Efforts to operationalize the needs assessment (2016-2020) process and findings

Colorado’s MCH Needs Assessment Summary provides an overview of the process and findings for the 2016-2020 statewide needs assessment which was fundamental to the selection of Colorado’s current MCH priorities. Please see section 3.) III.E.2.a. State Action Plan Narrative and III.F. Public Input sections for further detail on a) recent stakeholder input processes, b) use of needs assessment findings to drive program planning and c) performance management practices. 

2021-2025 Needs Assessment Update

Needs assessment activities have been gradually ramping up throughout 2018-9 with the goal of identifying Colorado’s 2021-2025 priorities by the fall of 2019. This timeline will support the transition of work efforts and resource allocation at the state and local levels to reflect any change in priorities for the next five-year cycle. To prepare for prioritization, the MCH program focused this year’s efforts on stakeholder communication and engagement, data collection, partnering on Colorado’s statewide health assessment, and data to prioritization process design, including the creation of a data to action timeline.

A communication strategy was developed and is being implemented to assure that both state staff and external partners are aware of the assessment and how they can participate. This web page was developed with information about the assessment. A kick-off webinar was conducted in August 2018, recorded, and posted on the web page. Monthly updates continue to be shared with state and local partners. A presentation was provided for local public health agency staff in May 2019. Stakeholder engagement is also occurring through key informant interviews, work group participation and an online survey.

The MCH Epidemiologist, in partnership with other MCH staff, developed and compiled quantitative and qualitative data to support the upcoming prioritization process. The MCH Snapshot that describes social determinants of health in the MCH population was updated. Data briefs developed include infant mortality, early childhood obesity, childhood obesity, mental health among children and youth, pregnancy-related depression and anxiety, substance use among women of reproductive age, children and youth with special health care needs, nulliparous term singleton vertex cesarean births  and the 2019 state trend analysis.  Interviews were conducted with MCH Implementation Team leads to learn about their perspective on the future of current priorities, and a brainstorming session was conducted with the MCH Advisory Team to identify potential priorities. Local public health agency priorities throughout Colorado were compiled to inform alignment opportunities with potential future MCH priorities. Finally, MCH staff summarized 22 recent and relevant reports produced by statewide partners to enhance data collection efforts and better assess the health status of the MCH population.

The MCH program also strategically leveraged the 2019 Statewide Health and Environmental Assessment by partnering with the CDPHE’s Office of Planning, Partnerships, and Improvement. The products and priorities from the statewide assessment will be used as building blocks for the MCH needs assessment. This 2018 assessment summary was published exploring seven themes that emerged in Colorado, and the following topics have been prioritized for Colorado’s public health improvement plan: behavioral and mental health; climate change; and healthy neighborhoods. 

The MCH Needs Assessment Project Manager recently designed a data to prioritization process that guides MCH staff to review data, research upstream factors, identify alignment opportunities and gaps, research potential strategies, and develop priority recommendations for the MCH Advisory Group to consider in October 2019.

Noted changes in the health status and needs of the state’s MCH population

Total resident births are down again in 2018, from 64,385 in 2017 to 62,874 in 2018. Colorado is monitoring an increasing trend in preterm birth between 2014 and 2016 (8.4% to 8.9%, respectively), which is also evident at the national level. The increase is most noticeable in late preterm births. Colorado’s infant mortality rate is holding steady at 4.7 per 1,000 in 2018. The African-American infant mortality rate dropped from 11.6 in 2016 to 6.3 in 2018. Please note, these data are statewide, so these rates differ from those reported for SPM 2. Colorado is closely monitoring maternal mortality as a new state law was passed to support reviewing and reporting of data on maternal deaths.

In relation to the identified priority needs, Colorado has made progress in a few areas including infant mortality among African Americans (mentioned above), developmental screening and referral, bullying, and substance misuse prevention.

• The percent of children ages 1-5 who received a developmental screening increased from 47.7% in 2011 to 65.4% in 2017. Please note, these data are from a state-based surveillance system, so the prevalence estimates differ from those reported for NPM 6.

• The percent of high school students who report being bullied on school property or electronically decreased from 25.6% to 24.1%. Please note, these data are from a state-based surveillance system, so the prevalence estimates differ from those reported for NPM 9.

• Colorado saw a significant decrease in the prevalence of women smoking cigarettes during the three months before pregnancy and during the last three months of pregnancy between 2009 and 2017 (before: from 23.2% to 14.5%; during: from 9.0% to 5.2%). Please note, these data are from a state-based surveillance system, so the prevalence estimates differ from those reported for NPM 14. 

