MCH Population Needs

MDPH conducts a comprehensive statewide needs assessment every five years and in interim years engages in activities to ensure that needs assessment is an ongoing process. Below are examples of efforts to monitor and assess the continuing needs of the MCH population in Massachusetts.

Office of Family Initiatives

The legislation Chapter 171 of the Acts of 2002: An Act Providing Support to Individuals with Disabilities and Their Families requires all state agencies under the Executive Office of Health and Human Services (EOHHS) to consult with individuals with disabilities about current level of services and receive input on how to make services more flexible and family-directed. The goal is to improve access, give families the ability to make decisions about how agency resources are allocated, and enhance community inclusion. In response, the MDPH Office of Family Initiatives conducts an annual survey and develops an annual Individual and Family Support Plan, which is submitted to the Secretary of EOHHS, the Governor, the joint committee on Human Services and Elderly Affairs and the House and Senate Committees on Ways and Means.

In 2018, 190 families responded to the survey (134 English, 53 Spanish, and 3 Portuguese). Common themes were the need for assistance in understanding and navigating MassHealth changes, including transition to ACOs; improving connections to families with similar diagnoses and life circumstances; the need for more respite for families caring for medically fragile children; and assistance with school-related issues for children with autism. MDPH uses survey results to improve collaboration with MassHealth, promote awareness of existing services, plan new services, and strengthen the system of care for children and youth with special health needs. Data collection for the 2019 survey is complete. Once all non-English surveys have been translated, analysis will be conducted. Results, including planned activities to address needs identified by respondents, will be available this summer.

WIC Nutrition Program

An annual needs assessment identifies WIC-eligible populations in all 351 cities and towns. WIC recently revised how it estimates eligibility using indication of Medicaid insurance on the birth certificate (which gives adjunctive eligibility for WIC) for prenatal care or labor/delivery, or WIC prenatal use as proxy of eligibility for WIC. These changes give a more accurate assessment of eligibility but preclude comparison with data from earlier years.

Using the new methodology, 211,304 women, infants, and children were eligible in 2017, a substantial increase from 2015 and 2016, and likely reflecting changes in methodology as earlier methodology used estimates of poverty from the 2010 Current Population Survey with a yearly adjustment factor to determine eligibility. Among those eligible in 2017, 49.4% of women, 81.5% of infants, and 52.2% of children participated in WIC. Local WIC agencies use needs assessment results for outreach plans to engage and enroll eligible families. WIC links participant records to MA vital records to better understand the demographics of mothers and infants who are estimated to be WIC-eligible but do not link to the WIC participant database. During the summer of 2019, WIC will be conducting its annual needs assessment of births that occurred in 2018, and anticipates reporting in September 2019.

In addition, WIC conducts an annual participant satisfaction survey. In January 2019, 6,126 surveys were completed, 28% in a language other than English, an increase from 17% in 2017. Overall, 65% of respondents were highly satisfied with WIC. A majority (73%) of participants joined when pregnant, and most new participants learned about WIC from friends and family. Areas for improvement included acknowledging participants’ knowledge and experience as parents when providing nutrition education, clarifying available/allowed foods, and better customer service at WIC offices.

Critical Congenital Heart Defects Hospital Survey

In 2011, the U.S. Department of Health and Human Services recommended that screening for Critical Congenital Heart Defects (CCHDs) be added to the Recommended Uniform Screening Panel for newborns. Congenital heart Defects (CHDs) are the most common type of birth defect in the U.S and account for nearly 30% of infant deaths resulting from birth defects. CCHDs, defined as CHDs requiring surgery or palliative care within the first year of life, comprise one quarter of CHD cases. Early diagnosis is vital to reduce morbidity and mortality. The MDPH Center for Birth Defects Research and Prevention (MCBDRP), in partnership with the Bureau of Health Care Safety and Quality, led efforts to implement this screening in MA birth hospitals. This included issuing communications and guidance to birth hospitals, establishing an advisory group to provide input on screening guidance, and collecting data to monitor screening activities and results. The MCBDRP conducted three surveys to determine the status of CCHD screening and identify potential challenges. Results demonstrated increases in the number of hospitals performing CCHD screening from 2012 to 2017. By late 2017, all MA hospitals were performing screening. The 2017 survey, however, identified several areas for improvement: 1) providing families with written information about screening, 2) following-up with mothers discharged before 24 hours post birth to ensure that screening is done during the 24-48 hour window for the testing, 3) the need for procedures to ensure that screening occurs for infants transferred within the hospital, and 4) more consistent and complete documentation of the screening results, referrals made for diagnostic testing, and the diagnoses made. These results have been addressed in updated guidance for hospitals that will be reviewed during another advisory group meeting in Summer 2019. After that meeting, the guidance will be finalized and distributed to hospitals.

Early Intervention Family Survey

Lead agencies for Part C Early Intervention (EI) Services are required to report annually on family outcomes to the Office of Special Education Programs (OSEP). In MA, family outcomes are measured through administration of the National Center for Special Education Accountability and Monitoring (NCSEAM) Family Survey, a research-based, validated instrument currently used by 23 states. The survey is distributed in March and October to families whose children have been enrolled in EI for at least six months and did not previously complete a survey. Surveys are hand delivered to eligible families by their Service Coordinators and come with a cover flyer explaining the purpose of the survey and a self-addressed, stamped envelope to return the survey to a private vendor. In calendar year 2018, 12,161 surveys were disseminated and 4,461 (36.7%) were returned. Survey responses are analyzed annually using the Rasch measurement framework producing results for three family outcomes: Percent of families who report that EI services have helped the family: a) know their rights (86.8%), b) effectively communicate their children's needs (84.1%), and c) help their children develop and learn (93.1%).  

