Ohio’s Needs Assessment Update
Ongoing Needs Assessment Activities
The Title V program uses an Action Group structure to manage its MCH Priorities and implement strategies within the 5-Year Action Plan. Each Priority Action Group is assigned an epidemiologist and program researcher to guide the work of a diverse stakeholder group. These stakeholders are made up of internal and external subject matter experts in that Priority topic as well as consumers. The Action Group Co-Leads are responsible for working with the stakeholder group to: update the 5-year Action Plan, assess performance measures outcomes, implement and monitor strategies to impact the performance and outcome measures, and create or identify an evaluation plan used to assess whether or not the interventions have been successful. In addition to the Domain Action groups, program managers utilize data collection, program evaluation, and surveys to solicit feedback and monitor program outcomes. External stakeholders involved in the Action Groups include sister state agencies, medical associations, providers, insurance, parent and family groups representing CSHCNs, universities, local health departments, and community agencies.
In addition to the Action Groups and stakeholder involvement, the BMCFH has created a data workgroup comprised of epidemiologists, researchers and policy analysts. This group is intended to increase awareness of the numerous data sources and program data in the BMCFH; cooperation among the staff responsible for data analysis, support, and production of data products and providing data support; and peer learning.
The following are examples of continued stakeholder involvement and feedback, data collection, monitoring, and evaluation that support and enhance the work of the five-year needs assessment and action plan strategies:
The Ohio Pregnancy Assessment Survey (OPAS) was designed in a partnership with the Ohio Department of Health (ODH), ODM and the Government Resource Center at the Ohio State University (GRC) to develop a statewide, ongoing, targeted population-based survey aimed at identifying groups of women and infants at high-risk for health problems. The 2016 data was synthesized to provide information to Ohio Equity Institute counties to improve intervention selection and implementation; as well as monitor statewide progress in maternal and infant health initiatives and infant mortality risk factors. In 2018, ODH received funding from CDC and the CDC Foundation to administer an opioid supplemental questionnaire. The purpose of this activity is to use the existing methodology and maternal and child health surveillance infrastructure within states using PRAMS methodology to implement rapid surveillance of maternal behaviors and experiences related to use of prescription pain relievers and other opioids among women who deliver a live-born infant. Data from this effort will inform state health departments, clinical providers, CDC, and other federal agencies on programs and policies to mitigate the risk of opioid exposure during pregnancy. Ohio is 1 of 36 sites implementing the supplement.
In September 2018, the ODH entered into contract with the Health Policy Institute of Ohio (HPIO) to lead a large, multi-faceted needs assessment and state planning process to include the State Health Assessment (SHA), development of the State Health Improvement Plan (SHIP), the Title V Needs Assessment, and the Maternal, Infant, and Early Childhood Home Visiting Needs Assessment (MIECHV). Alignment of needs, increasing efficiency and capacity, and greater utilization of stakeholders have been the foundational to the efforts. For the MCH areas, the population domain priority areas will be identified and aligned with the SHIP. Preliminary findings for the MIECHV assessment will also be complied and aligned. The project is managed through a SHA/SHIP Steering Committee and MCH/MIECHV Steering Committee working alongside ODH staff throughout the prioritization and decision-making process.
The process began with stakeholder engagement through five regional forums held in the Fall of 2018. An online survey was also administered to gather additional responses. Feedback was given by 373 regional participants and 400 surveys were submitted. Stakeholder responses were received from: local health departments, maternal and child health agencies and advocacy organizations, hospitals, public health organizations, health providers, home visiting agencies, education, families and those served by MCH funding. Additional meetings were held with the Parent and Medical Advisory Committee’s for CSHCN to capture specific feedback on needs.
