III.C.2.a. Process Description
Goals, Framework and Methodology
The Needs Assessment is used to evaluate competing factors which impact health delivery services from the program level and drives activities to improve the health status of the maternal and child health population. The goal of the West Virginia Title V Needs Assessment is to assure availability of a comprehensive quality, accessible maternal and child health system that will positively affect pregnancy outcomes, which ultimately results in positive health status for infants, children, adolescents and children with special health care needs by involving multiple stakeholders across the State. Staff of the MCH Epidemiology Unit, housed in the Division of Research, Evaluation and Planning, were responsible for the development of the 2020 Needs Assessment. The Office has numerous community partners and is involved and actively participates on several agency boards, advisory committees, work groups and study groups. The Epidemiology Unit was responsible for collecting, analyzing and reporting data compiled in the Needs Assessment. These findings were used to determine West Virginia’s priorities, set performance measures, develop the state action plan and incorporate evidence-based measures.
Assessing MCH Populations
For this Needs Assessment OMCFH included input from program staff, advisories, stakeholders, colleagues, families and residents relating to improving the health status among West Virginians.
Stakeholder Involvement
The Office utilized both a formal and informal process for involving stakeholders in the 2020 Needs Assessment process. The Office both coordinates and participates on numerous advisory boards throughout the year. Stakeholder input is continuously sought for program planning and quality improvement.
Quantitative and Qualitative Methods
The OMCFH used both qualitative and quantitative methods to assess the strengths and needs of each of six identified population domains. Qualitative methods included, regional community meetings, focus groups with families regarding Home Visitation Programs, the review of multiple documents reporting the findings of stakeholder and advisory groups, and focus groups with stakeholders regarding national and state performance measures. Quantitative methods included administration and review of multiple surveys and data sets. While the Office primarily relied upon established surveillance systems such as the Behavioral Risk Factor Surveillance System (BRFSS) and the Pregnancy Risk Assessment Monitoring System (PRAMS), other surveys were also utilized.
Interface of Needs Assessment Data, the State’s Priority Needs and Action Plan
The Office of Maternal, Child and Family Health compiled input from its stakeholders and staff to help select West Virginia’s National Performance Measures. During the data collection period, needs assessment input was solicited to identify and understand West Virginia’s priority needs. The Epidemiology Unit with direction from leadership formalized a list of priority needs based upon data findings. The list of priority needs was then utilized to select national performance measures and create state performance measures to aid in the development of West Virginia’s State Action Plan.
II.C.2.b Findings
III.C.2.b.i MCH Population Health Status
Women/Maternal Health
While progress has been made in recent decades, women and girls in West Virginia, continue to experience challenges. Far too many female residents are vulnerable to both economic and health related challenges such as poverty, limited access to childcare and elder care, gender wage gaps, limited access to health care and poor health.
Pregnant Women, Mothers, and Infants Up to Age 1
West Virginia’s resident live birth rate in 2017 was 10.3 live births per 1,000 population, which was less than the national 2017 birth rate of 11.8. West Virginia’s birth rate has been below the national rate since 2008 and continued its decline in tandem with the national rate. Birth certificate data shows there were 18,675 births in West Virginia in 2017.
West Virginia and United States Birth Rates, 2008-2017
Data source (WV): West Virginia Health Statistics Center, Vital Statistics Center. (National): CDC Wonder
Delivery Method
The proportion of cesarean deliveries in WV peaked in 2011 at 37.0% of all births, though that percent has decreased to around 35.0% in recent years. The proportion of caesarean sections in the U.S. has remained steady at around 35.0% since 2014. As with most negative birth outcomes, the proportion of cesarean delivery is greater in West Virginia than in the U.S., and there has been little change to that disparity over the last decade.
WV Resident Cesarean Deliveries, Percentage of Live Births, 2008-2017
Data source (WV): West Virginia Health Statistics Center, Vital Statistics Center. (National): CDC Wonder
WV Singleton Births Induced Prior to 39 Weeks Without Medical Risk Factors or Congenital Anomalies, Percentage of Live Births, 2013-2017
Notes: Previous c-sections were added to the parameters of medical risk factors in 2014. Percentages are calculated excluding the unknown values.
Data source: West Virginia Health Statistics Center, Vital Statistics Center
Premature birth
By 2016, WV returned to the 2008 percentage of preterm births, after a period of relatively small decline from 2009 to 2013. These changes in preterm births are driven primarily by changes in moderate to late-preterm births, those that occur at 32 through 36 weeks gestation. In 2010, the percent of moderate to late preterm births was 9.0% and by 2017 it had increased to 10.2% From 2008 to 2017, the extremely preterm birth percentage ranged from 0.8% to 0.6% and the very preterm birth percentage ranged from 0.8% to 1.1%.
The West Virginia Health Statistics Center examined birth certificate data from singleton births from 2008 through 2017 to determine the scope of the problem of late-preterm birth in the State. There was a small decrease in overall preterm births from 2009-2013, but the proportion of preterm births returned to 2008 levels by 2017 (12.0%).
West Virginia Preterm Births, Percentage of Live Births, 2013-2017
Data Source: West Virginia Health Statistics Center, Vital Statistics Center
Infant Mortality
Infant mortality is the result of a complex set of biological and social factors, and infant deaths have long been viewed as an important indicator of a population’s health. While the rest of the Nation has shown a steady decline in the rate of infant mortality since 2008, West Virginia’s rate has remained slightly above the national average for each of the last 10 years.
