MCH and CSHCN worked collaboratively to plan and conduct the Title V Five-Year Needs Assessment for grant years 2021-2025. In July 2018, the Title V MCH Director, Title V CSHCN Director, the MCH Assessment Division Administrative Program Manager, the State Systems Development Initiative (SSDI) Project Analyst, and the Child and Adolescent Health Division Administrative Program Manager, began meeting to develop a plan and timeline for Oklahoma’s Title V Five-Year Needs Assessment. The SSDI Project Analyst was designated as the coordinator for leading the state-wide needs assessment. Staff from the MCH Service, CSHCN at the Oklahoma Department of Human Services (OKDHS), and the Oklahoma Family Network (OFN) met to discuss the collaborative effort in October 2018. The focus of the meeting was to provide all members, existing and new, a foundational understanding about the process for the needs assessment. The SSDI Project Analyst developed a strategic plan and Gantt chart outlining the schedule for the two-year process to direct staff in the evaluation and selection of Title V priorities and performance measures.

 

In December 2018, MCH analysts began data collection of MCH health indicators relevant to the populations of women, infants, and children, including those with special health care needs. Data were compiled from the Pregnancy Risk Assessment Monitoring System (PRAMS), The Oklahoma Toddler Survey (TOTS), the Youth Risk Behavior Survey (YRBS), birth and death certificate data, client services data, and the National Survey of Children’s Health. A narrative template was designed to guide analysts in preparing summaries of data analysis. The narrative template provided a uniform, standardized guide for the preparation of stand-alone topic-specific reports. Thereby, extending the topic reports beyond the Five-Year Needs Assessment, allowing use as briefs on MCH-related health issues. However, the primary purpose of the narratives was to inform staff and leadership in the identification and selection of health priorities. The SSDI Project Analyst used the data compiled for the health indicators to build MCH dashboards, which would be maintained to give MCH and its partners’ timely access to data.

 

In March 2019, MCH Assessment released a public input survey via Qualtrics, the online survey software platform. The public input survey was completed by 681 respondents. Survey cards designed with QR codes were distributed at state meetings and conferences, listening sessions, and various routine meetings. Using a smartphone with a QR reader, respondents were routed to the Qualtrics website for completion of the survey. All responses were voluntary and anonymously recorded in the Qualtrics system. Results from the survey were used to identify topics that needed more in-depth assessment and to inform discussions in each Title V domain priority-selecting session.

 

Nine listening sessions were conducted between February 2019 and January 2020. Seven were tribal listening sessions that were held at different venues, including the Go Red for Women Conference which focused on native women (American Heart Association, representative from several Oklahoma tribes), a community baby shower (Cheyenne and Arapaho Tribes), and five separate tribal health care facilities (Choctaw Nation, Cherokee Nation, Chickasaw Nation, Muscogee (Creek) Nation, and the Northeastern Tribal Health System). The purposes of the tribal listening sessions were two-fold: 1) inform Title V programs about the needs and concerns of Oklahoma’s tribal communities, and 2) incorporate the American Indian perspective in the development of MCH priorities for the 2021-2025 Title V MCH Block Grant. The tribal listening sessions provided an improved understanding of the challenges experienced by Oklahoma’s American Indian population when accessing health care, the importance of culturally-informed care, and how programs and services could be improved. MCH conducted two non-tribal listening sessions – one with a family-youth center in Tulsa, Oklahoma, focused on serving the local African American community; the second was held in conjunction with the Joining Forces conference convened by the Oklahoma Family Network. The Joining Forces sessions included families and caregivers of children and youth with special health care needs.

 

In May 2020, MCH launched a Key Informant Survey via Qualtrics. This survey was constructed to collect data from MCH partners to determine if their programs and/or organizations focus on the selected Title V priorities for the upcoming grant cycle 2021-2025. Key informants included MCH partners who lead programs, departments, or agencies which provide health-related services to MCH target populations. Collected information was used to characterize the capacity of Oklahoma’s MCH-oriented health services and programs to meet the needs of MCH populations, as well as to identify areas of mutual interest and possible collaboration on future projects.

 

All compiled data from surveillance and registry systems, the public input survey, and the key informant survey enabled MCH staff to select performance and strategy measures and to formulate a Five-Year Action Plan. The plan continues to be assessed with key strategies targeting stated priority needs. Modifications and refinements to the plan are likely as local developments and emerging issues impact MCH programs, requiring changes or adaptations. MCH, CSHCN, and OFN are committed in partnership to use quality data for monitoring and evaluation efforts to achieve Title V program goals.

MCH Population Needs

The findings are organized by population domains and by the National and State Performance Measures Oklahoma selected for 2021-2025. Developed by MCH Analysts, the following narrative provides health care professionals with information on a topic’s contributing factors, incidence and prevalence, related social determinants of health, burden in Oklahoma, and what is being done in Oklahoma to address these issues.

