Needs Assessment Update

During interim years of the grant cycle, ongoing needs assessment activities are conducted in various MCH programs across the agency. This provides continuous monitoring of progress, measures/trends, discussions of programmatic work plans, emerging issues for MCH populations not reflected in the plan, assessing of the needs for the state’s MCH population and the evaluation of the capacity of the health care system to meet the MCH population needs. MS MCH provides an ongoing needs assessment update as an annual follow up to the comprehensive needs assessment that is completed every five years in conjunction with the beginning of a new grant cycle.

The Needs Assessment Update for 2019-2020

Activities have focused on continued collection, analysis, and reporting on topics central to the MS MCH population. Mississippi’s MCH Program reviewed both quantitative and qualitative data to identify areas of significant change in 2018 and 2019. The Office of Health Data and Research at MSDH utilized epidemiologists to analyze major quantitative measures of health, including data related to the eight National Performance Measures (NPMs) selected in 2015. The Mississippi MCH program uses a wide array for assessment, policy, planning, policy development, program implementation, monitoring and evaluation. Data sources included but are not limited to the Pregnancy Risk Assessment Monitoring System (PRAMS), and Mississippi Vital Statistics.

Population-based surveys, such as the Behavioral Risk Factor Surveillance System (BRFSS) and the Pregnancy Risk Assessment Monitoring System (PRAMS), provide valuable data for public health program surveillance and evaluation. Mississippi utilized PRAMS data for continued surveillance and evaluation. Disparities among sub‐populations (race/ethnicity, Medicaid/insurance enrollment status, age, geographic location) in the MCH population were highlighted and discussed. Reports were created and updated utilizing this data.

Mississippi has one of the highest infant mortality rates in the nation and has done significant work over the past five years to reduce infant mortality. The Infant Mortality Report is updated yearly as an ongoing needs assessment activity. Additionally, Title V surveillance and evaluation staff continued to monitor HRSA‐supplied data as they are made available via TVIS. Data continues to be provided to internal and external stakeholders via publications and reports.  MSDH also introduced the first County Health Profiles for our state. These profiles provide data on selected public health indicators chosen in collaboration with regional health departments and epidemiologists.  The report provides county age-adjusted rates, percentages for mortality, infant mortality, morbidity conditions, teen pregnancy rates and other public health related categories. The report also provides a comparison of the current period to previous period rates and percentages for Mississippi and the counties. 

 http://www.msdh.state.ms.us/msdhsite/index.cfm/31,8961,211,32,html

Mississippi Title V program realized an area of opportunity based on the previous 5-year needs assessment process results. The most relevant was the lack of experienced, dedicated staff to devote full time and attention to the needs assessment process. There was one experienced individual appointed to coordinate the process supported by a team of MCH staff sharing some duties and activities in the process. Unfortunately, the lack of dedicated staff may have caused the needs assessment to compete with other simultaneous Agency activities allowing less direct focus on the assessment. As a result, Mississippi entered in a contract with the University of Alabama to complete qualitative data as well as other components of the needs assessment. MSDH also hired its first full-time needs assessment coordinator July 2019.

The MCH Needs Assessment Coordinator has worked to coordinate all activities related to the MCH needs assessment.

Tasks include:

• Convene a project team of staff who will implement the assessment.
• Identify a leadership structure for the assessment.
• Develop a work plan and timeline.
• Use the Block Grant guidance to develop an overall approach to the assessment.
• Adopt guiding principles for the assessment.
• Research Framework to guide data collection efforts on social determinants of health.
• Work with University of Alabama (UAB) to design key quantitative data collection methods and identified desired data products (indicator selection beyond the national performance measures is ongoing and iterative).
• Collaborate with UAB to collect new and existing data sets and reports related to the MCH population that we could leverage for assessment purposes.

The current Needs Assessment strategy includes an assessment across MCH populations to include qualitative data (e.g., original surveys, focus groups, and key informant interviews) and quantitative data (e.g., national surveys, state surveys, and primary data collection). The original surveys and primary data collection will assess providers and MCH populations that include adult women, mothers, adolescents, young adults, youth with special health care needs, and families of youth with special health care needs. The surveys will be in multiple languages available online (preferred) and paper formats (when necessary). The focus groups will recruit women of childbearing age, parents of young children, Spanish speakers, Mississippi Choctaw Band members, adolescents, families of youth with special health care needs, and youth with special healthcare needs. The Key Informant Interviews will be conducted with service providers who work with MCH populations. The secondary data sources from national surveys. The State data sources include Mississippi morbidity data, child death review, and maternal mortality review. Primary data includes a contractor designed MS Maternal and Child Health Needs Assessment  Survey, Adolescent Survey, Families of CYSHCN Survey, CYSHCN Survey, and Provider Surveys.

Title V MCH Block Grant Need Assessment Framework

Logic Model

Title V Program Capacity

Organizational Structure

MSDH is the autonomous Title V agency for the state of MS. Unlike other states with multiple public health departments, MSDH serves the entire state. Agency functions are divided between the Governor and the Legislature according to agency structure. The Mississippi Department of Education (MDE), Department of Mental Health (DOM), and Department of Human Services (DHS) are executive branch agencies, while the MSDH is independent. Independent agencies are governed by boards. The Governor appoints board members who provide indirect influence. However, independent agencies must directly negotiate budgets and policy changes with the legislature. With the mix of executive and independent agencies, state agency heads do not function together as a cabinet, resulting in a number of horizontal power bases within the state government structure.