2008-2017 National and WV Resident Infant Mortality Rate, Per 1,000
Year |
WV |
U.S. |
2008 |
7.7 |
6.6 |
2009 |
7.8 |
6.4 |
2010 |
7.3 |
6.1 |
2011 |
6.8 |
6.1 |
2012 |
7.3 |
6.0 |
2013 |
7.5 |
6.0 |
2014 |
7.1 |
5.8 |
2015 |
7.0 |
5.9 |
2016 |
7.3 |
5.9 |
2017 |
7.0 |
5.8 |
Data source: (WV) West Virginia Health Statistics Center, Vital Statistics Center, (National) CDC Wonder
The three leading causes of infant death in West Virginia are in line with the leading causes of infant death in the U.S.: prematurity, birth defects, and sudden unexplained infant death.
Maternal Smoking
Tobacco use remains high across all WV populations, but most alarmingly in pregnant women. Maternal smoking during pregnancy can result in multiple adverse consequences for the neonate, such as preterm birth, low birth weight, and birth defects of the lip and mouth (CDC, 2019). According to WV Vital Statistics, the rate of smoking during pregnancy in WV for 2018 was 23.7% (preliminary). A decline in maternal smoking can be seen across multiple data sources, including PRAMS, MRS, and Vital Statistics, indicating the robustness of that decline across the varied populations sampled. In 2018, 38.1% of women insured by Medicaid smoked during pregnancy, while 11.5% of non-Medicaid insured women smoked during pregnancy.
WV Resident Smoking During Pregnancy, Percentage of Live Births, 2014-2018
Smoking status during pregnancy |
2014 |
2015 |
2016 |
2017 |
2018* |
Smoked |
27.9% |
25.3% |
25.4% |
24.7% |
23.7% |
Did not smoke |
72.1% |
74.7% |
74.6% |
75.3% |
76.3% |
Data source: WV Health Statistics Center, Vital Statistics System
*2018 statistics are preliminary
Note: Percentages are calculated excluding the unknown values.
Smoking in pregnancy, by Medicaid status in WV, 2014-2018
Data source: WV Health Statistics Center, Vital Statistics System
*2018 statistics are preliminary
Note: Percentages are calculated excluding the unknown values.
PRAMS examined the smoking habits of WV women before and during pregnancy. Respondents were asked if they smoked any cigarettes in the three months prior to pregnancy and the last three months of pregnancy. Those mothers who responded they smoked during either time-periods were asked additional questions about their smoking habits the perinatal period. While 24.9% of women in 2018 smoked during the last trimester of pregnancy, this is lower than the 34.8% of women that reported smoking in the three months before pregnancy.
Preconception and Last Trimester Smoking, 2016-2018
Data source: WV PRAMS
Maternal smoking three months before pregnancy is most common among mothers less than 29-years of age, those who receive Medicaid, and those with less than a high school degree; an alarming 65% and 55% of those mothers without a high school degree reported smoking in the 3 months before pregnancy and the last trimester of pregnancy, respectively, in 2018. A higher percentage of mothers who had a low birth weight newborn reported preconception smoking that those with a normal birth weight newborn. Though fewer women reported smoking in the last trimester of pregnancy, the demographic trends are similar to those who reported smoking before pregnancy.
Preconception Smoking by Demographic Group, 2016-2018
Data source: WV PRAMS
Last Trimester Smoking by Demographic Group, 2016-2018
Data source: WV PRAMS
Infant Smoke Exposure
Infants are particularly vulnerable to the effects of second- and third-hand smoke because they are still developing physically, have higher breathing rates than adults, and have little control over their indoor environments and thus cannot escape exposure to smoke. Infants exposed to high doses of secondhand smoke, are at greater risk of developing serious health effects such as asthma, pneumonia, ear infections, and SUID.
PRAMS data showed that the number of homes with infants where smoking was allowed remained stable between 2016 and 2017. In 2018, smoking was allowed in at least part of the home in less than 6% of homes.
Smoke Exposure in the Home, 2016-2018
Data source: WV PRAMS
Maternal Substance Use
Substance use and overdoses are national public health issues but are particularly widespread in WV. OMCFH funded early research into and service provision to address the opioid crisis. In 2009, a “Cord Blood Drug Study” was sponsored by the OMCFH using Title V funds to assess the prevalence of maternal substance abuse. According to the study, the prevalence of drug use in pregnancy appeared to be increasing, based on increasing numbers of infants diagnosed with NAS. Eight hospitals across WV collected cord blood samples anonymously from infants and all samples were tested for methamphetamine, cocaine, cannabinoids, opiates, methadone, benzodiazepines, buprenorphine, and alcohol. Evidence of drugs or alcohol was found in 19% of the samples. This study supported the theory that WV had a greater number of women using drugs and/or alcohol during pregnancy than was previously estimated. In 2011, the OMCFH partnered with the Perinatal Partnership to develop the Drug Free Moms and Babies (DFMB) project, in order to support pregnant and postpartum women on their journey to recovery from Substance Use Disorder (SUD).
The federal Child Abuse Protection and Treatment and Comprehensive Addition and Recovery Acts (CAPTA/CARA) of 2016 requires WV Hospitals to report a newborn that is affected by maternal substance use to the child welfare system. While SUD alone is not cause for removal, Child Protective Services is required to open a case, which may eventually result in infant or child removal from the home and placement into state care. Thus, maternal substance use impacts the foster care system, which has been overwhelmed by the effects of the opioid crisis and currently serves over 7,000 children at any given time.