 

WOMEN/MATERNAL HEALTH

Well Woman Care. The significance of the well-woman or preconception visit is that it provides a critical opportunity to receive recommended clinical preventive services, including screening, counseling, and immunization, and it is a means of optimizing preventive health care across a woman's lifetime. In 2018, 69.7% of Oklahoma women, ages 18 through 44, reported having a preventive medical visit during the previous year, slightly below the U.S. rate of 73.6% (Behavioral Risk Factor Surveillance System). Lack of insurance coverage is a significant factor as to whether women have a well woman visit in the previous year. Oklahoma women with health insurance reported a visit rate of 76.8%, compared to Oklahoma women who lacked health insurance coverage with a visit rate of 44.4%. Also, improvements in racial disparities, based on the preventive medical visit in the past year, show that 87.3% of non-Hispanic (NH) Black women to have had a preventive medical visit in the past year, highest rate for any race or ethnicity in 2018.

 

Current strategies in maternal health in Oklahoma include the Preparing for a Lifetime, It’s Everyone’s Responsibility initiative, the Preconception Collaborative Improvement and Innovation Network (CoIIN), COVID-19 in Pregnancy, and others. MCH partners with the Oklahoma Hospital Association (OHA) and the Oklahoma Perinatal Quality Improvement Collaborative (OPQIC) to develop methods that will standardize designation levels related to the levels of care at birthing facilities.

 

Maternal Mortality. MCH at the Oklahoma State Department of Health (OSDH) works in tandem with other agencies and organizations to improve Oklahoma’s maternal mortality and severe morbidity outcomes. Oklahoma identified the necessity for reducing risks for maternal mortality as one of the key measures identified for improvement in the 2020 Oklahoma Health Improvement Plan (OHIP). The target is to reduce the maternal mortality rate (MMR) from 29.1 per 100,000 live births (2018) to 26.2 per 100,000 live births by 2020. For the period 2004-2018, the majority of maternal deaths in Oklahoma were to mothers aged between 20 and 34 years (54.3%) whereas those mothers of an advanced age (42.6%), were 35 years and older.

 

The MMR reveals racial/ethnic disparities with African American/Blacks being three times more likely and Native Americans to be 1.5 times more likely to experience maternal death compared to whites. The Hispanic 2016-2018 MMR of 4.4 was the lowest among the populations (Table 1).

 

 

 

Oklahoma participates in the Alliance for Innovation on Maternal Health (AIM) Program to tackle the rising maternal mortality and morbidity rates. And, Oklahoma is one of nine states awarded the five-year State Maternal Health Innovation Program Grant in 2019. Currently, Oklahoma only has 48 birthing hospitals as seen on the map below.

 

 

PERINATAL/INFANT HEALTH

Infant mortality. Oklahoma experienced a 15% decline from 8.4 per 1000 live births in 2000 to 7.1 in 2018. Oklahoma ranked 46th in the nation in 2018. Approximately two-thirds of the infant deaths occur in the neonatal period (before 28 days), with the remaining third occurring in the post-neonatal period (28 days to 1 year), Figure 1. For the three-year period 2016-2018, NH-Blacks had the highest Infant Mortality Rate (IMR) at 13.7 per 1,000 live births, followed by NH-American Indian with 10.5 per 1,000 live births. The lowest IMR occurred among NH-Whites with 5.5 per 1,000 live births.

 

 

 

Figure 1. Neonatal and postneonatal mortality rates, Oklahoma, 2000–2018

 

Despite progress, IMR disparities continue to exist. NH-Black and NH-American Indian infants are twice as likely to die as NH-White infants. Whereas, the ratio of IMRs for NH-Black to NH-White has remained constant since 2000, the NH American Indian to NH-White ratio has increased, especially since 2012, Figure 2.

 

Figure 2. Three-year infant mortality rates by race and Hispanic origin, Oklahoma, 2000-2018

 

The risk of infant mortality has been shown to rise as pre-pregnancy body mass index (BMI) increases. Approximately 61% of infant deaths occurred to mothers’ whose pre-pregnancy was in the overweight or obese range, compared to 36% of infant deaths to a mother with pre-pregnancy weight within the normal range. Over 60% of the infant deaths were to mothers who were either overweight or obese prior to pregnancy.

 

For the three-year period 2016-2018, the top three leading causes of infant deaths were congenital anomalies, disorders related to short gestation and low birth weight (LBW), and sudden infant death syndrome (SIDS). The leading causes of neonatal mortality were preterm, congenital anomalies, and maternal complications of pregnancy. SIDS, unintentional injuries, and congenital anomalies were the leading causes for post-neonatal mortality. In 2016-2018, 64% of infant deaths were preterm, that is, born before 37 weeks of gestation, and 53% were born very low or low birth weight.

 

Oklahoma supports several programs to reduce infant mortality including statewide initiatives such as Preparing for a Lifetime, the Fetal Infant Mortality Review (FIMR) projects, the Infant Mortality Alliance, and the Maternal Mortality Review Committee. The state also participates in the national Preconception Collaborative Improvement and Innovation Network (CoIIN) project to improve the health of women prior to pregnancy.

