Ongoing Needs Assessment Activities and Operationalization

The BFH Data Action Team (DAT) leads the Title V ongoing needs assessment activities and supports the continued operationalization of findings. Throughout the year, DAT epidemiologists continuously collect, link, analyze, and interpret data related to the health of women, children, and families. The team provides data driven leadership and support to:

• Monitor health and well-being among Louisiana's women, children, and families
• Guide program planning and evaluation
• Inform health and other public policy initiatives
• Evaluate the effectiveness, accessibility, and quality of health services and prevention programs
• Support public health research
• Translate objective data to inform actions

The sections below describe the main activities to monitor population health, assess the needs of Louisiana’s families, and inform key Title V strategies.

Population Surveillance

Louisiana Pregnancy Risk Assessment Monitoring System (LaPRAMS): Understanding women’s experiences surrounding pregnancy and childbirth is a cornerstone of BFH’s efforts to improve the health of Louisiana mothers and babies. In partnership with the Centers for Disease Control and Prevention (CDC), Title V uses LaPRAMS as a primary source of quantitative and qualitative data around those experiences and maternal behaviors before, during, and immediately following pregnancy.

Louisiana Birth Defects Monitoring Network (LBDMN): The LBDMN is Louisiana’s active Public Health surveillance of children born with congenital medical conditions. By evaluating patient discharge information from all birthing hospitals in Louisiana, LBDMN staff generate confidential lists of children whose medical records are each reviewed by Data Collection Specialists across the state. These data are de-identified and analyzed for patterns and trends over time. Annual reports are prepared for the Louisiana legislature and the National Birth Defects Prevention Network.

Newborn Screening: The BFH Genetic Diseases Program and the Early Hearing Detection and Intervention (EHDI) program lead Louisiana’s newborn screening programs for genetics and early hearing loss, respectively. In order to monitor the number of newborns who are screened and track those in need of follow-up services, epidemiologists from both programs maintain statewide databases of all screens performed. Screening data are linked with birth data obtained through the Louisiana Electronic Events Registry System (LEERS) of the state’s Vital Records program.

Core State Violence and Injury Prevention Program (Core SVIPP): In 2016, BFH received CDC funding to focus on the areas of child abuse and neglect, motor vehicle accidents and intimate partner violence/sexual assault with the cross cutting area of traumatic brain injury (TBI). With Core SVIPP funding, BFH leads the State’s public health approach to violence and injury prevention through improved surveillance efforts, support for evidence-based prevention strategies, data dissemination, and promotion of policy initiatives. BFH’s Core SVIPP convenes statewide learning collaboratives on a shared risk and protective factors approach to the prevention of multiple forms of violence.

Mortality Surveillance

Pregnancy-Associated Mortality Review (PAMR): PAMR is Louisiana’s surveillance and action process which reviews all deaths in women during or within one year of pregnancy, and crafts recommendations for how to prevent future deaths. Louisiana PAMR recently completed a comprehensive review of 2011-2016 maternal deaths that occurred during or within 42 days of the end of pregnancy from a cause directly related to the pregnancy or its management. A comprehensive report of findings was released in August 2018. Beginning in FFY 2018, PAMR expanded its investigation to include maternal deaths that occurred during or within one year of the end of pregnancy from causes directly related to the pregnancy or its management (pregnancy-related deaths) and causes not directly related to the pregnancy (pregnancy-associated deaths).

Child Death Review (CDR) and Fetal-Infant Mortality Review (FIMR): Louisiana’s regional FIMR and CDR teams review unexpected fetal, infant, and child deaths to better understand why these deaths occur and how to prevent them. These teams provide prevention strategy recommendations to local Community Action and Advisory Teams and the State Child Death Review Panel (State CDR). Each year, BFH releases a Louisiana Child Death Review Report, which compiles key findings from data collected over a three year period, including causes of infant and child death by age, comparisons between Louisiana rates and national averages, and prevention recommendations.