In 2017, MRS indicated 7.2% of pregnant respondents reported a problem with drugs or alcohol currently and 9.1% reported problem with drugs or alcohol in the past. MRS also found that, of those PRSIs submitted in 2017, 2.8% reported current opioid abuse treatment and 2.7% reported previous opioid abuse treatment.
The Birth Score program tracks the rates of intrauterine substance exposure (IUSE) and signs of NAS in infants. The percent of infants with IUSE has hovered just below 15% from 2017 to 2019; the percent of infants born with signs of NAS has remained close to 5%.
IUSE and Signs of NAS among Infants born to WV Residents, 2017-2019
|
IUSE |
NAS |
||
|
N |
% |
N |
% |
2017 |
2,265 |
14.3 |
802 |
5.1 |
2018 |
2,148 |
14.3 |
737 |
4.9 |
2019 |
2,052 |
13.4 |
862 |
5.6 |
Data source: West Virginia Birth Score Program, 2020
Breastfeeding
Breastfeeding rates have increased in WV; between 2014 and 2018, the percentage of infants breastfed at discharge from the hospital increased from 58.3% to 62.9%.
West Virginia Births by Breastfeeding Status, Percentage of Live Births, 2014-2018
*2018 data is preliminary
Data source: West Virginia Health Statistics Center, Vital Statistics Center.
The U.S. Breastfeeding Report Card reports that WV’s outcomes regarding breastfeeding, continue to increase, but still trail behind the U.S. as a whole.
Percentage of Children Who Were Breastfed, WV and U.S., 2009-2016
|
Ever breastfed |
Breastfeeding at 6 months |
Breastfeeding at 12 months |
Exclusive breastfeeding at 3 months |
Exclusive breastfeeding at 6 months |
|||||
|
WV |
U.S. |
WV |
U.S. |
WV |
U.S. |
WV |
U.S. |
WV |
U.S. |
2012 |
62.3 |
80.0 |
34.3 |
51.4 |
17.7 |
29.2 |
27.8 |
43.3 |
11.5 |
21.9 |
2013 |
64.6 |
81.1 |
35.8 |
51.8 |
18.3 |
30.7 |
32.6 |
44.4 |
14.1 |
22.3 |
2014 |
65.4 |
82.5 |
33.0 |
55.3 |
20.2 |
33.7 |
36.8 |
46.6 |
19.0 |
24.9 |
2015 |
68.6 |
83.2 |
40.1 |
57.6 |
24.3 |
35.9 |
36.3 |
46.9 |
20.2 |
24.9 |
2016 |
68.2 |
83.8 |
36.5 |
57.3 |
25.5 |
36.2 |
34.5 |
47.5 |
15.2 |
25.4 |
Source: CDC National Immunization Survey (NIS), 2009-2016
Prenatal, Antenatal, and Postnatal Care for Mothers
PRAMS data in 2018 shows about half mothers received teeth cleanings prior to pregnancy, but there exists the remaining 50.4% that do not partake in visiting the dentist as part of prenatal care.
Percentages of mothers receiving teeth cleanings prior to pregnancy, West Virginia, 2018
Data Source: WV PRAMS
Obesity
Healthy lifestyles need to be promoted among all individuals, especially in a state with such a high burden of overweight and obesity like West Virginia. Pediatric overweight and obesity initiates a pattern that continues into adulthood which puts individuals at increased risk of diseases such as cardiovascular disease and diabetes. These behaviors are also taught, so children of adults who are overweight and obese may learn this practice, perpetuating the cycle further.
The obesity puts children at risk for developing heart disease, high blood pressure, cancer, asthma and diabetes. These obesity-related conditions, and the resulting burden on finances, quality of life, life expectancy, and the health care system, may be prevented by intervening early with children and adolescents by promoting a healthy lifestyle.
WV WIC rates in 2-4 year olds was 14.4% in 2010. WV was only one of three states that had increasing obesity rates (from 14.4% in 2010 to 16.4% in 2014). In 2016, even though obesity rates in this population were still increasing, the increase was at a much lower velocity (ie 16.4% up to 16.6%). The results are reported as WV had a 2.2% increase in prevalence (14.4% to 16.6%).
Child/Adolescent Health
Improving the health of children helps to ensure the health of future generations. In addition to physical and mental health, numerous factors influence children’s health including: socioeconomic factors, insurance, access to health care, and education. Details regarding the physical and mental health of children are discussed in more detail in the Children with Special Health Care Needs section.
Leading Causes of Death, by Age Group West Virginia 2015-2017
Rank |
<1 |
1-4 |
5-9 |
10-14 |
15-19 |
20-24 |
1 |
Congenital Anomalies 100 |
Unintentional Injury 27 |
Unintentional Injury 15 |
Unintentional Injury 18 |
Unintentional Injury 93 |
Unintentional Injury 263 |
2 |
Short Gestation 51 |
Congenital Anomalies **** |
Congenital Anomalies **** |
Suicide ****
|
Suicide 31 |
Suicide 61 |
3 |
SIDS 43 |
Homicide **** |
Malignant Neoplasms **** |
Congenital Anomalies **** |
Homicide 15 |
Homicide 32 |
4 |
Unintentional Injury 19 |
Malignant Neoplasms **** |
Homicide **** |
Malignant Neoplasms **** |
Malignant Neoplasms **** |
Malignant Neoplasms 12 |
5 |
Two Ties 15 |
Five Tied **** |
Heart Disease **** |
Homicide **** |
Congenital Anomalies **** |
Heart Disease 10 |
**** indicates that cell values range from 1-9 and are suppressed for data confidentiality purposes
Data source: National Center for Health Statistics (NCHS), National Vital Statistics System
Adolescent health spans many areas, from mental, physical and reproductive health to substance abuse to relationships. The choices made and behaviors adopted during these years affect adolescents' overall wellbeing and, potentially, their health throughout their lives.