 

Safe Sleep. Although infant sleep-related deaths are preventable, Oklahoma sleep-related infant deaths account for nearly one in five infant deaths. Some improvements have been seen, as the percentage of infants placed on their backs to sleep has steadily improved from 55.7% in 2000 to 76.1% in 2017, and Oklahoma has met the Healthy People 2020 goal of 75.9%.

 

For the two-year period 2016-2017, approximately 56% of Oklahoma infants shared sleep surface with someone else. Figure 4 shows rates of supine sleeping was highest among NH American Indians (79.9%), while NH Whites had the highest rate (60.5%) for putting the infants to sleep alone. NH Black infants had the lowest percentage for supine sleeping (63.0%) as well as the lowest percentage for sleeping alone (35.9%) on a surface (Figure 3).

 

Figure 3. Infant Safe Sleep Practices – Oklahoma PRAMS 2016-2017

 

Initiatives such as Preparing for a Lifetime have raised awareness among parents and caregivers about sleep factors that prevent infant deaths. The Preparing for a Lifetime Safe Sleep Work Group utilizes the American Academy of Pediatrics guidelines when educating Oklahoma families and caregivers, provides sleep sacks at participating hospitals, and maintains a crib project for families in need.

 

Breastfeeding. Mothers and babies who breastfeed experience improved health outcomes and lower risks for certain diseases. For the period 2016-2017, Oklahoma met the HP 2020 breastfeeding initiation goal of 81.9% with 84.7% of infants ever breastfed (PRAMS data) and just over 56% of Oklahoma infants were breastfed eight weeks or more. Although Oklahoma experienced an upward trend since 2004 in the overall percentage of infants ever breastfed and breastfeeding duration of 8 weeks or more, significant disparities by maternal age, race, Hispanic origin, marital status, and annual household income still exist. The 2016-2017 duration rates of breastfeeding eight weeks or more for Non-Hispanic (NH) American Indian women (48.1%) and NH-African American women (48.7%) were much lower than rates for NH-Hispanic White (58.4%) and Hispanic (57.8%) women, Figure 4. Breastfeeding duration rates among adolescent mothers (36.0%), having an annual income less than $24,000, and not being married (42.0%) were the lowest rates among all demographic age groups.

 

 

Disparities, although improving, continue to exist. Maternal practices in hospitals and birth centers can influence breastfeeding behaviors during a period critical to successful establishment of lactation. Oklahoma hospitals have enacted several practices as part of the Baby-Friendly Hospital Initiative in order to address potential barriers. There are 10 certified Baby Friendly Hospitals in Oklahoma.

 

CHILD AND ADOLESCENT HEALTH

 

Physical Activity/Obesity Prevention

Data from the National Survey of Children’s Health 2017-2018 show that 31.4% of children ages 6-11 years in Oklahoma were reported by their parents to have been physically active for at least 60 minutes on each of the past seven days. This is not statistically different than the 27.7% observed for the US. Among adolescents ages 12-17 in Oklahoma, 18.5% were reported by their parents have gotten at least 60 minutes of physical activity during the past seven days compared to 17.5% for the US. This difference was not statistically significant.

 

Data from the Youth Risk Behavior Survey show that the percentage of high school students who were physically active for at least 60 minutes on each of the past seven days has seen little change in Oklahoma, decreasing from 33.1% in 2011 to 29.2% in 2019 (Figure 5). Oklahoma’s 2017 percentage of 29.5% was not statistically different than the US average of 26.1% in 2017. Oklahoma did see improvement in the percentage of students who watched three or more hours of TV on an average school day, which decreased significantly from 36.7% in 2003 to 22.3% in 2019. However, the percentage of students who played video or computer games for three or more hours per day on an average school day increased significantly from 19.1% in 2007 to 48.0% in 2019. In 2019 in Oklahoma, 37.9% of public high school students attended PE class on one or more days during an average school week and 28.1% attended PE on all 5 days during an average school week.

 

Figure 5. The percentage of students who were physically active for at least 60 minutes per day for all seven of the past seven days: Oklahoma and the US, YRBS 2011-2019

 

 

Adolescent preventative medical visit. Access to health care is an important component of safeguarding the health of children. Health care can include the prevention, treatment, and management of illness and the promotion of emotional, behavioral, and physical well-being. While most children are healthy, many health problems can go unnoticed until a condition becomes severe. It is therefore essential to identify and treat health conditions early to prevent or mitigate the impact on a child’s overall health and development.

 

Uninsured children are more likely than insured children to have unmet medical needs, to delay seeing a doctor, and, when hospitalized, have higher rates of morbidity and mortality than children with insurance.1 Additionally, underinsured children are less likely to receive timely and appropriate care, to have a medical home, or to receive necessary referrals. Data from the National Survey of Children’s Health (NSCH) show that in 2016 and 2017, 10.2% of children ages 0-17 years did not have health insurance or a health coverage plan at the time of the survey, which was statistically significantly higher than the 6.1% observed nationwide. Additionally, 9.4% did not have continuous insurance coverage during the 12 months before the survey. Sample sizes were too small to look at other factors, such as race, gender, or age groups.

