Live Healthy South Carolina is a collaborative process led by the Alliance for a Healthier South Carolina (Alliance). The alliance represents a diverse group of more than 50 state and community leaders and organizations, including the SC Dept. of Health and Environmental Control (DHEC). SC’s first comprehensive state health assessment (SHA) and state health improvement plan (SHIP) were created through this initiative and were implemented in October 2018. The SHA and SHIP can be found on the Live Healthy SC webpage: https://www.livehealthysc.com/.
State Health Assessment:
The state health assessment (SHA) is a description of the health status of South Carolinians and was used to inform South Carolina’s 2018- 2023 State Health Improvement Plan. It also provides organizations and individuals access to a comprehensive compilation of state-level data in one location. The Alliance for a Healthier South Carolina (Alliance) led the development of the SHA, and two member organizations provided key support, DHEC and the South Carolina Office of Rural Health (SCORH).
Under the leadership of the Alliance, partners met to review data and consider additional data sources. The SHA includes qualitative and quantitative data from a variety of sources. Demographics, health outcomes and factors that affect health, for example, individuals’ health behaviors, community characteristics, the environment, and access to care, are presented. When available, 10-year trends and comparisons at a regional or national level are shown. Indicators addressing access to social and economic opportunities where South Carolinians live, work, learn, and play are also included to further investigate underlying causes of health disparities and health inequities. An effort was made to also include comparisons to the U.S. Department of Health and Human Services’ Healthy People 2020 (HP 2020) targets. Healthy People has provided science-based 10-year national objectives for improving the health of all Americans since 1979. The program establishes benchmarks, monitors progress over time to encourage collaborations across communities and sectors, and measures the impact of prevention activities. HP 2020 objectives are measurable and applicable at the national, state and local levels. Using HP 2020 provides the opportunity to track South Carolina’s progress towards the HP 2020 goals.
State Health Improvement Plan:
In addition to the development of the SHA, an activity called “Decision Walk Using Data” was used to present data from the South Carolina Office of Rural Health’s Rural Health Action Plan and the SHA to inform, educate, and engage stakeholders in a robust discussion about health outcomes in South Carolina. This was conducted three times between October 2017 and January 2018. The Alliance for a Healthier South Carolina (Alliance) and other community organizations participated. Additionally, in January 2018, a modified SWOT analysis called “Forces of Change” was conducted by the Alliance members to identify issues affecting the state’s health.
These activities led to the implementation of the first-ever 2018-2023 South Carolina State Health Improvement Plan (SHIP). The group utilized the Hanlon method to vote on priorities and narrowed the results to five priority areas:
1. Resilient Children (Adverse Childhood Experiences, Trauma and Resilience)
2. Chronic Health Conditions (Obesity, Hypertension, Heart Disease, Stroke and Diabetes)
3. Behavioral Health (Mental Health and Substance Use Disorders)
4. Health Care Transformation (Access to Care, Workforce and Integrated Health Care)
5. Factors that Affect Health (Social Determinants of Health and Health Disparities)
The seven SHIP objectives selected to address these first three priority areas include:
- Decrease the rate of nonfatal child maltreatment from 15.8 per 1,000 children to 14.2 per 1,000 children
- Increase the high school graduation rate from 84.6% to 88.8%
- Decrease the percent of adults ages 20 years or older who are obese from 33.2% to 31.5% Decrease the percent of adults who smoke from 20.6% to 18.5%
- Decrease the stroke death rate from 45.4 per 100,000 to 43.1 per 100,000
- Decrease the suicide rate from 15.7 per 100,000 to 14.9 per 100,000
- Decrease the rate of drug overdose deaths from 18.0 per 100,000 to 17.1 per 100,000
For the last two priority areas of the SHIP, the SC Office of Rural Health (ORH) Action Plan will be implemented to address Health Care Transformation and Factors that Affect Health.
