Goals, Framework and Methodology

The Connecticut Department of Public Health (DPH) is designated as the principal State agency for the allocation and administration of the Maternal and Child Health Block Grant (MCHBG). Federal legislation mandates that an application be submitted annually, and that an MCH Statewide Needs Assessment be conducted every five years. The Department completed its 2020 MCH Block Grant Needs Assessment, which will be submitted to HRSA with its federal FFY 2021 application in September of 2020. The Five-Year Needs Assessment identified nine (9) State priorities that are addressed with the selection of six (6) National Performance Measures (NPM), four (4) State Performance Measures (SPM), and 6 Evidence Based-or Informed Strategy Measures (ESM).

The MCH Needs Assessment and Planning process is an iterative, collaborative process that has engaged organizations, agencies, and residents across the state. The process was guided by a life course perspective to examine risk and protective factors across the lifespan, social determinants of health framework and a health equity lens to explore the upstream factors that influence population health, and a health equity lens to identify differential patterns of health across population groups.

The process for completing the MCHBG Needs Assessment was built upon engagement processes from the 2019 Connecticut State Health Assessment (SHA) with involvement of the Connecticut Maternal and Child Health Coalition. The Connecticut Maternal and Child Health Coalition is a group of almost 200 stakeholders representing all aspects of maternal and child health.  Members include health care providers, human services organizations, and advocates who meet regularly to advance the health of mothers and children throughout the State.  The group met in March 2020 to discuss data and provide insight into potential MCH priorities in the state.

Planning for Healthy Connecticut 2025 State Health Improvement Plan (SHIP) has been delayed due to COVID-19.  Although we were not able to align these processes at this time, we look forward to highlighting areas of alignment in our first annual update for the Title V Block Grant.

Stakeholder Involvement

The MCH chapter of the SHA acts as the core for the MCHBG needs assessment. Community engagement for the SHA included a series of focus groups conducted in collaboration with faculty and students from the University of Connecticut School of Public Health. The purpose of these focus groups was to identify community health concerns, assets and barriers to health; recommendations to address community health priorities; and residents’ vision for the future. Maternal, infant, and child health-specific populations represented in focus groups included: 

•       Black/African American Women 
•       Families Affected by Autism 
•       Families of Children with Special Healthcare Needs 

•       Hispanic Community
•       LGBTQ Younger Adults 

CT DPH held two data presentations with the Coalition and local health partners to share preliminary findings from the State Health Assessment and solicit feedback on its development. Both presentations occurred in August 2019. In addition, to further ensure that the SHA represents the perspectives and speaks to the most important needs of Connecticut’s residents, CT DPH presented a draft of this assessment report on its website for a public comment period in November of 2019.

The input collected from the community via these various means is detailed in a companion document, “Community Engagement.” Companion documents are available on the Coalition website.

The MCH Coalition was engaged via a data presentation, discussion, and rating exercise to identify the draft priorities for the MCH Five-Year Action Plan from the emerging themes that came out of the MCH Needs Assessment.  Key stakeholders were also engaged via feedback sessions to confirm the draft priorities for the MCH Five-Year Action Plan and gather input on how progress could be measured, and how partners could be engaged.  Two feedback sessions were conducted virtually due to COVID-19 shutdowns, with over 80 stakeholders participating from the Medical Home Advisory Council, and those who worked in the areas of Child Health, Adolescent Health, and Children and Youth with Special Health Care Needs. DPH also engaged internal and external subject-matter experts in each domain to provide input, guidance, and feedback on the priorities as well as the components of the Five-Year Action Plan.

Quantitative and Qualitative Methods

Quantitative and Qualitative methods were employed on the State Health Assessment on data collected through focus groups with MCH stakeholders across the State, public and partner input, Connecticut Department of Public Health (CT DPH) input, and analysis of secondary data.  Data sources included the Connecticut School Health Survey, Hospital Discharge Data, the National Survey of Children’s Health, the Pregnancy Risk Assessment Monitoring System, Vital Records, and the U.S. Census.  This data, along with supplemental stratifiers and indicators, was used to inform the MCH Block Grant Needs Assessment Report.

Data Sources 

The list of indicators used for the MCH Block Grant Needs Assessment was guided by existing initiatives (e.g., Healthy Connecticut 2020, National Prevention Strategy) and shaped throughout the process by the feedback from stakeholders and partners. During MCH-focused discussions for the Connecticut SHA, members of the Health Improvement Planning Coalition, Advisory Council, and State Health Assessment Indicators Advisory Group provided data on specific topic areas. 

