CMS) Program partners with health care providers, state agencies, and community organizations to coordinate health care service and supports for eligible CYSHCN and their families. During the reporting period, 74% of transition aged youth in the program receive ongoing transition planning and preparation.

Cross-Cutting/Life Course: Oral health is a priority for MCH and a strategic focus to improving health outcomes for women, infants and children. The Oral Health program provides training to organizational stakeholders and provides services including fluoride varnish, dental sealants, prevention education and comprehensive restorative treatment. School-based prevention programs targeting high-risk children, teledentistry, and tobacco prevention programs to pregnant women are provided. Oral Health conducts training and presentations on best practices and the importance of oral health in all MCH domains at the local, state, and national levels.

Needs Assessment Summary

In accordance with MCHB guidance requiring states to conduct a needs assessment every five years, Georgia conducted a comprehensive needs assessment that included a thorough review of available quantitative data and collection of qualitative data among members of the community and key leaders in MCH. The needs assessment provided an opportunity to report on health status, identify priority health needs, adopt measures to monitor improvement, enhance partnerships and engage new partners for MCH programs across the state. Eight priority needs were identified:

Prevent Maternal Mortality

Maternal Mortality will be continued as a priority in the 2020 needs assessment. The MMRC has provided the state with rich data on factors leading to maternal death. The strategies implemented over the next five years to address this need will center around continuing MMRC activities to ensure that all maternal deaths are identified accurately. Promoting well-women visits and the use of Long Acting Reversable Contraceptives (LARC) for women of reproductive age will improve the overall health status of women before they enter pregnancy and prevent maternal death.

Prevent Infant Mortality

Preventing infant mortality will be continued as a priority in the 2020 needs assessment as Georgia’s infants continue to experience a higher rate of mortality than the national average. Efforts to strengthen appropriate perinatal care, breastfeeding and safe sleep practices will continue as new opportunities to create partnerships through a statewide infant mortality prevention group, improve community education and awareness, and expand qualitative and quantitative data collection efforts will be developed.

Promote Developmental Screenings Among Children

Developmental screenings will be continued as a priority in the 2020 needs assessment due to the continued need in Georgia. The assessment identified the importance of continuing the priority area to ensure continued access and design creative service delivery approaches that include online screening opportunities to improve access and expand reach.

Increase Bullying and Suicide Prevention

Bullying is an emerging need identified as a new priority in the 2020 needs assessment. Suicide is the second-leading cause of death behind unintentional injury for children ages 10-17 in Georgia. MCH will expand partnerships and fill an important gap in public health work being done to address this issue.

Increase the Number of Children With and Without Special Health Care Needs Who Have a Medical Home

The 2020 needs assessment identified the need to create the medical home priority due to the importance of a patient-centered medical home to provide accessible, comprehensive, family-centered, coordinated, and culturally effective medical care. It is advantageous for CSHCN as they require coordination of care between providers and this priority will help ensure continuity of care.  

Improve Systems of Care for CYSHCN

Georgia will continue working on the priority to improve the overall system of care for CYSHCN to ensure system navigation and service delivery. MCH will address all aspects of a well-functioning system for CYSHCN, with a focus on health care transition to adult care. MCH will focus on ensuring that all children in CMS, the state program for CYSHCN, have a satisfactory transition plan and are linked with a medical home prior to discharge from the program.

Promote Oral Health Among All Populations

Oral health continues to be identified as a priority affecting all populations. Increasing oral health care utilization during pregnancy can impact the likelihood that the child will receive appropriate oral health care. MCH will continue to promote oral health among all populations by continually supporting the community water fluoridation program and specifically focusing on outreach to pregnant women and children as well as providing oral health care and education to children and adolescents.

Increase Father Involvement Among All Populations

The 2020 needs assessment identified the need to create a priority to increase father involvement among all populations. Research shows that father involvement is important during the prenatal period and every stage in the growth and development of a child. Targeting approaches to best engage fathers can improve maternal and birth outcomes and provide a valuable contribution in helping children and families to thrive. Identifying this strategy as a priority will help ensure enhanced MCH involvement throughout this area.