Adolescents often exhibit risky behaviors that can have immediate and prolonged detrimental health effects. Numerous adult diseases and causes of premature death can be attributed to risky behaviors in adolescence. Additionally, risky behaviors such as unprotected sex and bullying can lead to adolescents not meeting their full potential as adults. The Youth Risk Behavior Survey is a biannual survey of middle and high school students to assess risky behaviors in these populations.
Middle School
The 2017 YRBS middle school survey was completed by 2,089 students in randomly selected classrooms within 49 randomly selected public middle schools in West Virginia during the spring of 2017. The school response rate was 98% and the student response rate was 78%. The results are representative of all students in grades 6-8.
Bullying and Suicidal Behaviors
The 2017 West Virginia Youth Risk Behavior Survey revealed the following rates of bullying and suicidal behaviors reported by WV middle school students.
High School
The 2017 YRBS was completed by 1,563 students in 35 randomly selected public high schools in West Virginia during the spring of 2017. The school response rate was 100%, the student response rate was 78%, and the overall response rate was 78%. The results are representative of all students in grades 9-12.
Bullying and Suicidal Behaviors
The 2017 West Virginia Youth Risk Behavior Survey revealed the following rates of bullying and suicidal behaviors were reported by WV high school students.
Children with Special Health Care Needs Health
The federal Maternal and Child Health Bureau (MCHB) administers the National Survey of Child’s Health (NSCH) to provide robust state-level data about the status of children’s health. This survey was revised in recent years to incorporate the National Survey of Children with Special Health Care Needs. Due to the significant redesign and methodology changes, the 2016 data has been established as the new baseline and users are advised to compare to previous year’s data with caution. Multi-year estimates are generated to provided more accurate estimates, which is especially important for small states like West Virginia. The combined 2017/2018 survey estimates there were 88,838 CSHCN in the state of West Virginia, or 23.8% of the total child population. West Virginia has the second highest prevalence of CSHCN in the country.
The state of West Virginia does an excellent job of insuring children, with 94.3% of CSHCN reporting being covered by health insurance at the time of the 2017/2018 survey and 91.6% reporting having consistent coverage for the past 12 months.
Only 45.2% of CSHCN in West Virginia report receiving coordinated, ongoing, comprehensive care within a medical home. Both nationally and in West Virginia, rates of receiving all needed care coordination are falling behind the other components of the medical home measure.
|
2016/2017 |
2017/2018 |
||
WV |
U.S. |
WV |
U.S. |
|
CSHCN receiving coordinated, ongoing, comprehensive care within a medical home |
47.9% |
43.2% |
45.2% |
42.7% |
Medical Home Components |
||||
CSHCN with at least one personal doctor or nurse |
84.6% |
79.8% |
83.2% |
80.0% |
CSHCN with a usual source for sick care |
84.4% |
83.0% |
80.6% |
81.9% |
CSHCN who received family-centered care |
86.1% |
82.4% |
87.1% |
82.6% |
Children who had no problem getting referrals to doctors or services (state-level CSHCN estimate not available) |
75.2% |
77.9% |
Unavailable due to survey changes |
|
CSHCN who received needed effective care coordination, among those who needed care coordination |
59.0% |
61.8% |
56.3% |
73.5% |
Data source: National Survey of Children with Special Health Care Needs
While not a component of the medical home measure, transition services are integral to ensuring youth with special health care needs (YSHCN) are receiving services in a well-functioning system. Upon reaching adulthood, these youth face changing insurance, health care providers, and potentially losing community services and supports they have depended on. While all components of transition are lacking, the most profoundly lacking is pediatric health care providers taking the time to discuss and prepare the YSHCN to shift to adult health care providers.
|
2016/2017 |
2017/2018 |
||
WV |
U.S. |
WV |
U.S. |
|
YSHCN who received services necessary for transition to adult health care, ages 12 - 17 |
14.5% |
16.7% |
20.2% |
18.9% |
Components of Transition |
||||
YSHCN who had the chance to speak privately (without their parents or another adult in the room) with a doctor or other health care provider at their last preventive check-up |
39.4% |
45.8% |
43.6% |
47.0% |
YSHCN whose doctor actively worked with them to gain skills to manage his/her health and health care |
57.5% |
63.0% |
65.0% |
66.8% |
YSHCN whose doctor actively worked with them to understand the changes in health care that happen at age 18 |
32.3% |
31.1% |
32.9% |
34.4% |
YSHCN whose doctors discussed the shift to providers who treat adults, if needed |
12.6% |
17.3% |
18.8% |
20.0% |
Data source: 2016/2017 National Survey of Children with Special Health Care Needs
Families are the CSHCN’s primary caregivers and it is integral to engage them in the health care planning for CSHCN. Families can provide insight into the reality of the daily issues and barriers the CSHCN face. As such, the family, and CSHCN when they are developmental capable and of age, should be engaged by their health care providers at every possible opportunity. As mentioned, 87.1% of CSHCN in West Virginia report receiving family-centered care. The data is encouraging, especially considering 89.1% of CSHCN report their child’s doctors and health care providers usually or always make them feel like a partner in decision making.