Data for the MCHBG Needs Assessment were from a variety of sources:

•       Connecticut School Survey (CSHS)
•       Hospital Discharge Data
•       National Survey of Children’s Health
•       Pregnancy Risk Assessment Monitoring System (PRAMS)
•       Vital Records
•       United States Census

Other sources from which the health indicators were derived include, but are not limited to: Behavioral Risk Factor Surveillance System (BRFSS), National Immunization Survey (NIS), Substance Abuse and Mental Health Services Administration (SAMHSA) Survey on Drug Use and Health Model-Based Estimates, US Department of Health and Human Services Administration for Children and Families, Connecticut Department of Public Safety, Bureau of Labor Statistics, and the Connecticut Department of Energy and Environmental Protection. 

A comprehensive Maternal and Child Health Needs Assessment Report can be found in the Supporting Documents section.

Interface between the Needs Assessment data, the state’s Title V priority needs and the state’s Action Plan

Data from the Needs Assessment was used to identify the emerging MCH priorities across the state, which were used to identify the Title V Priorities for the state’s Action Plan.

Findings

MCH Population Health Status

Domain 1: Women’s and Maternal Health

Just over half of women who gave birth in Connecticut in 2016-2018 were non-Hispanic White, one quarter were Hispanic, 12.2% were non-Hispanic Black, and 10.2% were non-Hispanic Other race.  Hispanic and non-Hispanic Black women were disproportionately likely to reside in a female-headed household. 

Connecticut has the third lowest teen birth rate in the country.  However, among all women giving birth, prevalence of unintended pregnancy was high, especially for non-Hispanic Black women (57.0%).  This could contribute to racial disparities in maternal morbidity and mortality.  In the three months prior to becoming pregnant, diabetes was most prevalent among non-Hispanic Other race women (3.3%), high blood pressure among non-Hispanic Blacks (7.1%), depression among non-Hispanic Whites (10.9%), poly-cystic ovarian syndrome (PCOS) among non-Hispanic Other race (6.2%), and anxiety among non-Hispanic  Whites (22.1%).  Non-Hispanic Black and Hispanic women were more likely to be overweight or obese than their non-Hispanic White or non-Hispanic Other race counterparts.

During pregnancy, 11.2% of women in Connecticut developed preeclampsia in 2016-2018, which was highest among non-Hispanic Black women (16.3%) and lowest among non-Hispanic Other race women (7.0%).  Overall, 10.6% of women in Connecticut developed gestational diabetes, which was highest among non-Hispanic Other race women (16.0%) and lowest among non-Hispanic White women (6.5%). The prevalence of gestational diabetes was also strikingly high among the uninsured (17.1%) and is increasingly common with age.  Overall, 7.3% of women had thyroid problems, with the highest prevalence’s among non-Hispanic White women and older women. Finally, 3.7% of women had PCOS, with a range of 4.4% among non-Hispanic White women to 2.2% among non-Hispanic Black women.  Approximately eight to ten women die in Connecticut each year, due to pregnancy-related causes.

Following delivery of a live birth in 2016-2018, 11.6% of women in Connecticut reported postpartum depressive symptoms.  However, the racial/ethnic patterns shift, with lowest prevalence among non-Hispanic White women (9.3%) and highest among non-Hispanic Other race women (19.4%).  Among these women, less than half sought help for their symptoms, ranging from 20.8% of non-Hispanic Other race women to 44.6% of non-Hispanic White women.

Domain 2: Perinatal and Infant Health

Singleton preterm birth and low birthweight (LBW) rates show persistent racial disparities in Connecticut.  In 2014-2018, 6.2% of non-Hispanic White women gave birth preterm, compared to 10.4% of non-Hispanic Black women.  Similarly, 4.4% of non-Hispanic White women gave birth to an infant with LBW, compared to 9.8% of non-Hispanic Black women.  These patterns have been consistent for nearly 20 years, if not longer.  Connecticut’s infant mortality rate (IMR) was 4.6 deaths per 1,000 live births in 2017 down from 5.9 deaths per 1,000 live births in 2005 – a decrease of about 2.4% each year. Connecticut’s IMR has consistently remained well below both the US rate and the Healthy People 2020 target of 6 deaths per 1,000 live births since 2010.  However, disparities persist.  Non-Hispanic Black infants were more than three times as likely to die and Hispanic infants were 1.5 times more likely to die than non-Hispanic White infants in Connecticut in 2017.

Racial disparities in infant health continue postnatally.  Most women in Connecticut reported that their health care provider had recommended they place their infants to sleep on their backs during 2016-2018.  However, fewer women reported putting their infants to sleep on their backs only.  Only 62.2% of Black women reported solely back sleeping compared to 87.0% of White women.  Breastfeeding practices also vary by race/ethnicity.  While 85-95% of women of all race/ethnicities report initiating breastfeeding postpartum, by 8 weeks, only two-thirds of Hispanic and non-Hispanic Black women are still breastfeeding, compared to 72.9% of non-Hispanic Whites and 82.2% of non-Hispanic Other race women. 

