Kentucky identified the state priority needs during the 2015 needs assessment to be:

• NAS Care Coordination
• Treatment For Women With Substance Use
• Access to Care
• Breastfeeding Engagement
• Infant Mortality/SUID/Child Fatality
• Maternal Mortality
• Aces
• Childhood Mental Health/Suicide
• Oral Health of Children
• Obesity
• Children with Special Health Care Needs Services

During 2018, Title V continued to participate in program reviews, data analysis, and evaluations as part of an ongoing needs assessment. These analyses included data review, surveys such as the Behavioral Risk Factor Surveillance System (BRFSS) and PRAMS, advisory board reviews, and regional meetings. A stakeholder survey was developed and piloted at the 2018 KPA and KFAP meetings prior to use for the 2020 needs assessment. MCH has included the parent/consumer voice in survey assessment and education material review.

Emerging Needs

Throughout 2018, these needs continue to be priority with some measures worse than the national average. Patterns for infant mortality, NAS, unsafe sleep, and child injury are higher in the eastern KY where opioid rates are higher. Child suicide and maternal mortality rates continue to rise. Solvency of LHDs and Public Health transformation became an emerging issue for KDPH. To reduce burden on the LHD, MCH began strategically reviewing program structures and processes to identify ways to streamline, reduce or discontinue redundant or unnecessary activities for the LHD staff.

Organizational Structure

The KY Executive Branch has 11 cabinets, with the CHFS being the largest. The state health agency, KDPH, and OCSHCN are organizationally located within CHFS. Administration of the Title V program occurs through the Division of Maternal and Child Health within the KDPH.

The foundational statute KRS 211.180, gives CHFS the responsibility and authority to formulate, promote, establish, and execute policies, plans, and programs relating to all matters of public health. This allows MCH to collaborate with LHDs to fund Title V evidence informed strategies based upon the priority needs. MCH administers many programs, regulatory services, and health promotion initiatives, which include:

• Nutrition Services
  • Federal funded Special Supplemental Nutrition Program For Women, Infants And Children (WIC) including vendor enrollment
  • Nutrition education
  • Breastfeeding education, surveillance, and breast pump rentals
  • Medical nutrition therapy
  • Engagement with local farmer’s markets
• Early Childhood Development
  • Health Access Nurturing Development Services (HANDS), a voluntary home visitation program that supports families from pregnancy (primigravida/multigravida) through age 2 of the child
  • Child Care Health Consultation Program provides trainings and technical assistance to out of home childcare settings on health and safety
  • IDEA Part C, Early Intervention Services – First Steps provides comprehensive services for children with developmental disabilities from birth to age 3
  • Early Childhood Mental Health (ECMH) addresses social, emotional and behavioral issues for children through age 5 and various pilot programs for Help Me Grow
  • Partnership with Governor’s Office of Early Childhood and BHDID to contract with the 14 regional community mental health centers for program implementation
  • Birth Surveillance Registry (KBSR) provides surveillance for possible causes of birth defects through age 5 and linkage of children with birth defects to university genetic clinics and First Steps
  • Kentucky Strengthening Families (KYSF) focuses on enhancing the protective factors of the family
    • In 2019-20, KY will begin a new grant funded initiative in collaboration with the Governor’s Office of Early Childhood
  • Healing, Empowering, Actively Recovering Together (HEART)
• Child and Family Health Improvement  
  • Perinatal program provides technical assistance on reduction of early elective deliveries, presumptive eligibility, and linkage to resources
  • Maternal mortality reviews all maternal deaths, within one year of the end of the pregnancy
  • Pediatric programs include
    • Child Fatality Review and Injury Prevention
    • Coordinated School Health
    • School Health Nursing
    • Childhood Lead and Poisoning Prevention
  • Oral health programs address regulatory review of fluoridation processes for municipal water plants, public health registered dental hygiene programs, LHD register nurse program to screen children and provide fluoride varnish in childcare settings and school settings. While this section moved from MCH during the KDKH reorganization in December 2018, collaboration for activities continues.
• MCH Supportive Services provide epidemiologic support for
  • NAS Surveillance Registry
  • SUID case registry
  • Pregnancy Risk Assessment Monitoring Survey
  • Kentucky Birth Surveillance Registry with linkage to genetic clinics and IDEA Part C services
  • MCH Budget and Expenditure monitoring
• Health Promotions encourage healthy living and prevention activities such as physical activity, optimal nutrition, tobacco cessation/prevention programs, and healthy community programs. This branch moved during the reorganization; however, MCH continues to collaborate on programming for mothers and children.