III.C.2.b.ii. Title V Program Capacity
III.C.2.b.ii.a. Organizational Structure
West Virginia's Office of Maternal, Child and Family Health is located within the state's Bureau for Public Health, administered by the umbrella organization, the Department of Health and Human Resources (DHHR). A Cabinet Secretary is appointed by the Governor to administer DHHR. The Office is responsible for the administration of all Title V Programs in West Virginia as well as numerous other Programs funded by the state of West Virginia and its national partners.
The OMCFH is constituted of three divisions, plus a Quality Assurance/Monitoring Team, Early Intervention IDEA/Part C, and the Administrative unit. With the exception of the Children with Special Health Care Needs Program (CSHCN), the OMCFH does not deliver direct services but rather designs, oversees and evaluates preventive and primary service systems for WV women and men of reproductive age, infants, children, adolescents, and children with special health care needs.
Division of Perinatal and Women's Health (PWH): The focus of the PWH Division is to promote and develop systems which address availability and accessibility of comprehensive health services for women across the life span and high-risk infants in the first year of life. Administrative oversight includes an integrated perinatal care and education system paid for by Title V and Title XIX. PWH programs include the Home Visitation Program, Family Planning Program under which the Adolescent Pregnancy Prevention Initiative is housed; the Breast and Cervical Cancer Screening Program; WISEWOMAN; the Birth Score Program and Perinatal Programs which include Right From the Start.
Division of Infant, Child and Adolescent Health (ICAH): The goals of this Division are to recommend and implement standards of child health supervision from infancy to adolescence, implement care coordination for children with special health care needs, identify strategies for the prevention of childhood injuries, and coordinate prevention and education programs to improve child health. Both families and medical professionals are a key component of meeting these goals through their involvement in strategic planning and advisory committees. ICAH programs include the Children with Special Health Care Needs Program, the Oral Health Program, HealthCheck (EPSDT), the Adolescent Health Initative, and the Violence and Injury Prevention Program.
Division of Research, Evaluation and Planning (REP): The REP is responsible for epidemiological and other research activities of the OMCFH, including all programmatic data generation and program/project evaluation endeavors, as well as ensuring that the OMCFH's planning efforts are data driven. There are currently 16 epidemiologists assigned to different Programs within OMCFH and four data programmers. The Division administers the Pregnancy Risk Assessment Monitoring System (PRAMS) Project, and the Childhood Lead Poisoning Prevention Project (CLPPP), sponsored by the Centers for Disease Control and Prevention (CDC); birth defects surveillance; and in conjunction with the Office of Laboratory Services, the Newborn Screening Project, supported by State funds and revenue generation, the Newborn Hearing Project and the universal Maternal Risk Screening. This Division is responsible for SSDI data integration activities and grant application as well as the Title V Block Grant application and Needs Assessment. The Division is also responsible for development of data applications and data analysis for most OMCFH programs and projects.
The mission of OMCFH is to provide leadership to support state and local efforts to design and build systems of care that assure the health and well-being of all West Virginians. Most OMCFH resources are allocated to develop systems of care for population-based and target-specific prevention services, as well as build infrastructure for support of maternal, child and family health populations. Experiences gained from administrative oversight of varied grant requirements, program models, funding streams and data driven decision making, place OMCFH in a unique position to effectively design and deliver evidence based MCH services. The OMCFH uses a leadership team management approach with the Office Director, Division Directors and Quality Assurance Monitoring Director actively participating in decision-making and strategic planning.
The Office participates in West Virginia’s civil service employment system that is governed by its Division of Personnel (DOP). DOP works with agencies to establish, criteria for personnel classifications, develop registers of qualified applicants and assures that agencies follow established policies and procedures. Recently, DOP has also been working with the Office to develop plans for the recruitment and retention of certain employment classifications including nurses and epidemiologists. While the Office recruits its workforce from throughout the US, it is difficult to retain employees that are not from West Virginia because of lower than average salaries. As a result, retention efforts often focus on facilitating career goals, maintaining connections to family, and State benefits (including health insurance, generous leave policies, and an employer sponsored pension plan).
In order to improve workforce capacity, OMCFH leadership actively participates in activities sponsored by the Association of Maternal and Child Health Programs (AMCHP) including the annual conference, webinars and regional discussions. Staff also have the opportunity to participate in various DHHR workgroups through the Secretary’s Health Innovation Collaborative, Leadership Institute, new manager Boot Camp, and the Bureau for Public Health’s Quality Improvement Initiative.
The Office provides ongoing support for staff to attend professional development opportunities both in-state and out-of- state to assure the understanding and knowledge of evidence-based practice. These events support professional staff in maintaining necessary credentials related to their field. Opportunities include the Women’s Health Conference, Public Health Conference, KidStrong Conference, Celebrating Connections, Rural Health Conference, the State social worker conference, various National Program meetings and other local training programs.
III.C.2.b.ii.b. Agency Capacity
Statewide System of Services
The OMCFH has historically purchased and/or arranged for health services for low income persons, including those who have health care financed under Title XIX. The Medicaid expansion of the 1980's resulted in health financing improvements, but it was Title V energy that developed obstetrical risk scoring instruments and recruited physicians to serve mothers and children, including those with special health care needs. It was also Title V that established standards of care and developed formalized mechanisms for on-site quality assurance reviews.
OMCFH continues to ensure a statewide system of services that reflect the Title V principles of comprehensive, community-based, coordinated, family-centered care. Examples of this work include: actively tracking health professional shortage areas and recruiting professionals in underserved areas; providing statewide family centered care coordination services for children with special health care needs; developing and implementing maternal risk screening tools, expanding services through home visiting where appropriate, leading efforts to implement trauma informed screening in pediatric practices, increasing utilization of developmental screening tools and assuring prenatal care is offered to all women regardless of their ability to pay.