An increasing concern in Connecticut is infants born with Neonatal Abstinence Syndrome (NAS) – a condition where a neonate goes through withdrawal from certain drugs that they were exposed to in the womb.  Most commonly, NAS is due to chronic maternal opioid exposure.  In Connecticut, the number of hospital discharges for infants born with NAS in 2017 (440) was three times higher than the number in 2003 (137).  Collaborative partnerships have formed in Connecticut between non-governmental professional organizations, multiple state agencies, and public/private professional organizations to address NAS in the state.

Domain 3: Child Health

Overall, 92.2% of children aged 0-17 years old were reported to have excellent or very good health in Connecticut in 2017-2018.  However, disparities exist in some manageable and preventable childhood conditions, indicating room for improvement.   Just under 10% of children in Connecticut currently had asthma in 2019, ranging from a prevalence of 8.2% in families earning >$75,000 annually to 14.1% in families earning <$35,000.  In 2019, 14.3% of children in Connecticut had dental decay in the past year.  However, the proportion varies substantially by sociodemographic subgroups.  Families with incomes >$75,000 had the lowest prevalence of children with dental decay (10.9%), while children in families earning <$35,000 had the highest (20.7%).  Similar disparities exist by race and insurance coverage for both asthma and dental decay.

The medical home model for children and adults is a proven approach to provide comprehensive and high-quality primary care.  In 2017-2018, Connecticut (49.4%) trailed the U.S. average (59.9%) in the proportion of children without special health care needs who received coordinated, ongoing, and comprehensive care within a medical home.  Connecticut also exhibits disparities across race and ethnicity for children receiving care within a medical home. Non-Hispanic White children receive care within a medical home 32% more than non-Hispanic Black children, 30% more than Hispanic children, and 14% more than non-Hispanic children of any race. 

The proportion of children with a mental/behavioral health condition who received treatment or counseling declined in both Connecticut and the U.S. between 2011-2012 and 2017-2018.  In Connecticut, the proportion declined from 69.9% to 56.6%.  Between 2012 and 2017, the proportion of children under three years-old who received a developmental screening rose consistently from 16.2% to 39.8%.  However, this is still less than half of the population, indicating that improvement is still needed, but appears promising, given the current trend lines.

Adverse Childhood Experiences (ACEs) are stressful or traumatic events, including abuse, neglect and household dysfunction that occur during childhood.  Adverse childhood experiences and trauma are risk factors for depression, anxiety, and post-traumatic stress disorder.  In their most extreme form, ACEs can result in death.  In Connecticut in 2015-2018, over two out of five deaths due to family violence occurred among Connecticut’s youngest residents between 0-17 years of age.  Non-Hispanic White residents comprised the largest proportion of deaths related to family violence, followed by non-Hispanic Black and Hispanic residents, respectively.  Based on population rates, non-Hispanic Black residents had proportionately higher rates than other race and ethnicity groups.  To address the immediate threat of violence, as well as long terms health consequences, the State of Connecticut is engaged in several public health and policy initiatives.

Domain 4: Children with Special Healthcare Needs

Children and youth with special health care needs (CYSHCN) have or are at increased risk for chronic, physical, developmental, behavioral, or emotional conditions. In addition, they often require more health-related services beyond what is required by children generally.  There is a well-documented benefit for children in having health insurance. In 2001, nearly three-quarters of children and youth with special health care needs had private insurance (73%).  However, in 2016, the proportion of children and youth with special health care needs who had either private or public insurance was split relatively evenly (54% and 48%, respectively).

Among CYSHCN, Connecticut (42.7%) was slightly ahead of the U.S. average (39.8%) in the proportion of children who received coordinated, ongoing, and comprehensive care within a medical home in 2017-2018.  In contrast, only 50.4% of CYSHCN in Connecticut were reported as receiving needed and effective care coordination, compared to 59.8% of children in the U.S. on average, in the same time period.  Connecticut (13.5%) also trailed the U.S. (18.9%) in the proportion of 12-17-year-old CYSHCN who received the services needed to transition to adult health care.  Families of CYSHCN reporting receiving care in a well-functioning system varied greatly by age.  In 2017-2018, the proportion was 24.0% for 0-5-year-olds, 32.0% for 6-11-year-olds, and 3.3% for 12-17-year-olds.  Overall, 11.2% of parents of CYSHCN reported they were usually or always frustrated getting services for their child, compared to only 0.3% of parents of children without special health care needs. 

