Every five years, the Maternal Child Health Epidemiology (MCH Epi) Program leads the statewide five-year needs assessment.  The Title V Epidemiologist/Grant Coordinator is responsible for leading and coordinating needs assessment activities, which includes identifying ongoing opportunities to seek input on needs and priorities throughout the state.  MCH Epi staff support all programs receiving Title V funding, and they support many unfunded partnerships with planning, goal development and implementation of Title V-related activities. This year, in 2019, we added an additional staff person (an evaluator) to the MCH Epi program who has already made significant contributions to the evaluation of current Title V objectives, strategies and evidence-based measurements.

The MCH Epi program collaborates on many different projects and analyses related to the MCH population in NM.  Program staff interface with community-based health promotion teams located in each of New Mexico’s Public Health Regions, regional epidemiologists, community health councils, and representatives from tribes, primary care and hospital systems. To assure ongoing communication and opportunities for input among stakeholders, the Title V Epidemiologist leads quarterly meetings of Title V internal and external participants, and the MCH Epi PRAMS team holds quarterly Steering Committee meetings for the Pregnancy Risk Assessment Monitoring System (PRAMS) and Toddler Survey surveillance activities, with Steering Committee members drawn from clinical and program partners and those who work with MCH data around the state.

MCH Data Collection

Data collection is monitored through several main sources, including the National Survey of Children’s Health, the NM Behavioral Risk Factor Surveillance Survey (BRFSS), NM Vital Statistics birth and death data, and PRAMS, which are accessible within the NM Indicator-Based Information System (NM-IBIS) data query system. NM-IBIS draws from other databases such as Census/American Community Survey, NM YRRS (state equivalent to YRBS) and hospital discharge data. Since PRAMS is housed in the MCH Epidemiology program, we utilize this database conveniently and quickly. Staff publish indicator reports throughout the year and routinely prepare datasets for sharing through the NM-IBIS and data dashboards. MCH Epi also administers the NM Toddler Study, a follow-up study to PRAMS. This study has produced early childhood data that can be used to monitor longitudinal MCH indicators in New Mexico.

Other databases used in continuous needs assessment include:

The Guttmacher Institute- The Guttmacher Institute (AGI) is a leading research and policy organization committed to advancing sexual and reproductive health and rights in the US and globally. Data from AGI is used by NM FPP and MCH Epidemiology to track changes in the teen birth rate by state and to provide comparisons with other states and national trends.

Kids Count Data Center- The Kids Count Data Center is a project of the Annie E Casey Foundation, which annually compiles a robust list of indicators on economic, health, education and community well-being at the state level.

National Survey of Children’s Health- This survey provides a comprehensive data query system for national and state-level indicators on child well-being at the state level.

RWJF County Health Rankings- RWJF provides a source of county and sub-county wellness data and provides rankings of health outcomes for each jurisdiction.

Environmental Tracking System- This is a CDC-sponsored birth defects tracking tool which also measures environmental exposures for the birth through early childhood population.

At the community level, we work with the state’s health promotion teams in each of the four health regions including the metropolitan area. These teams are made up of an epidemiologist and health promotion/education staff who work closely with regional health councils and are well connected to resources and stakeholders in the community. Annual data reports from home visiting and other early childhood programs are also a useful way to monitor indicators in the MCH population. Additionally, many of the activities written about in the Family Engagement and Public Input narratives of this grant are used as mechanisms for continuous feedback for the needs assessment.

Program Evaluation

There are many efforts in each program which serve to inform the effectiveness of strategy areas and to measure client satisfaction. These are described in detail in the Family Engagement narrative. Starting in 2019, the new Epi/Evaluator in the MCH Epi program began evaluating parts of the Title V program. Starting with our safe sleep initiatives, he has worked with the Title V Director and other partners on a statewide safe sleep plan, which includes objectives and strategies to align and evaluate the disparate safe sleep efforts going on in the state. This is an important first step to be able to evaluate safe sleep-related indicators in the future. This position will also work with the Title V Epidemiologist and domain leaders to evaluate the alignment and measurability of each domain’s objectives, strategies and ESM’s in place and going forward to the 2020 needs assessment.