Priorities were discussed through the lens of health outcomes, social determinants of health, prevention and health behaviors, and healthcare system and accessibility. A review of data has been conducted using data from the National Outcome Measures (NOMS), National Performance Measures (NPMS) and over 500 metrics compiled in the ODH on-line SHA. Top priorities are being identified through a crosswalk of stakeholder feedback and data analysis based upon Ohio’s performance in comparison to the United States. Prioritization criteria for the five population domains includes the ability to track progress, potential for impact, nature of the problem and alignment. Priorities will be identified in the Fall of 2019 and the development of the Five-Year Action Plan will follow for submission in July 2020.
The SHA was completed in June 2019 and the SHIP will be completed in the Fall of 2019 in accordance with the Public Health Accreditation Board.
Title V Program Capacity
The Bureau of Health Services joined the Bureau of Maternal, Child and Family Health (BMCFH) in June 2019. The BMCFH houses the majority of Title V programs and now includes WIC program, Children with Medical Handicaps and Asthma programs. The Tobacco and Domestic Violence Programs moved to the Bureau of Health Improvement and Wellness but will maintain close working relationships across BMCFH programs.
The Title V Block Grant is administered by BMCFH. ODH is in the process of hiring a Bureau Director who will also serve as the Title V Director. The Assistant Bureau Chief also serves as the Director for Children with Special Health Care Needs (CSHCN).
The BMCFH is designed to improve the health status of women, infants, children, adolescents and CSHCN in Ohio by identifying needs and implementing programs and services to address those identified needs. The BMCFH capacity to address the five population health domain needs is accomplished by engaging in a multidisciplinary, collaborative approach to health improvement in coordination with internal and external stakeholders. Our primary goal is to serve as a safety net for all MCH populations including racial and ethnic groups disproportionately affected by poor health outcomes.
Programs administered and housed within the BMCFH funded by Title V include: Title X Family Planning (FP), the Ohio Collaborative to Prevent Infant Mortality (OCPIM), Ohio Equity in Birth Outcomes Institute (OEI), Ohio Infant Mortality Reduction Initiative (OIMRI); Help Me Grow (HMG) Home Visiting, Maternal Infant and Early Childhood Home Visiting (MIECHV) program, Ohio First Steps for Healthy Babies Breastfeeding Initiative; Centering Pregnancy, Child Fatality Review (CFR), Fetal Infant Mortality Review (FIMR), Pregnancy Associated Mortality Review (PAMR), Sudden Infant Death (SID) Program, Safe Sleep, prenatal tobacco cessation, Save Our Sight vision programs, Genetics Services, Sickle Cell Services, Children’s Hearing and Vision, Newborn Screening for Critical Congenital Heart Disease state mandated by SB4Ohio Revised Code 3701-5010, screening for 36 metabolic, endocrine, and genetic conditions, Ohio’s Birth Defects Information System state mandated by ORC 3705-30, Gestational Diabetes Collaborative, Perinatal Quality Improvement programs, Early Childhood Comprehensive Systems (ECCS) program. DMCFH also houses the School and Adolescent Health and School Nursing programs, the Universal Newborn Hearing Screening (UNHS), and the Infant Hearing Program.
The Children with Medical Handicaps (CMH) program serves CSHCN and administers a diagnostic, treatment, and hospital-based service coordination program, supporting team based service coordination for conditions such as spina bifida and hemophilia; community based service coordination, supporting public health nurses in local health departments who assist families in linking to local resources and helping families navigate the health care system. BHS utilizes vital committee/council structures to foster open dialogue, receive input and feedback regarding CSHCN needs across the state. One of these committees is the Medical Advisory Council (MAC), whose members are appointed by the Director of Health, and represents various geographic areas of Ohio, medical disciplines and treatment facilities involved in the treatment of children with medically handicapping conditions. BHS also houses the Parent Advisory Committee (PAC) composed of parents from around the state who meet regularly to advise CMH. The mission of PAC is to assure that family-centered care is an essential component in the development and delivery of programs and services for CSHCN.