Family Planning Cluster Analysis:
Along the same lines, in a cluster analysis was conducted in 2018 to determine if ‘like’ counties according to 8 characteristics to determine how family planning clinics operate and/or plan for delivery of services. A summary of characteristics are included as an attachment to this document. This model was applied to the live birth records for 2015-2017 to determine how best to group like counties when developing programs, scaling projects and delivering services. The cluster analysis grouped counties that were alike on all of these 8 variables, or characteristics into 3 major groupings. This analysis will be used for Title X program planning and the 2020 Title V MCH Needs Assessment.
2020 Title V Needs Assessment:
The MCH Epidemiologists have developed an analytic plan to address these priority areas for the upcoming needs assessment. Plan include using a social determinants of health framework modeled by HRSA to examine if established measures/data align with the goals and strategies outlined in Priority Area #5 of the SHIP (Factors that Affect Health). Suggested sources of data will be analyzed to assess the current status of: (1) access to health care, (2) community assets, leadership and engagement, (3) economic development, (4) education, (5) housing and (6) cross-cutting (which includes: communications, rural infrastructure and socio-economic factors of poverty, racism/social justice, and sexism).
This work will complement the quantitative analyses planned to examine all NOMs and NPSs stratified by race/ethnicity, gender and age. A public input survey has been developed and widely distributed to collect information, opinions, and thoughts on a wide range of maternal and child health topics in addition to a set of questions on social determinants of health and reactions to racism. This information will help us better prioritize the needs of all related MCH populations.
Organizational Structure:
The organizational structure at SC DHEC has remained largely unchanged since the previous needs assessment submission. The Title V MCH and CYSHCN program continue to be housed within the MCH Bureau, which remains with the Public Health Deputy Area of the agency. An organizational chart has been included as an attached. SC DHEC’s Client Services includes all the regional and local public health offices and clinics across the state as well as the state public health laboratory.
Dr. Lillian Peake resigned as Director of Public Health in February 2019, since then Nick Davidson, previous Bureau of Community Health Services Director has served as interim. Mr. Davidson reports directly to the Agency Director, Dr. Rick Toomey, who voted by board in December 2018 and joined the agency officially in February 2019. Lisa Davis continues to serve as Chief of Staff for Public Health reporting to the Director of Public Health. Kimberly Seals continues to serve as the SC MCH Director and Tammy McKenna continues to serve as the SC CYSHCN Director. An up-to-date organizational chart is included as an attachment.
Agency Capacity
South Carolina DHEC is a centralized state public health and environmental protection agency. The agency has at least one public health clinic in each of SC’s 46 counties, for a total of 78 facilities across the state’s four regions: Upstate, Midlands, Lowcountry, and Pee Dee. As a centralized public health system, Title V programmatic activities in these regions, counties, and clinics are coordinated by the agency’s central office, located in Columbia, SC. This structure allows DHEC to have the capacity to promote and protect the health of SC mothers and children, including CYSHCN.
Women/Maternal Health: The Division of Women’s Health within the MCH Bureau includes the Preventive Health Program, the Rape and Sexual Assault Prevention Program, and the Personal Responsibility Education Program (PREP). The Division also host the Choose Well program which provides infrastructure and capacity building enhancement for Title X services. The Title X Preventive Health program uses Medicaid funds under a Preventive Health State Plan Amendment and provides comprehensive preventive health services in clinics across the state.
The DHEC Division of Women’s Health includes the SC Adolescent Health Coordinator (SCAHC). This role helps to ensure that programs such as the Title X FP program and PREP are providing services that meet the needs of adolescents in SC.
Child Health: The DHEC MCH Bureau includes two divisions that impact the health of children: the Division of Children’s Health and Perinatal Services and the Division of Children and Youth with Special Healthcare Needs. During the development of the Bureau of Health Improvement and Equity, perinatal and infant health activities, formerly in the Division of Research and Planning, were realigned into the now Division of Children’s Health and Perinatal Services. The Division includes the statewide NBS, First Sound, and PPNBHV programs. Each public health region has an MCH Program Manager to oversee responsibilities associated with these and other programs within the DHEC clinics around the state. The school nurse consultant provides education for and coordination of school nursing activities across SC through a contract with the Dept. of Education.