This year the Adolescent Health Coordinator and the Title V Epidemiologist worked with a contracted evaluation company, APEX Evaluation, to create a thorough evaluation of the Peer Youth Development program. This evaluation not only meets program objectives, but it facilitates feedback from adolescents on health topics they deemed most important.

The Children’s Medical Services (CMS) program has been historically difficult to evaluate due, in part, to problems with the program’s data systems and difficulty measuring the ROI of care coordination provided by the medical social workers.  CMS has contracted with the Center for Development and Disability (CDD) evaluation team headed by Dr. Anthony Cahill to provide an evaluation of the work of the program.  The evaluation will include both qualitative and quantitative data.  This is described further in the report narrative.  The work will also include assistance with the CYSHCN portion of the 2020 Needs Assessment.

Noted Changes to the MCH needs from 2015 Needs Assessment

One change in the needs for the MCH population in New Mexico is in the infant and maternal health domains. While New Mexico does not have an elevated overall infant mortality, rate compared to the national rate, African Americans do have an alarmingly high rate compared to the state. For the time period of 2015-2017, the rates of infant mortality in New Mexico were as follows: 

The New Mexico Birth Equity Collaborative was officially founded in 2018 to focus on, or center, black women and their babies. There has been significant collaboration between this group including the Title V Director/Bureau Chief, MCH Epidemiology, the Maternal Health Program and the Child Health Program. For New Mexico, this not an emerging public health issue, but rather one that the state now has more capacity and commitment to address. We have incorporated the work of the Birth Equity Collaborative into our social determinants of health CoIIN through provider bias and paid family leave policy work.

Health equity is the lens that the Title V team has chosen to use for the upcoming needs assessment. This guides the work we are doing now and plans going forward. The Title V Epidemiologist has been working with the DOH Office of Health Equity to actively integrate equity into needs assessment practices. This includes, but is not limited to: health literacy, asset-based data presentation, equitable practices in research, cultural competency, and incorporating social justice. This is an area that our Title V Director/Bureau Chief is committed to, not just for Title V but for the entire Bureau. The plan over the next year is to provide staff trainings on health equity and ensure that the principles are incorporated into all FHB programming.  The DOH Office of Health Equity has also been reinvigorated now with a new administration, and the Title V Director is working with them to completely revamp the DOH Health Equity Report. 

Emerging MCH Issues

Two areas of concern have emerged over the past two years demanding response from public health practitioners in NM and across the United States. Migration and immigration pose growing challenges for our state on the southern border with Texas and with Mexico. A re-emerging issue, the separation of children from their families is gravely concerning to us as health professionals. Governor Lujan Grisham has made a priority for NM DOH staff to help assess the health and needs of unaccompanied and separated minors at the border, and we as Title V staff are part of the responding personnel.

Another area of concern is for missing and murdered indigenous women in New Mexico. Albuquerque, NM has the highest number of missing or murdered Native American women in the United States. Deb Haaland, U.S. Representative from Laguna Pueblo, is bringing national legislative policy and awareness to this problem. Along with tribes and UNM colleagues, we will support efforts to prevent violence against these women and to strengthen data systems for analysis of missing or murdered women.

The breadth of the state’s Title V partnerships and collaborations with other federal, tribal, state and local entities that serve the MCH population

The partnerships that the Title V program have cultivated over the years reach across the entire state and exist in every domain. The Title V Director, the MCH Epi staff, the Maternal and Child Health Programs and the Children’s Medical Program make up the leadership team of Title V in New Mexico, and we have representation from this team in all our collaborations that work to serve the MCH populations in New Mexico.