Community health centers have played a critical role in improving access to health care for all populations across WV. The community health center network is supported with State appropriations and there are multiple centers that actually receive both state and federal resources.
Other State Agencies and Private Organizations
The OMCFH works in close coordination with the State Medicaid agency, the Bureau for Medical Services (BMS). BMS provides funding support for many OMCFH Programs including Right From The Start, the State’s medical case management program for pregnant women and infants to age one; HealthCheck, West Virginia’s EPSDT Program; Breast and Cervical Cancer Case Management Services and the Children With Special Health Care Needs Program.
In 2009, the Office began collaborating with the Bureau for Children and Families to assure adequate health care services to children in foster care. What began as a pilot project to ensure all foster children received a timely EPSDT screening upon entry into foster care, has evolved to ensuring all foster children in the state receive adequate medical care. The EPSDT screening exam form has been modified to incorporate a two-question trauma screening tool, the Abbreviated PTSD Checklist. The CSHCN Program and HealthCheck will develop a provider training on the value of completing these trauma screening questions. The Office has determined that foster children fit the federal definition of CSHCN due to the trauma they experience and their increased risk of developing a special health care need as a result. This makes all foster children categorically eligible to receive services from the CSHCN Program. The CSHCN Program care coordination teams will complete a care plan for all foster children. This care plan incorporates a psychotropic medication review to ensure appropriate prescription and management of these medications. Care coordination services will be provided in collaboration with Aetna, the managed care organization contracted by BMS to be the health insurance provider for all foster children in West Virginia.
In February 2006, with support from the Claude Worthington Benedum Foundation and encouragement by then First Lady Gayle Manchin, a group of health care professionals convened at the Governor’s Mansion to collaborate and address the poor health of mothers and babies in West Virginia. The state had some of the worst health outcomes in the country related to low birth weight, infant mortality, and teen pregnancy.
As a result of this meeting, the participants created the West Virginia Perinatal Partnership to work together for their shared interest of improving the health of mothers and babies in West Virginia, as well as have a positive impact on their environments, their family situations and their futures. The Partnership engaged various partners and contributing organizations through the 2006 Key Informant Survey and hosted the first Perinatal Summit. A Central Advisory Council was established to help organize subcommittees to address a variety of issues which had been identified. The members of the Central Advisory Council included rural providers, chairs and directors of perinatal health care organizations, deans and representatives from the state’s three medical schools, the Office of Maternal, Child and Family Health and payers of care in West Virginia. The Partnership has become recognized throughout the state for its effectiveness in bringing together individuals and organizations involved in all aspects of perinatal care. The Office has supported the work of the WV Perinatal Partnership to implement the Drug Free Moms and Babies Project, and to implement a smoking cessation in pregnancy project.
State Support for Communities
West Virginia’s Adolescent Health Initiative is a project developed and coordinated by the Infant, Child and Adolescent Division, Office of Maternal, Child and Family Health. The vision of the Project is to promote optimal physical, emotional, cognitive, social, and spiritual well-being for children and youth throughout West Virginia. Its mission is to support community collaborative efforts designed to develop the assets youth need to thrive and become successful across the State of West Virginia.
Formal work with the Adolescent Health Initiative (AHI) began in 1988. The OMCFH funds a dedicated network of eight regional Adolescent Health Coordinators across the State of West Virginia. The Initiative is designed to introduce, develop, train, and provide needed technical assistance to youth, parents, teachers, health care professionals, other regional networks, and civic groups with focused attention on improving adolescent health indicators while building asset-rich communities.
Coordination of Health Components of Community-Based Systems
The OMCFH embraces the principles of comprehensive, community-based, coordinated, family centered care, and works continuously to assure coordination with the health components of community-based systems. When possible, the Office works to involve family members at all levels of decision making. Parents actively participate in most of the advisory committees that the Office coordinates and/or participates in including, but not limited to the Children with Special Health Care Needs Medical Advisory Board, Newborn Hearing Screening Advisory Board, the Developmental Disabilities Council, the Commission to Study Residential Placement and the Commission for the Deaf and Hard of Hearing. The Office frequently works to identify parents to participate in the advisory groups of other agencies.
In addition, OMCFH uses Title V funds to support the involvement of parents of children with special health care needs. These parents play an active role in establishing policy for the Children with Special Health Care Needs Program, training of staff and families, assisting families with identified needs and assuring that family voices are ever present in decision making.
On a broad level the Office coordinates access to comprehensive health and related services through the medical home using the principles and guidelines established by the American Academy of Pediatrics. The primary vehicle for this coordination is through OMCFH’s EPSDT Program, called HealthCheck. The HealthCheck Program promotes regular preventive medical care and the diagnosis and treatment of any health problem found during a screening. Medical providers provide children regular check-ups, screenings and preventive services based on a schedule established by medical, dental and other health care experts, including the American Academy of Pediatrics. Medical providers also treat children when they are sick or refer them to an appropriate specialist if they need to see one.
While HealthCheck is funded by the Bureau for Medical Services (Medicaid), nearly all Title V Programs follow HealthCheck recommendations and guidelines. Programs utilize the HealthCheck Program to distribute educational messages to providers and families. For example, the Oral Health Program utilized the HealthCheck infrastructure to educate providers on the importance of age one dental visits. In addition, the Children with Special Health Care Needs Program utilizes HealthCheck’s established Policies and Procedures to assist families in accessing services not currently covered within the Medicaid plan.