As per the mandates and authorizations in state statute, services provided by OCSHCN include:

• Direct care gap-filling clinics for those children with a diagnosis on the agency’s eligibility list
• Audiology services, including hearing conservation, testing, hearing aid fittings, and programming for cochlear implants. OCSHCN administers KY’s Early Hearing Detection and Intervention (EHDI) newborn hearing screen surveillance program
• Foster care support programs, which support children with special needs in the child protective service system in collaboration with DCBS
• Family to Family (F2F) Health Information Centers, providing assistance to families and professionals in navigating health care systems; information, education, training, support and referral services; outreach to underserved/underrepresented populations; health programs and policy guidance; and collaboration with other F2Fs, family groups, and professionals in efforts to improve services for CYSHCN
• Operation of the First Steps (Early Intervention) point of entry in the state’s largest region
• Care for CYSHCN through partnerships and collaborations.

Agency Capacity

Title V services are provided in all 120 counties to assure utilization of programming for the MCH population through partnerships and collaborations as described later in the application.

Workforce Development and Capacity:

MCH employs 95 public health staff focused on improving the well-being of all KY women, infants, children, adolescents, and their families. With 154 employees statewide, OCSHCN strengths include organizational structure, collaborative history, financial management, and affiliation with hospitals and universities.

KY CFHS leadership stabilized during 2018 after the appointment of Secretary Adam Meier. Secretary Meier continued the work begun on KHW and supported efforts with KDPH focused on addressing mental health needs to reduce suicides, response to the opioid epidemic, and the Hepatitis A outbreak.

KDPH Commissioner Jeffery D. Howard, MD, continues his service to the Commonwealth. Dr. Howard, a KY Appalachian native, attended the University Of Louisville School Of Medicine prior to the Harvard T.H. Chan School of Public Health. Dr. Howard often states, “KY’s number one public health focus is to address the state’s opioid epidemic.” Dr. Howard has spent much of 2018 traveling to LHDs to understand, at the community level, the public health needs of KY and funding concerns. Technical support and information was provide about Public Health Transformation. Dr. Howard continues to support programming addressing the opioid crisis, NAS, mobile harm reduction pharmacy, and much more that has influence or impact on the health of mothers and children.

Dr. Henrietta Bada, a neonatologist with the University of KY, has served as the Director for the Division of Maternal and Child Health as well as KY’s Title V Director since 2017. Dr. Bada serves as the Mary Florence Jones Professor and Vice Chair of Academic Affairs of the Department of Pediatrics at the University of Kentucky, where she practices clinical neonatology and is an attending for the neonatal abstinence care unit. Dr. Bada, a graduate of the University of Santo Tomas, Manila, Philippines, earned a Masters of Public Health from the University of South Florida. She is Board Certified by the American Board of Pediatrics in General Pediatrics and Neonatal-Perinatal Medicine. She has been involved in clinical and basic science research for several years. Her areas of research include newborn brain disorders, perinatal addiction, and developmental follow-up. She served as Principal Investigator (PI) of the Maternal Lifestyle Study (MLS) in collaboration with other PIs from the University of Miami, Wayne State University, and Brown University. The MLS is a longitudinal follow-up of children exposed to cocaine and or opiates in utero until the children reach 16 years of age. Dr. Bada has numerous publications with recent ones related to the findings on follow-up of children and adolescents who had prenatal drug exposure.

Shellie A. May, BSN, an alum of Bellarmine University’s Donna and Allen Lansing School of Nursing & Clinical Sciences, has served as OCSHCN Executive Director since January 2018.  She has served on a number of boards and committees focused on KY’s most vulnerable children, including OCSHCN’s former Board, the Kid’s Center for Pediatric Therapy, and Easter Seals of Louisville.  She has served on planning and fundraising committees for organizations focused on CYSHCN and oversees OCSHCN Children with Medical Complexity (CMC) CoIIN Grant from Boston University.  She has experience in both administrative and executive level positions, as well as fundraising and legislation.  She has been a mentor for parents of medically fragile children.  As a CMC mother, she brings an important perspective into the life and challenges of CYSHCN and their families.  Shellie continues to be a strong resource for CYSHCN parents.