NM Title V staff have led the state’s CoIIN efforts to improve infant mortality since 2012.  Currently staff are participating in two CoIIN projects, one on social determinants of health and the other focused on prenatal care in the border region.  The CoIIN projects involve multi-sector participation and have been a springboard for many partnerships, including working with the NM Hospital Association. This partnership initially started with a focus on reducing non-medically indicated deliveries, but now has branched out into support for other Title V efforts around perinatal regionalization and the maternal mortality review. 

The MCH Epidemiology program works closely with both area and Navajo Tribal Epidemiology Centers (AASTEC and NEC).  We participate in NM Tribal PRAMS, the Navajo area MCH workgroup, and cross-jurisdictional needs assessments and data sharing.  We initiated the NM Tribal PRAMS census surveillance starting in 2018. Tribal PRAMS data collection began in May 2018, and AASTEC is completing its first year of data collection.  MCH Epidemiology (PRAMS) staff also worked with both TECs to plan a two-day MCH Tribal Maternal Child Health Symposium in the fall of 2018.

Noted changes in the state’s Title V program capacity or its MCH systems of care, particularly for CSHCN, and the impact of these changes on MCH services delivery

The Maternal Health Program (MHP) has experienced changes that have created some difficulty in reporting on the NPM that was selected during the 2015 needs assessment process. The MHP is staffed by the program manager and an administrative assistant. Much of the program work is concentrated on licensing the midwife workforce for the state as well as with the High-Risk Fund program.

The High-Risk Prenatal Fund is a program that provides Title V funding to clinics that serve high-risk (socioeconomic and health outcomes) pregnant women. These funds are an important safety net for those who need prenatal, delivery and post-partum care and do not qualify for any other form of healthcare assistance. While these numbers are reported in the Title V yearly application, the programming is spread over numerous organizations so that is difficult to create unified objectives and measurements for this program. The gestational diabetes project (referenced in the 2018 Annual Report for Maternal Health Domain) is the closest that we are able to get to preventative clinical visits for women served by Title V dollars.

Since 2016, capacity to address maternal mortality has increased substantially, as has its focus as an emerging issue in New Mexico. While it did not emerge as a focus during the last 5-year needs assessment, it has steadily risen in importance as a public health problem, both in NM and across the United States. In response, the Maternal Health Program (MHP) worked for three years to institutionalize a Maternal Mortality Review (MMR) board. While the rates of well-women visits could always be improved, New Mexico does not currently have a specific program to directly fit this measure. However, we have tracked postpartum (inter-conception) visits and leveraged opportunities to connect women to services along the life course.

Programmatic and leadership changes and vacancies in the Adolescent Health Program also created some changes in activities with the adolescent domain NPM. The NPM around adolescent well-visits was addressed with a project between the Title V Office of School and Adolescent Health and Envision NM, a partner at the University of New Mexico. While the need to increase well visit rates has not changed, the Title V program capacity changed due to vacancies. Envision NM also experienced a leadership change, which slowed the work. These changes did lead to expansion and deeper development by Title V staff in the Peer Youth Development program in 2019.

Changes in organizational structure and leadership

The entire leadership of the Department changed in January 2019, with the election of a new Governor Michelle Lujan Grisham.  The new DOH Secretary is Kathyleen Kunkel, and the Deputy Secretary is Dr. Abinash Achrekar, a cardiologist who previously worked at UNM.  At the time of this writing we do not yet have a new Public Health Division Director; however, Dr. Karin Rhodes is planning to start in this position July 8, 2019.  Three of the four PHD Regional Directors also changed in 2019, so we will have a new and revitalized PHD Leadership team moving forward. 

The structure of the Family Health Bureau has stayed mostly the same, although we will be losing one of our programs in 2020 with the creation of a new Department of Early Childhood Education and Care. From DOH this will take the Families FIRST perinatal case management program from FHB, the FIT Early Intervention (Part C) program from the Developmental Disabilities and Supports Division, and home visiting and childcare programs moving from CYFD.