 

Assessing physical, emotional, and social development is important at every stage of life, particularly with children and adolescents. Preventive medical visits provide an opportunity for providers to influence health and development and they are a critical opportunity for screening patients for suicide, mood disorders, and substance abuse and dependence. Data from the 2016 and 2017 NCHS show that during the 12 months before the survey 74.2% of children ages 6-11 years had one or more preventive visits and 73.5% of adolescents ages 12-17 years had one or more preventive visits. By income level 72.1% of children in households with an income 0-99% of the Federal Poverty Level (FPL) had one or more preventive visits whereas 86.5% of children in households with an income 400% or greater FLP one or more preventive visits.

 

Teen Pregnancy. Related to health care access, teen pregnancy has been a long standing public health concern. Teens have higher rates of unplanned pregnancy and enter later into prenatal care than older mothers. Babies born to teenage mothers are at elevated risk of poor birth outcomes, including higher rates of low birth weight, preterm birth, and death in infancy. Teen birth rates are at historic lows in Oklahoma and decreased 59% from 71.5 births per 1,000 females ages 15-19 years in 1991 to 29.6 in 2017. However, Oklahoma’s teen birth rate has declined at a slower pace (59%) than the national average, which decreased 70% during the same time span, Figure 6.

 

Figure 6. Teen Birth Rates by Age of Mother: Oklahoma, 1991 to 2018

 

 

 

Compared to other states in the nation, including the District of Columbia, Oklahoma’s teen birth rates ranked the 5th highest for 15-19 year olds, the 3rd highest for 18-19 year olds, and the 7th highest for 15-17 year olds. Racial and ethnic disparities exist among teen births in Oklahoma. In 2018, Hispanics had the highest teen birth rate at 36.7 births per 1,000 females ages 15-19, followed by NH-Blacks at 33.8, NH-American Indians at 31.1, whites at 23.4, and NH-Asian Pacific Islanders at 10.4.

 

Repeat teen births continue to be an important public health concern. In 2017, nearly one in five births (17.5%) was to teen females with one or more previous live births. One in five (20.9%) females ages 18-19 years had one or more previous live birth(s) and one in twelve (8.4%) females ages 15-17 years had one or more previous live birth(s).

 

MCH has continued the administration and monitoring of the following state and federally funded teen pregnancy prevention (TPP) programs/services: Oklahoma Healthy YOUth (OHY), Personal Responsibility Education Program (PREP), and Pregnancy Assistance Fund (PAF). PREP funds supported implementation of adolescent pregnancy prevention projects through contractual agreements with the city-county health departments in Oklahoma City and Tulsa.

 

The number of state-funded adolescent pregnancy prevention projects in local county health departments supported by MCH totaled five administrator areas in 24 counties. Coverage areas were determined and prioritized through analysis of county-level teen birth rate data. MCH supported projects continued to use evidence-based programs (EBPs).

 

Bullying.

In Oklahoma, the prevalence of having been bullied on school property during the 12 months before the 2019 survey was 19.4%, a statistically significant increase from 17.5% in 2009. The prevalence of having been bullied electronically during the 12 months before the survey was 14.5% in 2019, which shows no statistical change from 15.6% in 2011 (Table 3).

 

	Table 3. Trends in the prevalence of bullying: Oklahoma YRBS, 2009-2019
		2009	2011	2013	2015	2017	2019
Bullied on school property in the past 12 months		17.5	16.7	18.6	20.4	21.3	19.4
Bullied electronically in the past 12 months		-	15.6	14.3	14.5	16.1	14.5

 

Females were more than 1.5 times as likely as males to have been bullied on school property at 24.5% and 14.3%, respectively. Females were twice as likely as males to have been bullied electronically at 19.2% and 9.7%, respectively.

 

 

 

 

Table 4. Prevalence of bullying by gender: Oklahoma YRBS 2019
	Female	Male
Bullied on school property in the past 12 months	24.5	14.3
Bullied electronically in the past 12 months	19.2	9.7

 

Additionally, data from the YRBS 2019 show that students who were bullied on school property or bullied electronically were more likely than students who had not been bullied to report signs of depression, suicidal ideation, and current use of alcohol.

 

MCH works with the Oklahoma Department of Mental Health and Substance Abuse Services, and the Oklahoma State Department of Education providing training to parents and community members to understand the pervasiveness and the damaging effects of bullying, learn the signs of bullying and how to help schools, and communities implement effective strategies to prevent the continuation of bullying in the community.

 

CHILDREN WITH SPECIAL HEALTH CARE NEEDS

 

Children and youth with special health care needs (CSHCN) is defined by MCHB as children who “have or are at increased risk for chronic physical, developmental, behavioral or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally.” Exact estimates for the number of CSHCN in Oklahoma is difficult to establish due to this broad definition. The complexity of the child’s condition is widely variable when defining CSHCN. Additionally, different survey data may not include the same CSHCN when describing who these children are. Other than primary health care, children and youth with special health care needs and their families often require additional support. Areas of additional support include, but are not limited to, social services, transition, education, and mental health.