The prevalence of mental/behavioral health conditions has been increasing among children and has been found to vary by geographic and sociodemographic factors. Further, the receipt of treatment is also generally dependent on sociodemographic and health-related factors. Adequate insurance and access to a patient-centered medical home may improve mental health treatment.  In Connecticut, a slightly higher proportion of non-Hispanic White children with a mental/behavioral condition received treatment or counseling, compared to Hispanic children with a mental/ behavioral condition (71% and 66%, respectively). Conversely, 29% of non-Hispanic White children and 34% of Hispanic children with a mental/behavioral condition did not receive treatment or counseling.  In 2017-2018, 4.0% of children (aged 3-17) in Connecticut had ever been diagnosed with Autism Spectrum Disorder (ASD).  This is almost double the national percentage. This may speak to more awareness and screening of ASD among Connecticut residents when compared to the US overall.

Domain 5: Adolescent Health

Use and misuse of illicit drugs (e.g. heroin, fentanyl, cocaine), prescription opioid medications and alcohol are major issues nationally and in Connecticut.   In recent years illicit drug use among Connecticut high school students has declined.  Nonetheless, over 10% of high school students reported ever taking prescription pain medication for non-medical reasons.  Prevalence was highest among Hispanics (14.2%) and lowest among Whites (8.0%).  Prevalence was notably consistent across grade levels.  Only 3.7% of Connecticut high school students currently smoke cigarettes and only 1.3% report frequent use.  In contrast, 44.8% report ever using an electronic vaping product, 27.0% report current use, and 8.5% report frequent use.

Bullying is considered a traumatic event, and fighting may be considered either a traumatizing experience or a consequence/outcome of having repeated exposure to trauma. Bullying also indicates disruption in the school setting that impacts school connectedness, which is an important protective factor for substance use, sexual behavior, mental health, and academic success.  In recent years, Connecticut females were more likely than Connecticut males to be bullied on school property. In 2019, 21.3% of females and over 14% of males reported being bullied on school property in the past 12 months.  Bullying was more common among younger students and among Hispanics and non-Hispanic Whites, compared to non-Hispanic Blacks.  The percentage of females being cyberbullied is also consistently higher than the percentage of males in recent years, with 17.3% of females and 11.4% of males reporting the experience in the past 12 months.  Youth who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are more likely to be bullied, both on school property and electronically, when compared to students who identify as heterosexual. The percentage of LGBTQ youth who reported cyberbullying was almost double the percentage of heterosexual youth who reported cyberbullying, 26.9% versus 14.9%.

In the 2019, the prevalence of physical dating violence was 8.7% among students who reported only opposite sex partners, compared to 19.5% among students with partners of the same sex or both sexes.  Prevalence of sexual dating violence varied dramatically among high school students, with 8.8% of heterosexual students reporting it, compared to 24.2% of those identified as being gay/lesbian/bisexual, and 25.4% of those “unsure” of their sexual identity.  Among Connecticut high school students, 7.5% report being forced to have sexual intercourse in their lifetimes.  Prevalence was 4.1% of heterosexual students, compared to 17.9% of gay/lesbian/bisexual students, and 6.1% of those unsure of their identity.

Nationally, suicide contemplation by high school students in the last 12 months was 17.2%. By comparison, Connecticut is below the national average. In 2019, 15.9% of females and 9.3% of males reported considering suicide in the past 12 months.  In 2019, 8.3% of females and 5.2% of males attempted suicide.  Significantly more Hispanic students (10.1%) attempted suicide compared to Blacks (5.8%) and Whites (5.7%).  In 2017, 5.8 youths (aged 10-19 years) per 100,000 died by suicide in Connecticut.  In 2018, the rate was 2.8 per 100,000.

The mission of the DPH is to protect and improve the health and safety of the people of CT by: assuring the conditions in which people can be healthy; promoting physical and mental health, and preventing disease, injury and disability. In 2019, Ned Lamont was elected Governor and in May 2020, Governor Lamont appointed Dr. Deidre Gifford to serve as Acting Commissioner of DPH. 

The Title V Program is located within the Community, Family Health, and Prevention Section (CFHPS). The Title V Program is responsible for the direct or indirect administration of programs carried out with funds from the MCHBG. The majority of CT's activities serving mothers, infants, children, adolescents, and children and youth with special health care needs reside within the CFHPS, including: Autism Spectrum Disorder; Children and Youth with Special Health Care Needs including Respite and Extended Services; Family Advocacy; School Based Health Centers; Sickle Cell Disease; Maternal Mortality Review; Case Management for Pregnant Women; Family Planning; Healthy Choices for Women and Children; Supplemental Nutrition Assistance Program; Birth Defects Registry; Early Hearing Detection and Intervention; State Systems Development Initiative; Pregnancy Risk Assessment Monitoring System; Family Wellness Healthy Start; Provide Supplemental Nutritious Foods; Breastfeeding promotion and support; and Nutrition education. These programs either receive Title V funds or work in collaboration with the Title V Program.