• Although the prevalence of women using marijuana at any time during pregnancy crept up to 7.8% in 2016, it dropped to 7.2% in 2017.

• Colorado added questions on maternal mental health, substance use, family-friendly policies, parental leave, and social determinants of health to its new Health eMoms survey. In addition, Colorado added 13 questions on opioid use during pregnancy and six questions on disability to its Pregnancy Risk Assessment Monitoring System in 2019.

Noted changes in the state’s capacity or its MCH systems of care, particularly for CSHCN, and the impact of these changes on MCH services delivery

See Section III.B. Overview of the State for an update on the health insurance and the health care service delivery system as relates to the MCH population. See Section III.E.2.c. CSHCN population domain for more about CDPHE’s CYSHCN work.

Title V Partnerships and Collaborations

Colorado’s Title V MCH program works closely with partners from the nonprofit, education, government, media, and healthcare sectors to accomplish stated goals, with partnerships along the spectrum from communication through collaboration. All partners are invited to engage in the needs assessment process in order to inform issue identification and prioritization.

Please see Supporting Document – 2 for a list of specific partners actively engaged in each of Colorado’s MCH priority areas.

Changes in organizational structure and leadership

MCH Program Staffing Updates

With a change in governor in 2019, CDPHE has also experienced leadership transitions at the executive level.

Jill Hunsaker Ryan, MPH, started as the CDPHE Executive Director in January 2019. Jill is a public health professional with more than two decades of experience in the field. Most recently, she was a two-term Eagle County commissioner, where she focused her efforts on affordable health care, environmental protection, climate action, emergency preparedness and increasing mental health resources. Jill also has served as manager of the Eagle County Public Health agency. Jill was a previous director of the CDPHE Office of Health Disparities, now called the Office of Health Equity, and was a governor's appointee to the state Board of Health.

Carrie Cortiglio, MPH, started as the CDPHE Prevention Services Division Director in July 2019. Carrie has 20 years of experience in population health policy, a Masters in Public Health degree from Harvard University, and strong experience in organizational management and leadership. She has experience in policy and systems change, person-centered stakeholder engagement, and extensive background in navigating the executive and legislative branches of state government. Carrie comes from the Colorado Medicaid agency where she focused on population-level policy efforts to serve some of the most underserved people in our state. Having worked with the Medicaid population, Carrie has a deep commitment to health equity, and represented the state Medicaid agency on food security, working closely with CDPHE and the Colorado Department of Human Services. In her previous role, she also actively supported MCH efforts focused on c-section reduction and women’s mental health.

Colorado’s MCH program has two new additions.

Sarah Grazier, MNM, MCH Section Manager/Title V Deputy Director, joined the team in January 2019, following Heather Baumgartner’s resignation in October 2018. Previously Sarah managed federal demonstration grants for the Colorado Medicaid office, where she led the legislation, Medicaid state plan amendments and state rulemaking to bring the Colorado Money Follows the Person program into a state-funded sustainable model. For three years prior, she oversaw federal block grant and state-funded programs for the Colorado Department of Local Affairs, totaling more than $20 million of fund distributions annually in economic development and community services for all 64 counties in Colorado. Prior to her work in the public sector, Sarah worked in fundraising and communications for the nonprofit sector for more than 15 years. Sarah earned her Master’s in Nonprofit Management in 2005 and also serves as Affiliate Faculty at Metropolitan State University of Denver for the undergraduate Human Services Program.

Alexandrea (Alex) Murphy, MPH, joined the team in February 2019 as the Child Development Systems Integration Specialist and serves as the MCH Implementation Team lead for the developmental screening and referral priority. In order to more intentionally connect MCH developmental screening and referral strategies with access to evaluation and intervention efforts, this position shifted from the Maternal Wellness and Early Childhood Section to the Children and Youth with Special Health Care Needs Section. Alex most recently served as United Way of Metro Chicago’s Director of Health, managing a portfolio of agencies dedicated to primary, behavioral and mental health care and childhood obesity prevention. She led initiatives to expand access to health care through federal, state, and private foundation grants and partnerships. She also spearheaded an effort to secure funding from the Robert Wood Johnson Foundation to translate the science of adverse childhood experiences into policies and practices that foster resilience within the fields of education, justice and health. She’s committed to population health and systems change and has spent time working with youth and families at the Harlem Children’s Zone in New York City and in public schools in Chicago. Alex has a Master’s in Public Health from Yale University.