 

According to NSCH 2017-2018, it is estimated that there were 217,565 children with special health care needs in Oklahoma. This equates to about 23 percent of children in Oklahoma. The majority (73%) of children with special health care needs in Oklahoma are aged 6 or older (n=158,877). According to OKDHS Adult and Family Services, there were 16,685 medical children receiving SSI from October 2018 to September 2019. As such, less than ten percent of the children with special health care needs were receiving medical SSI. There is much work to be done to reach the children with special health care needs in the state of Oklahoma.

 

 

Through the Title V Block Grant, since 2018, partners have provided direct/enabling services to 5,365 children or families of children with special health care needs (see below). This year alone, partners have provided direct/enabling services to 886 children or families of children with special health care needs. Types of direct services provided by Title V partners include: Coordinated Family Advocacy, Behavioral/Mental Health Services, Education Consultation, Respite Services, Physical Services (such as Medical or Allied Health Services), Healthcare Transition Services, Sib Shops and others.

 

MEDICAL HOME:   

Data from the 2017-2018 National Survey of Children’s Health indicated that, among children ages 0-17 years with special health care needs, more than half (56%) in Oklahoma had care which did not meet medical home criteria. Similarly, 57.3% of children with special health care needs in United States had care, which did not meet medical home criteria. Differences by age in Oklahoma were not statistically significant.

 

Oklahoma Health Care Authority (OHCA), the state’s Medicaid agency, provides a variety of services in an attempt to assist in meeting the immense need for Medical Homes in Oklahoma. OHCA provides the Patient-Centered Medical Home managed delivery system, called Soonercare Choice Program, in which contracted partners are required to offer care coordination, such as assisting with referrals for specialty care. According to OHCA’s May 2020 Fast Facts, 12,099 children with special health care needs were enrolled in SoonerCare Choice with a little over half, approximately 59%, residing in urban areas of the state.

 

Not all children in Oklahoma with special health care needs are on Medicaid (Soonercare). For those children who are not currently on Medicaid or who do not meet the financial criteria for Medicaid, Oklahoma CSHCN currently has several contracted programs in place to help provide some level of care that meets the Medical Home definition. CSHCN currently partners with the Oklahoma Infant Transition Program (OITP) at OUHSC. OITP provides family support for newborns in the NICU which includes training, information, and emotional support activities while the child is in the NICU. Other community partners who currently provide care with a medical home approach include the Oklahoma Family Network (OFN), Sooner SUCCESS, Family Partners, and Oklahoma Family Support 360 Center (OKFS360°).

 

TRANSITION TO ADULT HEALTH CARE: 

Data from the 2017-2018 National Survey of Children’s Health indicated that, among children ages 12-17 in Oklahoma, more than three-fourths (78.2%) did not receive services necessary for transition into adult health care. This is compared with 81.1% nationwide; however, the difference was not statistically significant.

 

Oklahoma CSHCN contracts with Sooner SUCCESS at the Oklahoma University Health Sciences Center (OUHSC). Sooner SUCCESS has been charged with addressing Healthcare Transition in the state of Oklahoma. Sooner SUCCESS is currently conducting a pilot study with selected clinics at the OUHSC in order to establish standard policies and procedures for healthcare transition and increase the number of families at these pilot sites who are aware of and/or report receiving healthcare transition.

 

Oklahoma CSHCN also partners with the Sickle Cell Clinic at OUHSC. The Sickle Cell Clinic enrolls all patients with Sickle Cell Disease ages 13-21 into the Sickle Cell Transition Program and then follows them at least 2x per year. The Sickle Cell Clinic creates transition summaries for all patients in the transition age group and provides those summaries to the patients transitioning from pediatric to adult care. The Sickle Cell Clinic plans to establish better tracking to identify and reach out to those patients who have been lost to follow-up.

 

ACCESS TO SERVICES FOR BEHAVIORAL HEALTH NEEDS: 

Data from the 2017-2018 National Survey of Children’s Health indicated that, among children ages 3-17 in Oklahoma who have been diagnosed by health care provider with a mental/behavioral condition, 56.6% received mental health treatment or counseling.

 

According to the Oklahoma Department of Mental Health and Substance Abuse Services, for Fiscal Year 2019 there were 88,676 children aged 0-17 served by a Mental Health program in Oklahoma.

 

All of the current CSHCN Title V partnerships in Oklahoma either provide some type of direct trainings or assistance for mental and/or behavioral health or they provide information and referral to the families to help educate and encourage them to seek out assistance.

In Oklahoma, state health and human services are organized under the Cabinet Secretary of Health and Mental Health and the Cabinet Secretary of Human Services and Early Childhood Initiatives, offices which are appointed by the state’s governor. Kevin Corbett is the Cabinet Secretary of Health and Mental Health and Justin Brown serves as the Cabinet Secretary of Human Services and Early Childhood Initiatives. Health and human services agencies include the Oklahoma State Department of Health, Oklahoma Human Services, Oklahoma Department of Mental Health and Substance Abuse Services, Department of Rehabilitation Services, Office of Juvenile Affairs, Oklahoma Health Care Authority, and the Oklahoma Commission on Children and Youth. The Oklahoma Commission on Children and Youth (OCCY) has responsibility with planning and coordinating children’s services in the state, along with providing oversight for juvenile services. The agency heads of the major agencies serving children are appointed to serve on the OCCY.