National Violent Death Reporting System (NVDRS): In 2016, BFH received a grant award for $1.2 million for five years from the CDC to gather critical data on homicide and suicide using the NVDRS. Data from NVDRS helps state and local officials understand when and how violent deaths occur by linking data from coroners, law enforcement, and Vital Records. The data allow public health practitioners and violence prevention professionals to develop tailored violence prevention efforts.

Program-based Needs Assessments and Analyses

Reproductive Health Needs Assessment: BFH Reproductive Health Program (RHP) staff conducted a comprehensive assessment of needs, opportunities, and resources as part of the process of evaluating the program in preparation for applying for the 2017 and 2018 Title X funding opportunities. Using both qualitative and quantitative methods, including a statewide client survey, staff assessed the reproductive health needs of Louisiana residents and evaluated the reproductive health services offered through OPH Parish Health Units and contract sites around the state.

Children’s Special Health Services Provider Survey: In previous years, Louisiana Title V partnered with external consultants to administer the CSHS Physician Survey. In FFY 2017, the survey was redeveloped and disseminated by Title V epidemiologists. A noteworthy change to the survey was the expansion of the target population to include other professionals who conduct developmental screening. Internal and external stakeholders critically reviewed survey content before the dissemination of the new Provider Survey. Data collection was completed in March 2018. Results from the survey have been used to guide Title V efforts around provider education and technical assistance, as well as advocacy and policy efforts for youth transition, medical home, developmental screening, and insurance. A summary report will be disseminated in FFY 2019.

Early Childhood Risk and Reach: In FFY 2017, BFH released Early Childhood Risk and Reach in Louisiana, a report designed to inform policy and funding decisions that impact the distribution of critical resources that affect the health and well-being of children ages 0-5. The 2-part report compiles and analyzes specific indicators of early childhood well-being: Risk-analysis of 12 indicators of early childhood well-being and Reach-analysis of the availability publicly-funded early childhood programs by parish. The data contained in the report can be tracked over time allowing communities and the state to understand the strengths and vulnerabilities affecting the healthy development of young children. The next version of the report is being developed in alignment with the 2020 Title V and MIECHV needs assessments.

Changes in the Health Status & Needs of the State’s MCH Population

While the priority needs identified in the 2015 Needs Assessment continue to drive the work of Louisiana Title V, the following changes in the health status and needs of the MCH populations have influenced a shift in several State Action Plan strategies.

Maternal Health

Similar to the national trend reported by the CDC’s Pregnancy Mortality Surveillance System, Louisiana has seen an increase in pregnancy-associated mortality, although reasons for the observed increase are unclear.

Use of computerized data linkages, changes in the way causes of death are coded, and the addition of a pregnancy checkbox to the death certificate in many states (LA added mid-2012) have likely improved identification of pregnancy-related deaths over time.

A reliance on vital statistics alone to measure maternal mortality makes it challenging to determine whether increases are the result of improved identification of maternal deaths or changes in risk. Maternal mortality review committees are best positioned to comprehensively assess maternal deaths and identify opportunities for prevention. The PAMR review committee is currently reviewing 2017 cases. Of the 62 confirmed cases, the committee has reviewed 50 cases as of July 2019. The remaining 12 cases will be reviewed by the year’s end. Title V strategies to address this emerging need are described in the Maternal/Women Health narrative.

Adolescent Health

Louisiana has also seen a steady increase in adolescent suicide rates since 2010.

Image Source: Title V Information System (TVIS)

Through CDR, suicides of children <15 years of age were reviewed to identify prevention opportunities. In 2016, suicides were the second leading cause of death, after unintentional injury for children 10-14 years of age. From 2014-2016, the majority of violent deaths in children 10-14 years of age were due to suicide. Of the 22 children who committed suicide in this period, firearms caused 50% of the deaths and hanging/strangulation 32%. CDR panels identified modifiable factors contributing to the suicide fatalities, including access to firearms, insufficient knowledge on responding to children in crisis, hospitals’ approaches to suicidality, early experiences of trauma and inadequate resources to recognize and mitigate the trauma, bullying, and inadequate support for LGBTQ students. Title V strategies to address this emerging need are described in the Adolescent Health narrative.