Children with Special Health Care Needs: Key CYSHCN programmatic activities include care coordination, services for individuals with hemophilia, special formula, orthodontia, hearing assistance, support for craniofacial and sickle cell clinics, support for sickle cell foundations, Camp Burnt Gin, and Children’s Rehabilitative Services (CRS). A parent-to-parent mentor program is facilitated through a contract with Family Connections of SC. The CYSHCN Program has financial assistance programs for orthodontia, special formula, hearing devices, CRS, hemophilia, and most recently sickle cell. The eligibility for these programs include being a legal US citizen, a SC resident, having a household income at or below 250% of the federal poverty level (FPL) and having a covered medical diagnosis. The CYSHCN Program has contracts with three healthcare systems throughout the state to fund four multidisciplinary clinics to provide services to CYSHCN with severe craniofacial disorders. Additionally, the CYSHCN Program maintains contracts to provide support to four sickle cell organizations that provide services across SC for individuals and families affected by sickle cell disease or sickle cell trait.
Finally, the DHEC CYSHCN Program provides payment for office visits, durable medical equipment, prescriptions, and other needs under CRS for SC residents from birth through 18 years of age with a qualifying diagnosis. Financial assistance provided by CRS is available for CYSHCN living in households at or below 250% of the federal poverty level.
The Division of WIC previously in the MCH Bureau is now a part of the newly formed Bureau of Community Nutrition Services (CNS) and continues to provide educational classes, nutrition, counseling, and vouchers for healthy food to pregnant, breastfeeding, and postpartum women and to infants and children.
Cross-Cutting/Life Course: The DOH includes a school-based oral health program and a fluoridation program. The school-based oral health program uses a series of contracts with oral health providers around the state to provide oral health screenings within selected schools across SC. The fluoridation program works with the DHEC Bureau of Water and municipalities across SC to provide data and consultation for implementing community water fluoridation programs. Currently, 94% of SC’s community water systems are fluoridated.
MCH Workforce Development:
The MCH Workforce has remained mostly unchanged since the previous needs assessment submission and the MCH Bureau continues to make significant investments in workforce development and capacity building.
As part of the State Maternal and Child Health Policy Innovation Program (MCH PIP) South Carolina was selected to join two learning collaborative aimed at creating innovative state-level policy that improved access to quality health care for the MCH population. For the Association of Maternal & Child Health Programs MCH PIP Participating States (AMCHP) and Association of State and Territorial Health Officials (ASTHO) Promoting Innovation in State MCH Policymaking (PRISM) Project, South Carolina was selected and developed a core team with its partners to build our capacity to develop and implement policy solutions that address substance misuse and mental health disorders in women.
Similarly, the National Academy for State Health Policy (NASHP) Policy Academy selected South Carolina to work closely with SC DHHS to improve access to care for Medicaid-eligible pregnant and parenting women with or at risk of substance use disorders and/or mental health conditions through health care system transformation. South Carolina’s participation in both projects will help improve screening and referral for women and their families as risk of substance misuse and mental health disorders.
South Carolina participated in the first cohort of the Children’s Safety Network (CSN) learning collaborative. This collaborative focuses on reducing fatal and serious injuries among infants, children, and adolescents through the implementation and spread of evidence-based strategies in which South Carolina’s topic areas include poison prevention and suicided and self-harm prevention. While not a requirement, participation in this network has afforded SC the opportunity to hone in on activities related to NPM 5, NPM 7 and NPM 9.
Additional information on Workforce Development can be found in the Workforce Development section of the block grant found later in this document.
Partnership, Collaboration, and Coordination:
Partnerships, collaborations, and coordinated efforts are on ongoing and everchanging. These efforts have been included and described in other areas of this application and report.
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