 

Oklahoma administers the Title V MCH Block Grant through two separate state agencies, the Oklahoma State Department of Health (OSDH) and the Oklahoma Department of Human Services (OKDHS). As the state’s health agency, OSDH is authorized to receive and disburse Title V MCH Block Grant funds under the provisions for public health of Oklahoma Statute Title 63, Sections 1-105 through 1-108. These sections created the OSDH, and originally charged the Commissioner of Health to serve under the Board of Health, and outlined the Commissioner of Health's duties as "general supervision of the health of citizens of the state." In 2018, new legislation was enacted making the Board of Health an advisory body to the Commissioner of Health, who is now appointed by the state’s governor. Title 10 of the Oklahoma Statutes, Section 175.1 et.seq., grants the authority to administer the CSHCN Program to the OKDHS.

 

Organizationally, the Title V MCH Program is located in Family Health Services, under the Community Health Services branch, at the OSDH. Joyce Marshall, MCH Director, is directly responsible to the Assistant Deputy Commissioner of Family Health Services, Tina Johnson, who in turn reports to Keith Reed, Deputy Commissioner of Community Health Services. Deputy Commissioner Reed reports directly to the Interim Commissioner of Health, Lance Frye, MD. Tamela Hamilton, MD, is the Chief Medical Officer for the OSDH, reporting to Deputy Commissioner Reed of Community Health Services. MCH Service is structured with three divisions: Child and Adolescent Health (CAH), Perinatal and Reproductive Health (PRH), and MCH Assessment. Each division is supervised by an Administrative Program Manager with more than 15 years of public health experience. The respective staffs of these three divisions are highly trained with many years of experience in MCH programming.

 

Programs or projects administered by Title V funds, at least in part, include Preparing for a Lifetime, It’s Everyone’s Responsibility; Preconception IM CoIIN; MCH Cribs Safe Sleep Project; Pregnancy Risk Assessment Monitoring System (PRAMS); the Oklahoma Toddler Survey (TOTS); the Youth Risk Behavior Survey (YRBS); teen pregnancy prevention projects; positive youth development projects; bullying prevention; youth suicide prevention; the State Systems Development Initiative (SSDI); fetal and infant mortality review; school health, including school nurses; child passenger safety training; maternal mortality review; Becoming Baby Friendly; and other MCH-related programs and initiatives. MCH was awarded a State Maternal Innovation Program Grant which collaborates closely with Title V to achieve mutual goals and objectives.

 

The Title V CSHCN Program is located in the Adult and Family Services Division under Adult Services Director Kristi Blackburn, Adult and Family Services Director Patrick Klein and Deputy Director for Programs Linda Cavitt. Carla McCarrell-Williams is the Director of the CSHCN Title V Program. Ms. Blackburn reports to Justin Brown, the DHS Director. Mr. Klein reports to Ms. Blackburn. Mrs. Cavitt reports to Mr. Klein and Mrs. McCarrell-Williams reports to Mrs. Cavitt.

 

The CSHCN Program oversees the provision of social services to children receiving Supplemental Security Income (SSI) by providing training and guidance to the social services specialists throughout the state, who are responsible for developing and monitoring service plans for children who receive SSI and other services through the OKDHS. CSHCN program information can be accessed via the social services specialists and the OKDHS website. Contracts are in place with the Oklahoma Family Network, Comprehensive Pediatric Sickle Cell Clinic, Family Support 360°, Oklahoma Infant Transition Program, Family Partners, Sooner SUCCESS, and the JD McCarty Center to provide high quality, family-centered services to Oklahoma’s CYSHCN.

 

Brief bio-sketches for key MCH and CSHCN staff are attached and can be obtained by contacting MCH at (405) 271-4480 or paulaw@health.ok.gov. Related organizational charts are also attached.

Oklahoma Title V maintains the capacity to assure that services are available throughout the state for all five population health domains. MCH, CSHCN and the Oklahoma Family Network (OFN) work collaboratively to provide services and technical assistance for service providers and families statewide.

 

MCH continues to be involved in the work of the Oklahoma Perinatal Quality Improvement Collaborative, the Child Health Group, Child Death Review Board, Suicide Prevention Council, Bullying Prevention Coalitions, Home Visiting Advisory Group, Child Care Advisory, Children’s State Advisory Work Group, Sooner SUCCESS Advisory Group, among others, to improve the well-being of women, infants, and children throughout the state, including CSHCN. Oklahoma’s MCH Service continues to lead Preparing for a Lifetime, It’s Everyone’s Responsibility, the statewide infant mortality initiative launched in 2009 to reduce infant death overall and to eliminate the racial/ethnic disparities in infant death.