The Title V Program resides within the Community, Family Health and Prevention Section (CFHPS). The CFHPS works to improve the health of the overall population across the lifespan, especially mothers, infants, children, adolescents and other vulnerable groups, by establishing opportunities that support healthy living habits through education, early detection, access to care and chronic disease prevention. The CFHPS is comprised of the following units: 1) Women’s Health and Prevention; 2) Adolescent and Child Health; 3) Maternal and Child Health Epidemiology; 4) Chronic Diseases; 5) Women, Infants and Children (WIC); and 6) Epidemiology. The CFHPS also includes the: 1) Genomics Office; 2) Office of Oral Health; and 3) Office of Injury and Violence Prevention. Staff work collaboratively across units and offices to coordinate resources and maximize program capacity.

Leadership:

Rosa M. Biaggi, MPH, MPA, and Mark Keenan, RN, MBA serve as the Section Chiefs in the CFHPS. Marc Camardo, MPH, is the Supervising Epidemiologist and serves as the Title V Director, SSDI Director, and Acting Dental Director and reports to Mark Keenan. Ann Gionet, BBA, is the Children with Special Health Care Needs Director and reports to Mark Keenen. Selma Alves, MPH, is the MCHBG Family Advocate and reports to Ann Gionet.

Title V Capacity to Provide and Assure Services

Domain 1: Women/Maternal Health

Family Planning: promotes decreasing the birth rate to teens, age 15-17, preventing unintended pregnancy, and increasing access to primary reproductive health care. Case Management for Pregnant Women: provides comprehensive perinatal and inter-conception services to pregnant and post-partum women, who are alcohol or other drug dependent and at high risk for poor birth outcome. Family Wellness Healthy Start Program: to promote healthier pregnancies and reduced rates of birth complications among African American and Hispanic women. The program serves pregnant and postpartum women and their children up to two years of age. MCH Information and Referral Service: toll-free hotline for information on health and related services. Pregnancy Risk Assessment Monitoring System (PRAMS): provides the DPH with data about maternal health, experiences, and behaviors during the perinatal period, and advance knowledge about risk and protective factors among CT mothers, and to investigate the associations between these factors, birth outcomes and maternal and infant health. Personal Responsibility and Education Program (PREP): Pregnant teens are at increased risk for health complications including premature birth, delivering low birth weight infants, other serious health problems, and death. The DPH partners with youth services to implement evidence-based programs in schools and other settings. Maternal Mortality Review (MMR): confirms cases of perinatal maternal deaths and develops policy recommendations. The Office of Oral Health works with the American College of Obstetrics and Gynecology and the March of Dimes to address oral health during the prenatal period.

Domain 2: Perinatal/Infant Health

DPH supports sites for primary care and pregnancy testing at family planning clinics. Outreach services in Hartford engage pregnant women into early and regular care. Breastfeeding provides optimal nutrition for infants and is associated with decreased risk for infant morbidity and mortality and maternal morbidity. CT has a Baby-Friendly hospital initiative. CT birth facilities require further education on adhering to the standard clinical practice guidelines against routine bottle supplementation when breastfeeding.

Connecticut State Law mandates that all newborns delivered in the state be screened for selected genetic and metabolic disorders. The Newborn Screening Program consists of: Testing, Tracking, and Treatment. Specimens are tested at the State Laboratory; all abnormal results are reported to the DPH Tracking Unit who reports the results to the primary care providers and assures referrals are made to the State funded Regional Treatment Centers (RTCs). All babies born in CT are screened prior to hospital discharge or within the first 4 days of life for early identification of increased risk for selected metabolic or genetic diseases so that medical treatment can be promptly initiated to avert complications and prevent irreversible problems and death.

The Early Hearing Detection and Intervention (EHDI) Program coordinates data collection, tracking, and surveillance as part of the public health system; and promotion of timely diagnosis of hearing loss and prompt enrollment in Birth-to-Three through partnership building and provider and parent educational initiatives. The goal of this program is to reduce the loss to follow-up/documentation of infants who have not passed a physiologic newborn hearing screening examination prior to discharge from the newborn nursery in order to improve quality developmental outcomes for infants identified with hearing loss.