BMCFH also utilizes the medical expertise of two highly skilled physicians who serve as subject matter experts in addressing issues directly impacting MCH populations. Mary Katherine Francis, MD serves as the Assistant Medical Director. Dr. Francis oversees medical issues with the goal of developing and implementing public health policies to improve the health of all Ohioans. Her work places a strong focus on efforts to decrease Ohio’s infant mortality rate, improve maternal health outcomes and collaborate with health care providers. Dr. Francis began her career in the public sector as a licensed social worker and spent many years working in the areas of child welfare and mental health.
In addition, Cynthia Shellhaas, MD, MPH provides medical consultation to BMCFH programs serving reproductive age/pregnant women/children/families and guides ODH’s work in fetal, child and pregnancy fatality and mortality reviews. Dr. Shellhaas is a licensed OB/GYN specializing in maternal-fetal medicine (high risk obstetrics) and holds a full- time faculty position in the Ohio State University's department of OB/GYN.
Key Leadership and Notable Changes
With the change of Governor new leadership is evolving within the ODH. Amy Acton, M.D., MPH, was nominated Director of Health in February 2019. A licensed physician in preventive medicine with a master’s degree in public health, Dr. Acton has more than 30 years of experience in medical practice, government and community service, healthcare policy and advocacy, academic and nonprofit administration, consulting, teaching and data analysis. Dr. Acton received her medical degree from Northeastern Ohio University College of Medicine and completed her internship and residency training in pediatrics at Albert Einstein College of Medicine in New York City, and at Nationwide Children’s Hospital in Columbus. She also completed residency training in preventive medicine at OSU where she also earned a master’s degree in public health. As part of her residency training at OSU, Dr. Acton served at ODH from 1995 to 1996 in what was then known as the Division of Family and Community Health.
Dr. Mark Hurst joined ODH in June 2019 as the Medical Director to advise the Director of Health on clinical and medical issues. Dr. Hurst is board-certified in psychiatry and addiction psychiatry with more than 25 years of work experience with the State of Ohio. Previously, Dr. Hurst worked at the Ohio Department of Mental Health and Addiction Services (OMHAS) for more than 26 years, most recently holding the positions of director and medical director of the agency. While at OMHAS, he served as the clinical lead for the department, including the supervision and leadership of Ohio’s six regional psychiatric hospitals and all drug and alcohol recovery services in the Ohio Department of Rehabilitation and Corrections.
Lance Himes returned to the position of General Counsel. He has also served as interim director and director of the agency. He has more than 15 years of public health experience.
William (Will) McHugh returned to ODH in May 2019, serving as Assistant Director. Will has more than 20 years of previous experience at ODH. His experience has included early intervention, the public health laboratory, infectious disease, communicable disease, and public health preparedness.
In May 2019, Joanne Pearsol joined ODH as the Deputy Director of the new Office of Performance and Innovation where she will develop statewide policies and strategic plans to carry out the mission of public health in coordination with local health departments, public health providers, as well as community action agencies. She will oversee public health accreditation activities as well as lead the agency’s quality improvement efforts. Joanne most recently served as the Associate Director for the Center of Public Health Practices at The Ohio State University’s College of Public Health.
Anna Starr is currently serving as the Interim Chief for the Bureau of Maternal, Child and Family Health. Ms. Starr leads Child and Specialty Health Section including genetics and newborn screening efforts.
Bobbi (Burke) Krabill is the Assistant Bureau Chief to the (former) BHS and is the Director of Children and Youth with Special Health Care Needs.
Laura Rooney, MPH, is currently serving as the Interim Title V Director. Ms. Rooney is the Title V Maternal Child Health Block Grant Program Services Administrator and prior to this role, she served as the Adolescent Health Program Manager within the BMCFH.
Reena Oza-Frank has extensive training and expertise as a Maternal and Child Health epidemiologist. She manages the Epidemiology and Research/Evaluation sections for the Bureau. Dr. Oza-Frank leads the State System Development Initiative (SSDI) and Ohio Pregnancy Assessment Survey (OPAS).
Maurice Heriot, was hired as the BMCFH Financial Program Manager in March 2018. Prior to this position, Mr. Heriot served as fiscal liaison for MCH within the Office of Financial Affairs.
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