 

MCH has developed and maintained close working relationships with state-level programs and with regional directors of the county health departments. Multiple and various opportunities exist to engage in activities with OSDH leadership to promote and advocate for Title V programs, including regular meetings for Deputy Commissioners, Directors, and Managers. The Title V MCH Director attends standing meetings with all Family Health Service Directors, providing opportunities to discuss crosscutting activities. MCH routinely collaborates with other OSDH programs to address issues of mutual interest, including preconception care, health across the life span, family planning, maternal mood disorders, breastfeeding, tobacco cessation, obesity, injury prevention, immunizations, newborn screening, adolescent pregnancy prevention, school health, infant safe sleep, family resource and support services, child care, early childhood, and social determinants of health.

 

MCH population-based services are provided through county health departments, professional service agreements, vendor, sub-recipient and state agency contracts, requests for proposals, and invitations-to-bid. Despite being administratively separate from the OSDH system, the Oklahoma City-County Health Department and the Tulsa Health Department are essential MCH partners, providing services and/or administering projects through direct contracts with the MCH Service.

 

The Oklahoma CSHCN Program at OKDHS oversees service provision to children receiving Title XVI Supplemental Security Income (SSI) through training and guidance to over 95 Social Service Specialists. These Specialists are responsible for writing, implementing, and monitoring plans for all children receiving SSI benefits and other services, via OKDHS. Families of children receiving SSI, but not Medicaid, are contacted to assure they are aware of services available through the CSHCN Program. Title V funds non-Medicaid compensable inpatient behavioral and psychological services to children in OKDHS custody. The CSHCN Program contracts with clinics to provide care to neonates in the Tulsa and Oklahoma City metropolitan areas. The CSHCN Program also contracts with community-based programs that provide education, information, referral, advocacy and resource navigation to families of children with special health care needs statewide.

 

CSHCN continues to develop relationships with various state and local agencies, and divisions within those agencies, in order to educate them about the CSHCN population and advocate for this population. CSHCN continues to be involved on the Sooner SUCCESS Interagency Council, Healthcare Transition Committee, Oklahoma Caregiver Coalition and Respite Subcommittee, Oklahoma Transition Council, and Joining Forces Committee, among others.

 

Title V funds are used to support program collaboration and coordination, and community activities across the state. To assure families have a voice in MCH and CSHCN programs and activities both MCH and CSHCN contract with the Oklahoma Family Network (OFN). OFN has created a statewide network of families which enables state Title V programs to engage with families at the individual and community levels on MCH-related issues. The MCH Title V Director, the CSHCN Title V Director, and the OFN Executive Director attend monthly MCH/CSHCN program meetings for strategic planning purposes and to review and discuss progress of relevant initiatives.

Title V MCH Block Grant funds 37 full-time equivalent (FTE) positions. Of those employed by MCH, 9 have more than 10 years’ experience working in MCH, 13 have 5-10 years’ experience and 11 staff members have less than 5 years with the program. The CSHCN Program consists of two staff funded in part by Title V dollars, including the Title V CSHCN Director and one program staff, both with more than 10 years’ experience at Oklahoma Department of Human Services working with populations with special needs. Both entities contract with the Oklahoma Family Network which has more than 20 years’ experience providing a family voice to programs and agencies serving children and youth across the state.

 

A more detailed description of the training conducted for the development of Oklahoma’s MCH-related workforce can be found in Section III.E.2.b.i. of the block grant narrative, Workforce Development. Brief biographies of key Title V staff who serve in lead MCH and CSHCN-related positions and program staff who contribute to the state’s planning, evaluation, and data analysis capabilities are attached.

 

Oklahoma’s Title V programs have strong relationships with state and community-based public and private partners, and emphasize through these relationships the goal of promoting and protecting the health of MCH populations. The MCH Title V Director, CSHCN Director, and the OFN Executive Director are members of the Child Health Group and have provided continuing input into the formulation of statewide efforts to address health needs in the child and adolescent population.

 

Stakeholder input into Title V programming and activities is sought via a variety of mechanisms. These include regular meetings, opportunities for collaboration on supplemental grant applications, surveys, staff participation in projects, and in more informal ways during networking opportunities. MCH consults with the OSDH tribal liaison when tribal participation is key to the work being discussed and works with the OSDH Office of Minority Health, to assure those communities who need to be part of the planning and implementation process are included.

 

Table III.C.2.b.iii.1 highlights key partner programs and agencies that Oklahoma Title V and OFN collaborate with to improve health across the five domains: women/maternal, perinatal/infant, child, adolescent, and CYSHCN.