Domain 3: Child Health

The DPH is working with primary care providers to incorporate parental education on developmental milestones and communicates benefits of standardized developmental monitoring and screening to parents and providers in primary care settings highlighting the CDC’s “Learn the Signs. Act Early” materials.  The Children and Youth with Special Health Care Needs program coordinates the CT State Heath Improvement Plan Developmental Screening Workgroup and links activities with the CT Act Early team to increase developmental screening through the strategies of conducting an educational and awareness campaign that targets families and communities on the importance of developmental monitoring and screening; training community and healthcare providers to improve screening rates and coordination of referrals and linkage to services; and engaging in cross systems planning and coordination of activities around developmental screening.

The Immunizations Program distributes vaccines to providers throughout the state, conducts surveillance for vaccine preventable diseases, conducts quality assurance reviews for vaccines for children programs, conducts educational programs for medical personnel and the public, works with providers using the immunization registry to assure that all children in their practices are fully immunized, promulgates rules and regulations related to vaccination requirements for day care, schools, colleges and universities.

The DPH Nutrition, Physical Activity, and Obesity (NPAO) Program has been implementing the Go Nutrition and Physical Activity Self-Assessment for Child Care (Go NAPSACC) initiative with center and home-based early care and education programs (ECEs) to address childhood obesity.  Go NAPSACC is an online system that helps ECEs create a healthier environment for the children they serve through a five-step improvement process: best practice assessment, action planning, implementation, training and technical assistance support, and re-assessment to evaluate progress.

Domain 4: Children and Youth with Special Health Care Needs (CYSHCN)

The DPH requires the CYSHCN community-based networks to: 1) operate programs that are family-centered with family participation and satisfaction; 2) perform early and continuous screenings; 3) improve access to affordable insurance; 4) coordinate benefits and services to improve access to care; 5) participate in spreading and improving access to medical home and respite services; 6) participate in developing the community-based service system of care, and 7) promote transition services for youth with special health care needs. Emphasis is placed on family education and in building care coordination capacity within provider practices.

The Connecticut Medical Home Initiative (CMHI) for CYSHCN includes five community-based regional medical home care coordination networks; a statewide point of intake, information and referral; provider and family outreach and parent-to- parent support; and access to respite and extended services.

Respite Services: Care provided in or out of the home giving relief to the family/caregiver from the daily responsibilities of care provision for the child/youth with special health care needs. Respite services are family-directed.

Extended services: Deemed medically necessary and appropriate by the medical provider of the CYSHCN, and include durable medical equipment, pharmaceuticals, specialized nutritional formulas and other DPH’s approved extended services/goods for families of CYSHCN whose income is less than or equal to 300% of the federal poverty level guidelines and who are not eligible for the CT Medicaid or Healthcare for UninSured Kids and Youth programs.

The DPH established the Medical Home Advisory Council (MHAC) to improve the community-based system of care for CYSHCN by ensuring their connection to a medical home that is accessible, compassionate, comprehensive, coordinated, continuous, culturally effective and family-centered. The MHAC includes representation from parents (families/caregivers) of CYSHCN, partners in the CMHI, service providers, community-based organizations, and public and private agencies.

The DPH is fully committed to fostering a system that provides all YSHCN the services necessary to make successful transitions to adult life including adult health care, work and independence.

Domain 5: Adolescent Health

The DPH works with multiple state partners and stakeholders to address the needs of CYSHCN, as well as the health of every adolescent in the state. This includes a firm commitment to increasing access to comprehensive health services offered primarily at Community Health Centers (CHCs) and School Based Health Centers (SBHCs), including an emphasis on prevention and well-child visits.

SBHCs are freestanding medical clinics licensed as outpatient or hospital satellite clinics that are located within or on school grounds. SBHCs serve students, Pre-Kindergarten through grade 12, and are in elementary, middle and high schools. SBHCs provide primary care, mental health services, and health promotion/education/risk reduction activities. Dental care is also available at some sites.

Connecticut DPH supports 92 school health services sites in 27 communities throughout the state. Included are 80 School Based Health Centers (SBHC) and 12 Expanded School Health Services (ESHS). Services vary by site and can include diagnosis and treatment of acute injuries and illnesses, management and monitoring of chronic disease, physical exams, administrating immunizations, prescribing and dispensing medications, laboratory testing, counseling, health education, health screening, psychosocial care, and prevention services.

Mental health services are a priority within the SBHCs and experienced adolescent health clinical staff that provide medical, mental/behavioral health services are employed. One focus is suicide prevention among adolescents. Care is delivered in accordance with nationally recognized medical/mental health and cultural and linguistically appropriate standards.

Rosa M. Biaggi, MPH, MPA and Mark Keenan, RN, MBA are Chiefs of the CFHPS and previously served as the Title V Maternal and Child Health Director. Marc Camardo, MPH, is the current Title V Maternal and Child Health Director, State Systems Development Initiative Director, and Acting Oral Health Director and reports directly to Mark Keenan. Ann Gionet is the Children with Special Health Care Needs Director and reports to Mark Keenan. Ms. Gionet coordinates the public input section for the block grant application by holding focus groups and contacting individual family readers.