In addition to using these data in the annual report to OSEP, MA uses the information to identify needed improvements to EI services. Each of the 60 MA EI programs receives an individual report comparing their return rates and family outcome results to aggregate state numbers.

Emerging Issues

Paid Family and Medical Leave

In June 2018 an Act relative to Paid Family and Medical Leave (PFML) was passed. Effective in 2021, the Act provides wage replacement and ensures job protection. Progressive features of the MA legislation include broad definitions of “child” (biological, adopted, foster, step child or legal ward), “family member” (spouse, domestic partner, child, parent, parent of spouse or domestic partner, grandchild, grandparents and siblings), and “health care provider” (any individual determined by the Department of Family and Medical Leave to be capable of providing health care). The benefits include between 50%-80% of wage replacement with a maximum of $850 weekly. This is a success for families in MA, as research clearly indicates that paid parental leave increases female labor force participation, improves family and child health outcomes, and contributes to workforce retention. Through the Infant Mortality CoIIN and Essentials for Childhood, Title V substantiated efforts to pass this legislation by collaborating with state and community partners to provide information on the benefits of paid parental leave for infants, families, communities and businesses. MDPH has met internally to discuss a role for public health in the implementation of the new legislation including supporting eligible families in applying for the benefit and providing input on data collection and strategies to measure the impact of the legislation on family economic well-being.

Pay Equity

Another law that went into effect in 2018 with positive implications for the MCH population relates to gender pay equity. In 1945, MA became the first state in the country to pass an equal pay law, but the gender pay gap persists here and across the country. On average, MA women working full-time earn only 84% of what men earn. The gap is even larger for some women of color. On July 1, 2018, an updated equal pay law went into effect in MA, “An Act to Establish Pay Equity,” that provides clarity on what is unlawful wage discrimination and adds new protections to make workplaces more fair and equal. 

Immigration

Over the past few years there has been growing concern about both proposed and new immigration policies, including family border separation, deportation priorities, and request for cooperation from local officials. This heightened level of stress is negatively affecting families and their children. For example, WIC caseloads have been lower than expected, in part due to fears among immigrant families about negative consequences of accessing public benefits. Title V programs are responding to these concerns by conducting creative family outreach and engagement, ensuring staff  reflect the populations they serve, and, in collaboration with the MA Immigrant and Refugee Advocacy Coalition, educating frontline staff about individual rights when interacting with immigration officials.

Agency and Program Capacity

Organizational Structure, Leadership, and Staffing

Over the past year, the MA Title V program saw significant leadership changes. In February 2018, Craig Andrade became the Title V Director and Director of BFHN, when Ron Benham retired after 35 years at MDPH. Dr. Andrade was previously the Director of the Division of Health Access within BCHAP and oversaw many Title V programs including Sexual Health and Youth Development, School Health, and the Office of Oral Health. In March 2018, Aaron Beitman became the BFHN Director of Administration and Finance, replacing Kathy Messenger who also retired after nearly 40 years at MDPH. Mr. Beitman worked at the Secretariat prior to joining MDPH. Finally, the Director of BCHAP, Carlene Pavlos, left MDPH in March 2018. BCHAP is a key partner in the development and implementation of the Title V state action plan and collaborates with BFHN on many MCH programs and initiatives. In June 2019, Ruth Blodgett was named the Director of BCHAP. Prior to coming to DPH, Ms. Blodgett held several leadership roles at Berkshire Health Systems. Further information about the Title V Partnership senior management team and their qualifications is provided in Attachment 2.

The organizational charts for BFHN and BCHAP are below, and show the divisions and programs within each bureau. BCHAP was restructured during 2018 to better align programs with similar topical areas. The newly formed Division of Child/Adolescent Health and Reproductive Health includes the following programs, which contribute significantly to the MCH Block Grant: Sexual and Reproductive Health, Adolescent Health and Youth Development, School Health Services, and the School-Based Health Center program. An MDPH organizational chart is attached, which shows the location of BFHN and BCHAP within the Department.

As of June 2019, approximately 184 full-time equivalent (FTEs) employees throughout MDPH work on Title V Partnership programs, with 101 FTEs paid from Title V Partnership funds. Approximately 19 of the Partnership-funded total are based in the MDPH regional offices or other off-site locations. There are approximately 83 FTEs working on MCH programs but paid through other federal grants. In addition, BFHN employs over 13 parents of children and youth with special health needs for the EI Parent Leadership Project, Family TIES, and Universal Newborn Hearing Screening Program. 

The share of total staffing supported by Title V continues to decrease due to reduced Title V funding that has not kept up with inflation and bargaining unit increases and due to successful efforts to cost-share staff with other federal discretionary grants. These totals and percentage distributions may continue to change during FY20 as efforts continue to bring the Title V budget into a more secure long-term equilibrium based on expectations of little or no future growth in allocations from HRSA/MCHB. The staff support may also be affected by the loss or reduction of federal discretionary grants.

Partnerships, Collaboration, and Coordination

MDPH is committed to building, strengthening, and sustaining partnerships with other organizations to better serve the MCH population and expand the capacity and reach of the Title V program. MDPH collaborates with families, public and private sector entities, federal, state and local government programs, clinical providers, academia, and public health organizations. Section E.b.2. Family Partnerships and Attachment 3 describe Title V’s partnership with families. Attachment 4 describes partnerships with external organizations, including government agencies, universities, and public health organizations and MCH programs within MDPH. These partnerships, collaboration, and coordination give depth and effectiveness to the MA Title V program and are integral to daily operations.