MCH Leadership Staff:

• Connie White, MD, MS, FACOG is the Senior Deputy Commissioner for Clinical Affairs, and is Board Certified in OB/GYN with emphasis on patient education and preventive medical care
• Henrietta Bada, MD, MPH, is the MCH Division and Title V Director and is Board Certified in pediatrics and neonatal-perinatal medicine and directs all MCH programming 
• Andrew Waters, MPH, is the Assistant MCH Division Director and manages day-to-day MCH operations, budget planning and administration, and functions as the MCH legislative liaison
• Jan Bright, RN, BSN, Manager of the Child and Family Health Improvement Branch, and Title V Block Grant Administrator has 29 years of pediatric nursing experience
• Tracey Jewell, MPH, Manager of the Program Support Branch, MCH Epidemiologist with over 20 years of experience in DPH and Title V
• Nicole Nicholas, MS, RD, LD; Manager of the Nutrition Services Branch has  
• Paula Goff, MS; Manager of the Early Childhood Development (ECD) Branch has over 31 years of experience in ECD programs and IDEA Part C
• Julie McKee, DMD; State Dental Director: KY Oral Health Program.
• Laura Beard, MCH Family Consultant: Early Childhood Mental Health, KY Strengthening Families, and family informed workgroups.
• Vivian Lasley-Bibbs, MPH, directs the Office of Health Equity and is a Health Disparities Epidemiologist and Healthy People 2020 State Coordinator

OSCHN Leadership Staff:

• Shellie A. May, BSN, OCSHCN Executive Director, has served in many public non-profit programs supporting care of children with special needs
• Cherjuantoe Moran, MBA, Director of the Division of Administrative and Financial Services, has over 19 years in various roles in the Office of Management and Budget with Louisville Metro Government
• Karen Mercer, RN, BSN, Interim Director of the Division of Clinical and Augmentative Services has over 20 years of state government service, with over 17 years at OCSHCN and three with the Department of Juvenile Justice
• Ivanora Alexander, BS Biomedical Engineering, Assistant Director of Support Services and has worked over 18 years with rehabilitation engineering with children and adults with special health care needs
• Jonathan Borden, Ed.D. Internal Policy Analyst III, OCSHCN Title V MCH block grant coordinator, has over 15 years of experience dealing with policy analysis and reporting in both the public and private sectors
• Debbie Gilbert, Co-Director, F2F, served 6 years with the Council on Developmental Disabilities (CCDD). She is currently State Coordinator for Family Voices, and she is a state affiliate of Parent to Parent of KY
• Sondra Gilbert, Co-Director, F2F, works with the Am. Acad. of Pediatrics Section on Home Care, Midwest Genetic Network, CMC CollN, Family Voices, and Parent to Parent of KY

Cultural Competence

MCH partners with the Office of Health Equity (OHE) to promote activities raising awareness of health inequities. The OHE provides training on aspects of cultural competence for communities and programs. The OHE partnered with MCH to provide training focused on:

• Public health equity approaches
• How to incorporate equity approaches into state plans for smoke-free environments in public housing
•  Ways to address infant mortality disparities seen in communities of color, in particular African American

OHE prepares the biennial Minority Health Status Report to inform key decision makers about health disparities and inequities affecting Kentuckians. With the guidance of OHE, KDPH adopted a department wide health equity policy to guide equity efforts.

Partnerships, Collaboration, and Coordination

Partnerships with state agencies and community partners extend the reach and influence of MCH. MCH and OCSHCN strive to collaborate with federal partners and private organizations to help meet aligned agency goals and to address the priority needs of the women, children and children with special health care needs. With a 90-plus year history of service provision, OCSHCN has developed formal and working relationships with a variety of programs providing services to children.

Partnerships exist with WIC, family planning, FQHCs, BRFSS, Department for Child Welfare, DBHDID, DMS, and FRYSC. In addition, KY partners with KY Injury Prevention and Research Center at UK, the bona fide agent for injury prevention and the statewide injury prevention plan for children. KDPH and OCSHCN have cross collaboration to provide home visitation to medically complex children in foster care, training, workforce development, expertise, and specialty providers for gap filling services for children with special needs. These collaborations exist with First Steps, Early Hearing Detection and Intervention, Zika Registry, and Child Welfare.