The CFHPS employs 91 permanent staff with expertise and skills in various areas of public health having graduate degrees or have experience in nursing, social work, allied health, health education, research, evaluation, epidemiology, law, planning, administration and management. Most CT's Title V program activities reside organizationally within the CFHPS. The proposed FFY 2021 plan will maintain overall staff support at 22.0 FTE positions.

The MCHBG supports a full time equivalent in the Health Information Systems and Reporting Section to maintain vital record databases containing information on births, deaths, hospitalizations and risk factors related to maternal and child health. Epidemiologists use vital record information to help direct and evaluate Title V program activity. Funding from the MCHBG also provides support for staff in the Newborn Screening Program, the Fiscal Office, Public Health Systems Improvement, and Grants and Contracts.

Staff from other programs across the DPH collaborate and/or provide support to the Title V staff. These programs include: Obesity, Asthma, WIC, Environmental Health, STD, HIV, Vital Records, State Laboratory (Newborn Screening) and Tracking Units, Oral Health, Tobacco, Nutrition, Facility Licensing, and Injury and Violence Prevention.

Number, location and full-time equivalents of staff who work on behalf of the Title V Program

The State of Connecticut is highly invested in supporting efforts to implement the core public health functions (assessment, policy development, and assurance) and to achieve increased accountability through ongoing performance measurement and supporting an adequately sized and skilled workforce.

In March 2020, the DPH sponsored a Maternal Health Disparities Summit which served as a state-wide opportunity to leverage the great work of providers, community based organizations, and advocates to enhance how we care for Women of Color, with a critical focus on maternal morbidity and mortality. The Vice Admiral Surgeon General Jerome Adams, MD was in attendance and was the keynote speaker. In addition, Charles Johnson, founder and 4kira4moms, worked relentlessly with congress to pass the preventing maternal death act (H.R.1318) presented his testimony. At the Summit, the Governor announced that a Gold Ribbon Commission will be created. The Commission will support the following:

1. Convene and Facilitate a Statewide Commission to Focus on the Causes of Maternal Morbidity and Mortality.
2. Address the Social Determinants of Health and Racial and Ethnic Biases Impacting Women of Color.
3. Create, Enhance, and Strengthen Collaborations between Providers, Community Based Organizations, Networks, State Agencies, Private Agencies, and Advocacy Groups.
4. Explore Innovative Models of Care that Support Health and Wellbeing Across the Life Cycle and Foster Healthy Communities.

HCT2020 State Health Improvement Plan (SHIP)

Maternal, Infant, and Child Health Action Team 2019 Accomplishments

• Partners advocated for Paid Family Medical Leave which passed and went into effect on October 1, 2019. The law will allow employers to provide employees paid, job-protected leave (12 weeks) for health-related reasons.
• Partners collaborated on Connecticut’s Screening to Succeed conference to ensure developmental awareness and promotion, developmental screening and connection to services by providing families and providers with knowledge, resources, and tools for effective coordination and community wide implementation.
• Through Maternal and Child Health Services Block Grant (Title V) funding, DMHAS successfully allocated funding for expanding the implementation of One Key Question (OKQ) and supported this effort by offering trainings sponsored by Every Woman Connecticut and Planned Parenthood. OKQ is an initiative that provides women of childbearing age recommendations for either becoming pregnant or preventing pregnancy.

Within DPH, several initiatives are underway to reduce adverse birth outcomes and risk factors associated with poor birth outcomes, and to address disparities in these health indicators.  The initiatives listed below may not be directly funded by the MCHBG but are in alignment with the mission of improving the health of the MCH population.  These initiatives will continue and include the following:

• DPH completed the 2020 update of the State Health Needs Assessment. The report will be released this summer as the State Health Improvement Plan (SHIP) Coalition launches a series of planning workshops to advance the health improvement plan update. A DPH team is working with partners across the state to design the framework of the Healthy CT 2025 State Health Improvement Plan for its release in 2021. The development of the plan involves multiple virtual meetings and webinars to discuss priority areas and cross-cutting themes. The plan’s strategies will focus on policy, systems, and environmental changes to address upstream causes of poor health. The priorities under consideration include: a) access to health services and primary healthcare, b) economic stability, particularly around issues of poverty and employment, c) access to healthy eating and issues of food security, d) housing quality and stability, and e) community resilience as it relates to crime/violence and emergency preparedness. In addition to launching Healthy Connecticut 2025, DPH is undergoing preparations for its reaccreditation application due by the first quarter of 2022.