The Children with Special Health Care Needs Program also works to assure access to comprehensive health and related services through the medical home. In 2010, the Program made a conscious decision to begin integrating their care coordination activities with the team of health care providers working with each enrolled child. With permission from the families, the eleven care coordination teams share information across providers and coordinate multi-disciplinary discussion when necessary.
The Office promotes early and continuous screening, evaluation and diagnosis via a number of its Programs. These Programs include HealthCheck, Breast and Cervical Cancer Screening, Family Planning, and WISEWOMAN, supported by Medicaid and the Centers for Disease Control and Prevention as well as its Title V Programs including Oral Health, Newborn Screening, and Children with Special Health Care Needs Programs. The Office relies on the combined infrastructure of these Programs to promote newborn screening, well-child visits, cancer screening, cardiovascular screening, preventive oral health services and other important services.
West Virginia has experienced a high degree of success in the implementation of the Affordable Care Act. Record numbers of residents have health insurance (94%), but the issue of adequate insurance remains troubling for many families. West Virginia’s Medicaid Plan does not provide coverage for expensive medical foods needed by many children with special health care needs. As a result, OMCFH utilizes Title V funds to assure that families have access to these life sustaining products.
III.C.2.b.ii.c. MCH Workforce Capacity
OMCFH currently maintains 156 professional, technical and administrative support positions and 18 temporary contract positions. In addition, the Office maintains five paid parent positions. Experiences gained from administrative oversight of varied grant requirements, program models, funding streams, and data driven decision making, place OMCFH in a unique position to effectively design and deliver evidence based MCH services. Biographical sketches of the Office Director and Senior Management:
James Jeffries, MS-Title V Office Director
Education:
Master of Science, Mountain State University, Beckley, WV, 2006
Bachelor’s Degree, Physical Education, WV Institute of Technology, Montgomery, WV, 1991
Professional:
Director, Division of Infant, Child and Adolescent Health Division (2013-2018)
Director, HealthCheck Program, OMCFH (2009-9/2013)
Director, Quality Assurance Monitoring, OMCFH (2008-2009)
Quality Assurance Monitor, OMCFH (1998-2008)
Kathryn G. Cummons, MSW, LICSW, ACSW-Director, Division of Research, Evaluation and Planning,
Education:
Master of Social Work, West Virginia University, 1988
Bachelor of Social Work, West Virginia University, 1974
Professional:
Director, Division of Research, Evaluation and Planning, OMCFH (2000-Present)
Clinical Social Worker, Comprehensive Psychological Services (1999-2000)
Clinical Social Worker, Charleston Area Medical Center (1989-1990) and (1998-1999)
Director of Social Work Services and Discharge Planning, CAMC (1990-1998)
Administrator, Northern Tier Youth Services, Foster Care (1984-1989)
Supervisor, Lutheran Youth and Family Services, Residential Treatment (1981-1984)
Teresa Marks, MS– CSHCN Director; Director, Division of Infant, Child and Adolescent Health
Education:
Healthcare Administration, MS, Marshall University, 2019
Secondary Education, BA, Marshall University, 2001
Professional:
Director, Division of Infant, Child and Adolescent Health, OMCFH (2019-Present)
Director, Division of Perinatal and Women’s Health, OMCFH (2018-2019)
Program Director, West Virginia Oral Health Program, OMCFH (2014-2018)
Workforce Coordinator, West Virginia Oral Health Program, BPH (2013-2014)
Program Coordinator, WV Asthma Education and Prevention Program, BPH (2012-2013)
Program Assistant, WV Cardiovascular Health Program, BPH (2010-2012)
Director of Education, Sylvan Learning Center (2007-2008)
Service Coordinator, Autism Services Center (2006-2007)
Director of Education, Sylvan Learning Center (2003-2006)
Teacher, Chesapeake (Ohio) Union Exempted Village School District (2001-2003)
Aimee S. Bragg, LNHA, Director, Division of Perinatal & Women’s Health
Education:
Bachelor of Science, Health Services Administration, 1993
Professional:
Director, Division of Perinatal & Women’s Health, OMCFH (2019-Present)
Assistant Administrator/HR Director, Jackie Withrow Hospital, BHF/DHHR (2005-2019)
Administrator, Heartland of Keyser, HCR Manor Care (2000-2002)
Assistant Administrator/HR Director, Heartland of Beckley, HCR Manor Care (1997-2000)
Melissa Baker, MA – MCH Epidemiologist, PI/Director PRAMS
Education:
Public Health Distance Education, Johns Hopkins University, Baltimore, MD, 1997/98
Master of Arts, Marshall University, Huntington, WV, 1989
Bachelor of Arts, Marshall University, Huntington, WV, 1987
Professional:
MCH Epidemiologist, PI/Director PRAMS, OMCFH (2002-Present)
PRAMS Coordinator, OMCFH (1996-2002)
Legislative Analyst, WV Legislature (1991-1996)
Mechanisms for Culturally Competent Approaches
Ensure Training
Staff from the OMCFH ensures the provision of training in areas of cultural and linguistic competence whenever possible. The Office maintains the ability to provide continuing education units for nurses and social workers and utilizes this to incentivize training when possible. The Office has offered numerous training opportunities on poverty and cultural competence via staff meetings, provider training, and conferences. These events reach internal staff, family leaders, medical professionals and community grantees.
Collaboration with Diverse Groups
The Office collaborates with a broad group of stakeholders throughout West Virginia. This network includes community leaders, church pastors, and family advocacy groups. The Office provides training and participates in strategic planning activities throughout each year.