 

Table III.C.2.b.iii.1. Key Partnerships with Oklahoma Title V
Chickasaw Nation	Cheyenne Arapaho Nation	Southern Plain Inter-tribal Health Board	Cherokee Nation	Choctaw Nation	Muscogee (Creek) Nation
Indian Health Service	Sooner SUCCESS	WIC	Go Red for Women	John 3:16 Mission, Tulsa	OK Child Care Resource and Referral Association
Oklahoma City County Health Department	OK Department of Mental Health and Substance Abuse Services	Families	Northeastern Oklahoma Tribal Health System	Oklahoma State Department of Education	Central Oklahoma Healthy Start
Head Start State Collaboration Office	Family Support and Prevention Services  (OSDH)	March of Dimes	Youth Services Tulsa	Child Death Review Board	OU Department of Pediatrics (OKC)
Oklahoma Development Disabilities Council	Oklahoma Healthcare Authority	Oklahoma City-County and Tulsa Fetal and Infant Mortality Review Teams	Oklahoma Institute for Child Advocacy	Head Start State Collaboration Office	Tulsa Healthy Start Projects
County Health Departments	Maternal, Infant and Early Childhood Home Visiting Programs (MIECHV,OADDH)	OU Health Science Center Child Study Center	Oklahoma Primary Care Association	Oklahoma Commission on Children and Youth	OU Health Sciences Center
Healthy Schools Oklahoma	Screening and Special Services (OSDH)	Oklahoma Turning Point	Oklahoma Partnership for School Readiness (OPSR)	OU Children's Medical Center	Safe Kids Oklahoma
Immunization Service (OSDH)	Child Care Services (OHS)	Center for Health Statistics (OSDH)	OU College of Social Work	OU College of Nursing and School of Medicine	The Oklahoma Transition Institute
Oklahoma Suicide Prevention Council	Oklahoma Partnership for School Readiness (OPSR)	Injury Prevention Service (OSDH)	Oklahoma Highway Safety Office	Oklahoma Tribal Child Care Association (OTCCA)	Child Care Advisory Committee
Oklahoma Mother's Milk Bank (OMMB)	Oklahoma Hospital Association	Perinatal Center of Oklahoma	Oklahoma Family Network	George Kaiser Family Foundation	American College of Nurse Midwives
Association of Women’s Health, Obstetrics and Neonatal Nurses	The Parent Child Center of Tulsa	Community Service Council (Tulsa)	Child Guidance (OSDH)	Oklahoma Perinatal Quality Improvement Collaborative	OSU-Tulsa
OU Medical Center Women's Services	Center for the Advancement of Wellness (OSDH)	Oklahoma Autism Network	Center for Early Childhood Professional Development (CECPD)	Kirkpatrick Family Foundation	Tulsa Health Department
Little Dixie Healthy Start	Coalition of Oklahoma Breastfeeding Advocates (COBA)	SoonerStart (OSDH)	Oklahoma State Medical Association (OSMA)	Variety Health Center	Emergency Preparedness and Response Service (OSDH)
Oklahoma Breastfeeding Resource Center (OBRC)	Oklahoma Center for Poison and Drug Information	THRIVE	AMPLIFY	Maternal Health Task Force	Maternal Mortality Review

 

The identification and selection of Oklahoma Title V priority needs were based on the results of a public input survey, tribal listening sessions, analyses of state data, a capacity assessment of Title V and MCH-related programs, recognition of ongoing and emerging issues, and the expertise of MCH and CSHCN professionals. While not exhaustive of all possible assessments, combined these efforts afforded a rich and varied examination of strengths and needs of pregnant women, mothers and infants, and children in the state of Oklahoma.

 

After the data were collected and analyzed, the Title V Block Grant Coordinator held a series of guided discussions for each domain using the information from the listening sessions, state data, survey input and staff and family expertise. Contractors, MCH and CSHCN staff and family representatives participated and worked to identify priorities and emerging needs. These selected priorities (eight to ten per domain) were used to guide the selection of the final eight Oklahoma Title V priorities by the MCH/CSHCN leadership team.

 

Using a multi-voting technique and the PEARL (Propriety, Economics, Acceptability, Resources, Legality) test, MCH/CSHCN leadership discussed and voted on the potential priorities and then determined which met the PEARL test criteria for Title V programs. Table III.C.2.c1 shows the potential priorities considered by Oklahoma Title V for inclusion in the top priorities for the state.

 

Table III.C.2.c1 List of Potential Title V Priorities for Oklahoma

Resources and Title V capacity were kept in mind when selecting priority needs. The final Title V Priority Needs were chosen as a result of needs assessment findings, existing capacity, and potential for improvement (See Table III.C.2.c2).

 

Table III.C.2.c2 Oklahoma Title V Priority Needs 2021-2025

The following performance measures in Table III.C.2.c3 were selected based upon the findings from our current five-year needs assessment and alignment to selected Title V priorities. Oklahoma Title V elected to continue the three State Performance Measures from the previous Needs Assessment cycle, due to their continued importance in improving the health and well-being of the MCH/CSHCN population and their relationship to current priorities. Specific rationale is listed in the third column for each performance measure selected along with the Oklahoma MCH Title V Priorities impacted by each measure.

 

 

The above referenced state and national performance measures were chosen as those that best represented the needs of the Oklahoma maternal and child health population through extensive surveys and listening sessions conducted throughout the state resulting in MCH Priority areas identified. These measures were also selected based upon data trends and health impact upon residents.