• The CT MCH Coalition is made up of over 130 stakeholders that meet quarterly and are dedicated to improving the health of mothers, infants and children statewide. The Maternal, Infant and Child Health focus area of the State Health Improvement Plan directly impacts and supports the MCHBG activities in several areas including perinatal/infant health, child health, children with special health care needs, and oral health. The MCH Coalition members support efforts such as: creating a developmental screening media campaign and distributing materials; promoting awareness of developmental screening tools for use in their communities; enhancing school-based dental sealant programs; and increasing the use of fluoride varnish in primary care practice, school-based programs and community access points, to name a few.

• DPH participates in the Every Woman Connecticut (EWCT) Learning Collaborative, which seeks to increase expertise and self-efficacy in implementing routine pregnancy intention screening and appropriate care, education, and services to ultimately improve birth spacing, increase pregnancy intentionality, and the proportion of Connecticut women who deliver a live birth who report discussing preconception/interconception health with a healthcare worker.

• The maternal mortality review program is responsible for identifying maternal death cases in Connecticut and reviewing medical records and other relevant data related to each maternal death case, including, but not limited to, information collected from death and birth records, files from the Office of the Chief Medical Examiner, and physician office and hospital records. Legislation passed in 2018 established a maternal mortality review committee within the DPH to conduct a comprehensive, multidisciplinary review of maternal deaths for purposes of identifying factors associated with maternal death and making recommendations to reduce maternal deaths. Members of the committee represent a wide range of licensed health care professionals. Through the work of the committee, CT identifies and characterizes these maternal deaths as pregnancy-related or pregnancy-associated maternal deaths. The committee is charged with excluding deaths that, though tragic, were not classified in either of these two categories.

• The Medical Home Advisory Council (MHAC) was established to provide guidance and advice to the CT Department of Public Health in its efforts to improve the community-based system of care for children and youth with special health care needs (CYSHCN) by ensuring their connection to a medical home that is accessible, compassionate, comprehensive, coordinated, continuous, culturally effective and family-centered. The MHAC's membership includes representation from parents (families/caregivers) of CYSHCN, partners in the Connecticut Medical Home Initiative, service providers, community-based organizations, and public and private agencies.

• CT Title V staff serve on the CT Council on Developmental Disabilities, which works to improve life for CT citizens through policy and service improvement regarding such issues as housing, access to health care, transportation, emergency planning for individuals with special needs, employment, and family/self-advocacy training. 

• The Children and Youth with Special Health Care Needs program collaborates with the University of Connecticut, University Center For Excellence in Developmental Disabilities to improve access to comprehensive, coordinated health and related services including trainings on the importance of developmental screening and distribution of the CDC’s “Learn the Signs. Act Early” materials.

• The Developmental Screening workgroup, coordinated by DPH staff, hosted the “Screening to Succeed Conference An Early Childhood Call to Action for Communities to Promote Developmental Awareness and the Power of Community Connections.” With 130 attendees, the call to action was designed to excite conference participants to take the next steps, get inspired and bring back messages and tools shared during the conference to the community. Attendees included parents, family advocates, and care coordinators, along with providers of health care and early care & education programs. Conference presenters worked to help equip communities to increase developmental awareness and promotion, developmental screening, and connecting to services by providing families and providers with the knowledge, resources, and tools for effective coordination and community wide implementation. The conference highlighted that developmental screening is part of a continuum, overview of various screening tools, examples of best practice, and linkages to resources.

Partnership and Collaborations by Domain

The priorities needs were identified through examination of needs assessment findings, as well as discussion and rating and ranking methodology with both internal and external MCH stakeholders. Fifteen (15) emerging priority areas were presented and further discussion yielded an additional ten (10) priorities for consideration across the domains. A rating tool was used to help participants consider specific selection criteria in an effort to identify their top priorities.  Please see the table below for a description of the selection criteria:

Following the rating exercise, internal DPH MCH staff conducted an additional crosswalk of the highest overall rated priorities against the following additional criteria to reach a final decision:

• Data – Do we have data to support and measure ongoing efforts for this area?
• Existing Programs – were there programs already existing in the State that were presently addressing this issue?
• Capacity – does the Department have the capacity and support to do work in this area?

When examining the highest overall rated priorities against all criteria, DPH was able to establish the 9 highest priority needs for the State, that were also best positioned for successful implementation. 

Based on the identified state priorities, six (6) national performance measures and three (3) state performance measures have been selected to address over the five-year Title V program period.

Emerging Issues

Emerging issues were identified as those topic areas that were ranked high in importance during the early stakeholder meetings; however, these were not selected as one of the nine (9) state priorities. The two high ranking emerging issues include Technology & Social Development and Paternal Engagement.