Title V Program Capacity and BFH Organizational Structure

Since 2012, Louisiana Title V has experienced an extraordinary period of growth and alignment. Between 2012 and 2016, Title V evolved from administratively distinct programs to a single unified Bureau of Family Health. And then in 2017, Emergency Medical Services for Children and the Louisiana Commission for the Deaf, also were incorporated under BFH. This administrative alignment has afforded the opportunity for more collaboration between staff, shared strategies, and synergistic work. However, it has necessitated a new structure to support the complex organization of ~300 staff statewide carrying out the bureau’s work.

In 2017, BFH created a Strategic Planning Committee to guide the organization through a process to identify a new set of values, vision, and mission for BFH, along with a guiding strategies and goals for all programs under the BFH umbrella. Concurrently and informed by feedback from the Committee, BFH leadership also began discussions about and an updated organizational structure. Several months into the process, BFH sought out technical assistance through the MCH Workforce Development Center (WDC) in applying a public health strategic management approach to the formation of the new organization.

Through the WDC’s trainings and coaching support, the following core organizational strategies have emerged that are now guiding how BFH will work and structure staff, programs, and initiatives:

• Identify, understand, and respond to complex challenges and opportunities
• Align resources and efforts to improve health outcomes in the populations we serve
• Build coordinated partnerships toward action
• Test, scale, and spread solutions for impact
• Contribute to the public health evidence-base 
• Foster a positive culture rooted in our Bureau’s values

New Organizational Structure: BFH’s draft organizational structure is attached, however some changes continue to be made as implementation progresses. The vision behind the reorganization is to enable BFH staff to address the strategic questions above and to create synergies and coordination between similar efforts and programs. BFH leadership decided to align efforts through five new teams: 

• Strategy, Policy, Alignment, Communications, Equity (SPACE) Team: The SPACE team sets the standards and ensures an equity-focused approach for BFH’s strategy development and implementation, policy response and development, alignment of efforts across teams around common aims, and effective communication with staff, partners, and populations we serve.
• Business Operations Team: Business Operations sets the standards for BFH’s accountability, efficiency, and stewardship of the public dollar, providing instrumental support for health promotion initiatives across the Bureau
• Data to Action Team: Data to Action sets standards for BFH’s data quality and security, leading data interpretation and translation for systems change and leveraging quality data collection, analysis, and communication to foster positive change in health outcomes. 
• Clinical Services and Systems Team: Clinical Services and Systems sets the standards for BFH’s support, linkage, and provision of high-quality, client-centered care in clinical settings. 
• Family and Community Systems Team: Family and Community Systems sets the standards for BFH’s development, coordination, and provision of family and early childhood systems of care in Louisiana. 

On March 2019, the WDC hosted a two-day in-person training and strategy session to continue the team building process. This session focused on using a change management and adaptive leadership lens to walk BFH through tools for action planning and goal setting. From a strengths-based perspective, representatives from each team, identified as “change agents” learned about these tools and how to apply them to their teams. Throughout the summer of 2019, WDC is hosting monthly TA webinars to support teams as they apply the tools and develop goals for the next year. In September 2019, the WDC will return for an additional training after team have used the tools and created one-year goals. This training will focus on action planning and implementation.

Title V Partnerships and Collaborations

BFH is continuing with many of the partnerships and collaborations as described in the 2015 Needs Assessment Summary. And, with the addition of new programs under BFH, several new federal, state, and local partnerships have formed. The tables below illustrate the breadth of BFH’s partnerships and collaborations with other federal, state and local entities that serve the MCH population in Louisiana. In alignment with the guiding BFH strategy to Build coordinated partnerships toward action, Title V will leverage the 2020 Needs Assessment to intentionally identify the key partnerships that need to be cultivated and coordinated across the Bureau’s activities.