MSDH is the state agency responsible for administering the TVBG, located organizationally within the Office of Health Services (HS). HS directly supports the agency's mission to promote and protect the health of Mississippians through a variety of programs designed to prevent disease, maintain health, and promote wellness for all ages. The Office of Health Services has two primary areas of focus: Health Maintenance and Health Promotion. Health Maintenance strives to improve healthcare services for women and infants, increase efficiency and utilization of available services, and enhance knowledge and skills of both consumers and providers of healthcare services. Health Promotion encourages achievement of optimal health and physical well-being while seeking to minimize risks for chronic disease and injuries. Together, the two areas provide a comprehensive approach to improving health outcomes.

The agency is organized into three public health regions, each serving a particular geographical area. This structure allows MSDH to address the needs of children and families, especially those with low incomes, in a family-centered, community-based and coordinated manner that ensures access and availability of quality healthcare. We have an estimated total of 194 Title V staff, 36 in Region 1, 48 in Region 2 and 64 in Region 3. The other remaining staff are located within our central office (46). There are several positions that are vacant and may remain vacant in FY 2018 due to certain agency restrictions.

Updated organizational charts for MSDH and Mississippi MCH are included in the supporting documents section as well as a detailed listing of MCH Leadership and Program Capacity.

MCH Workforce Capacity

Title V-funded MCH and CYSHCN staff work at multiple levels within MSDH (Central Office, 3 Regions, and local health departments in 82 counties). Mississippi MCH-related programs are organized within the Office of Health Services. A core leadership group oversees MCH-related program areas, including: Perinatal, Infant and Pediatric Care, Developmental Screening, Children and Youth with Special Healthcare Needs, Reproductive and Women’s Health, and Chronic Disease Prevention and Health Promotion. Mississippi MCH currently has MCH Coordinators, MCH Nurses, Pediatric consultants, parent consultants, epidemiologists and various other Title V positions that help move the needle on outcomes in Mississippi.

Mississippi Title V block grant and infrastructure made the shift towards a population health perspective and life course model for programs and data collection in FY16. A key driver is the concept in the ability to work systematically and less programmatically. This also includes developing a framework for increased accountability, measuring inputs and outcomes and looking at how they are related. The ultimate goal would be to improve health and growth potential for Mississippi’s Title V population which includes investing in a strategic balance between quality,  quantity and strengthening linkages between tools (i.e. standards/evidence-based screening tools, curriculum, and assessments) and actions.

iii. Title V Program Partnerships, Collaboration, and Coordination

MS MCH focuses on multiple determinants of health and those determinants make it impossible for one entity or one sector alone to bring about population health improvement.  There are broader efforts that include many sectors needed to make a larger societal commitment to health. With this in mind, MSDH has continuous internal discussions and will consider options for completing a formal assessment of its MCH partnerships in the future.

During the 5-year cycle, the MSDH underwent many changes including reorganization at many levels. Stronger collaboration between agency components as well as with external stakeholders has been the focus for Health Services for the past several years. During the cycle, Health Services has grown from primarily maternal and child health bureaus to a group of seven offices including Women’s Health, Child and Adolescent Health, Preventive Health, Oral Health, Office of Tobacco Control, WIC, and the Office of Health Data and Research. These offices work collaboratively to optimize use of funding, decrease overlaps, fill gaps, and strengthen agency capacity for meeting the needs of the MCH population.

MSDH Health Services has taken great strides to increase collaboration across the state, especially between state and local level components of the agency. During the past few years, the Health Services leadership team has worked to build relationships between central office staff (hinds county) and regional staff (located in 82 counties). Maternal and Child health nurses host quarterly meetings to discuss trends, all program areas within Health Services, provide updates and they also receive RN updates in best practices and new areas of education.  There are also multiple collaborations ongoing between Title V programs and other MSDH program areas within MSDH. Those partners include Office of Preventive Health, Bureau of Infant Health, Chronic Disease Prevention, Immunizations, Vital Records, Office of Health Policy and Planning, Injury Prevention, Tobacco Control, HIV and STD Prevention, Environmental Health and The Office of Performance Improvement.

MS MCH has long-standing relationships with numerous public and private organizations and service providers to carry out the scope of work within the MCH Block Grant. Initiatives for partnerships with governmental agencies and non-governmental agencies continue to flourish in Mississippi. The methodology for supporting and initiating such collaborations comes from different sources. Many times the directives for the collaborations come from political leaders and state agency heads. Where the Needs Assessment is concerned, partnering methods are developed through strong networking and seeking out nontraditional partners to bring to the table. Mississippi’s needs assessment process has revealed the need for implementing collective impact strategies and strategically aligning partnership for more focused work.  These partnerships are vital to the strength of any Needs Assessment process as well improving outcomes for Mississippi families.

A more extensive discussion of MCH partnering and collaborations is contained throughout the narrative for the Block Grant application as well as a list of partnerships is included in the appendix.

The Title V program also works with and provides leadership to a broad range of partners including community health service systems such as local public health and FQHC’s; the private sector, especially managed care plans, nonprofit organizations, and MCH advocates; faith-based organizations; and universities.

Other federal investments:

MS MCH receives other federal investments through PRAMS and Early Hearing Detection and Intervention. Lead Program and Genetics. MCH partners with Preventive Block Grant, Women, Infants and Children, and the Breast and Cervical Cancer Program.

The Adolescent Health program partners with the Office of Preventive Health’s Personal Responsibility Education Program (PREP) in an effort to promote positive youth development and prevent or reduce negative health outcomes.  The PREP Program is funded through the Family and Youth Services Bureau, DHHS, in which the overall goal of the program is to reduce adolescent pregnancy and sexually transmitted infections (STIs). Mississippi PREP envisions all Mississippi youth to have access to evidence-based, medically accurate, age-appropriate sex education programs and resources, empowering adolescents to make safer reproductive health choices. Mississippi PREP carries out this vision by working with school districts, community-based organizations, and youth detention centers in counties that are in the most need of evidence-based sex education programs.