Securing Resources
The Office works to provide technical and financial support to meet the unique needs of culturally diverse groups. The Office provides financial support and staffing support for grant development to various agencies and community groups when possible.
Develop and Implement Performance Standards
The Office works diligently to establish standards and training for clinical health providers to assure culturally competent practices.
Provide Policies and Guidelines
The OMCFH maintains policies and guidelines that support culturally competent practice, particularly in its clinical services programs. However, the Office needs to develop internal policies for its staff.
III.C.2.b.iii. Title V Program Partnerships, Collaboration, and Coordination
The Office of Maternal, Child and Family Health has demonstrated an ongoing commitment to build, sustain and expand partnerships to work collaboratively and to coordinate services with other organizations.
Other MCHB Investments
The Office receives and manages the State System Development Initiative (SSDI) Grant. Staff assigned to this Project are housed within the Division of Research, Evaluation and Planning. The Office is also responsible for implementing the Maternal, Infant, and Early Childhood Home Visiting Grants (MIECHV). This Program reports directly to the Office Director and heavily coordinates its services with Right From the Start, HealthCheck, Birth To Three and Violence and Injury Prevention. In addition, the Home Visitation Program is merged with the Early Childhood Systems of Care Grant to assure that efforts are well coordinated. Externally, the Office works closely with West Virginia University to implement West Virginia’s Healthy Start Grant as part of the Right From the Start Program.
Other Federal Investments
The OMCFH is responsible for a number of other federal programs including: PRAMS, Breast and Cervical Cancer Screening, WISEWOMAN, Family Planning, Personal Responsibility Education Program, Prescription Drug Overdose, Rape Prevention Education, Sexual Assault Prevention, Lead Prevention, and various oral health grants.
Other HRSA Programs
The OMCFH works closely with the Division of Primary Care to leverage work with Federally Qualified Health Centers. Many of the Centers receive grant funds from the Office and nearly every center receives technical support for clinical services.
State and Local MCH Programs
West Virginia is a small state with regard to population. Therefore, the OMCFH is the only Program designated as an MCH Program in West Virginia.
Other Programs within DHHR
The Office works with the Health Statistics Center to obtain critical data from vital registration. The Office also works with the Office of Environmental Health Services to assure water fluoridation, the Office of Chief Medical Examiner to review maternal and infant deaths, the Office of Laboratory Services to assure tracking and follow-up of newborn screening, the Office Epidemiology and Prevention Services to identify and treat sexually transmitted diseases, and the Office of Emergency Medical Services to meet the requirements of children with special health care needs in emergency situations.
Other Governmental Agencies
The Office works closely with the Bureau for Children and Families on foster care initiatives and with the Bureau for Behavioral Health on several activities. In addition, the Office partners very closely with the Bureau for Medical Services to implement EPSDT, provide medical case management services to pregnant women, and to assure health care coordination of children with special health care needs.
Public Health and Health Professional Educational Programs
Under the leadership of the Bureau for Public Health, the Office has partnered with West Virginia University and Marshall University’s Public Health Programs.
Family/Consumer Partnerships and Leadership Programs
The OMCFH participates in several family/consumer partnerships programs. All of the Parent Network Specialists and several OMCFH staff have completed the Partners in Policy Making Training, and intensive multi-session training. Both the Birth to Three and Home Visitation Programs maintain advisory groups with parents and parents with children with special health care needs to address the issues that families and children face in early childhood.
III.C.2.c. Identifying Priority Needs and Linking to Performance Measures
West Virginia OMCFH used data and information provided from various programs, advisories, data sources and stakeholders to inform the priority needs selection for the 2020 Needs Assessment. Priority needs were selected based upon the findings from collected data and ranking of selected National Performance Measures by staff and stakeholder groups. Capacity, existing resources, feasibility and potential impact were all considered when selecting the priority needs.
The Office engaged several stakeholder groups in the selection process. These groups included but were not limited to the Perinatal Partnership, the Pediatric Medical Advisory Board, communities across the state and staff. This method for input assured that equal input was given for all population groups. Once the process was completed, epidemiology staff compared the results to other data resources available to assure that the selected priorities were aligned with the larger efforts of West Virginia’s Public Health System. While some differences in opinion were noted across stakeholder groups, strong consensus was achieved. In addition, while the identified needs are aligned with the larger public health focus in West Virginia, Title V remains unique in its focus on the maternal and child health population groups. Based upon these finding West Virginia has chosen the following priority need areas for 2020-2025:
- Smoking in pregnancy and smoke exposure in the home
- Infant mortality
- Preterm birth
- Injury – specifically bullying and suicide (attempted)
- Substance use in pregnancy and in youth/teens
- Breastfeeding initiation and duration
- Medical home
- Obesity in children
- Oral health in pregnancy
- Transition
To address these needs, West Virginia has selected the following National Performance Measures by domain:
NPM 2. Low risk cesarean delivery (Women/Maternal Health)
NPM 4. Breastfeeding (Perinatal/Infant Health)
NPM 5. Safe Sleep (Perinatal/Infant Health)
NPM 9. Bullying (Adolescent Health)
NMP 11. Medical Home (Children with Special Health Care Needs)
NPM 13. Oral Health (Women/Maternal Health)
NPM 14. Smoking (Women/Maternal Health, Child Health)
In addition, West Virginia will develop the following State Performance Measures:
SPM 1. Transition (Adolescent Health, Children with Special Health Care Needs)
SPM 2. Substance use in pregnancy (Women/Maternal Health)
SPM 3. Substance use in youth/teens (Child Health, Adolescent Health)
SPM 4. Obesity in children (Child Health)
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