Introduction - The Statewide Maternal and Child Health Needs Assessment for Utah, conducted for the HRSA Title V Block Grant, was a joint effort of the Utah Department of Health and the University of Utah. In Utah, the MCH Block Grant program focuses its activities in five domain areas including 1) Women/Maternal Health, 2) Perinatal/Infant Health, 3) Child Health, 4) CSHCN, and 5) Adolescent Health. The process was led by the UDOH Bureaus of Maternal and Child Health and Children with Special Healthcare Needs.

 

Needs Assessment Planning Process - As part of the Title V 2020 Maternal and Child Health (MCH) Needs Assessment, a Needs Assessment Leadership Team (NALT) was established to oversee the development and implementation of the 2020 MCH Need Assessment (NA) activities. The NALT consisted of the Maternal and Child Health (MCH) and Children with Special Health Care Needs (CSHCN) Bureau Directors, a Needs Assessment Project Lead, CSHCN Family Representative, MCH/CSHCN Epidemiologists, select MCH/CSHCN Program Managers, and Domain Leaders.

 

In order to inform Utah’s 2020 MCH/CSHCN NA, a literature review of NA methodologies and processes used by other states was conducted. Review included documentation of the processes used in selection of national and state priorities. This review provided insight into potential methods for Utah to use. Noteworthy processes were presented to NALT and followed with a discussion on what Utah’s process would be. Additionally, through this review, where available, survey instruments were reviewed to look for opportunities to enhance and compliment Utah’s surveys.

 

An indicator report of over 270 variables outlining measures related to Utah's MCH and CSHCN populations was created to inform the needs assessment process. Data sources included the American Community Survey (ACS), Pregnancy Risk Assessment Monitoring System (PRAMS), National Vital Statistics System (NVSS), National Immunization Survey (NIS), National Survey of Children’s Health (NSCH), and Youth Risk Behavior Surveillance System (YRBSS). Where available, rates were also stratified by race and ethnicity, and compared to Healthy People 2020 goals and the nation overall.

 

The 2019 MCH Indicator Report for Utah was shared with the NALT to provide an overview of the current strengths and weaknesses in the health status of Utahans. The report was used in selection of populations and topics to address in key informant interviews and focus groups. Additionally, the report was used by domain leaders to help identify questions for two surveys, MCH/CSHCN Stakeholder Survey and the CSHCN Parent Survey.

 

Methods - A community engaged approach was used to gather input from over 3,000 people through a variety of modalities including online surveys, key informant interviews, focus group discussions, face to face interviews, review of secondary data, interactive regional stakeholder meetings, and a statewide MCH/CSHCN summit. The following timeline outlines the activities of the Needs Assessment process:

 

 

Participation by method, is presented in Table 1.

 

 

The Utah Needs Assessment process served to inform the UDOH about MCH and CSHCN needs and was framed using the National Association of County and City Health Officials (NACCHO), Mobilizing for Action through Planning and Partnerships (MAPP) model. The four MAPP assessments as described below:

 

MAPP (Mobilizing for Action through Planning and Partnerships) Model with Annotated Modifications for the Utah Statewide Public Health Needs Assessment, 2020

 

 

 

 

Results

1.       Community Health Status Assessment

 Selected indicators from the 2019 Indicator Report were selected for their relevance to findings from other parts of the assessment as well as their absolute relevance in terms of real gaps or deficiencies in health status. It is important to note that health status indicators showed health disparities in many cases for other racial and ethnic groups. These disparities will be reviewed and addressed in strategic planning.

Health Insurance

Percent of women of reproductive age who reported being uninsured = 14.7%

Percent of children and adolescents who are continuously and adequately insured, ages 0 – 17 = 61.1%

Access to Care

Percent of Children with Special Health Care Needs, ages 0 -17 = 16.4%

Percent of children with special health care needs who have a medical home, ages 0 -17 = 18.4%

Percent of adolescents with and without special health care needs who received services necessary to make transitions to adult health care, ages 12 – 17 = 44.9%

Percent of Utah children who have received dental sealants ages 6-9 = 44.9%

Mental Health

Percent of women who reported postpartum depression = 14.7%

Percent of children and adolescents with a mental/behavioral condition who receive treatment or counseling = 50.0%

Percent of adolescents who reported feeling sad or hopeless = 33.0%

Percent of adolescents who reported making a plan about how they would attempt suicide = 17.1%

Percent of adolescents who reported attempting suicide = 9.6%

Percent of adolescents who reported being bullied on school property = 19.4%

Percent of adolescents who reported being electronically bullied = 18.0%

Substance Use

Percent of adolescents who reported that they currently use an electronic vapor product = 7.6%

Percent of adolescents who reported being offered, sold, or given an illegal drug on school property = 25.9%

Percent of adolescents who reported that they have never drank alcohol = 69.6%

Percent of adolescents who reported that they have ever used marijuana = 16.6%

Immunizations

Percent of children who have completed the combined 7-vaccine series = 67.9%

Percent of female adolescents who have received at least one dose of the HPV vaccine = 63.1%

Nutrition and Physical Activity

Percent of infants who were exclusively breastfed through 3 months = 55.5%

Percent of children who are physically active at least 60 minutes per day, ages 6 – 11 = 21.9%

Reproductive/Sexual health

Adolescent female Chlamydia rate, ages 15 - 19, per 100,000 = 1651

Teen birth rate, ages 18 - 19, per 1,000 female population = 30.0

2. Public Health System Capacity Assessment

Systems issues were often described by stakeholders during interviews and focus groups, using terms such as ‘social determinants of health’, ‘health inequities or disparities’, and lack of ‘universal healthcare’. Systems issues included problems such as poverty, geography/rurality, and the lack of affordable and accessible healthcare for everyone. Groups described as vulnerable included people with low income, but with low-wage jobs so they do not qualify for Medicaid, immigrants who may be afraid to seek any governmentally funded service, and underrepresented minorities and their children.

 

Socio-political norms were described as prevailing values of self-reliance and small government and used as a rationale to limit funding to health and social programs. Utah ranks among the lowest states in funding per capita for education, public health, school nursing, and has not been favorable to Medicaid expansion. Participants lamented that Utah describes itself as a family state, yet it does not pay for important services to help families thrive. Participants felt strongly that Utah needs to invest more funding into MCH/CSHCN programs. The Utah Indian Health Advisory Board made a specific recommendation to invest more into MCH/CSHCN programs. Despite limited funding, public health and other care workers were described as hard working and doing more with less.

 

Specifically:

o More investments are needed in school health, CSHCN, WIC, and Home Visiting.

o More “situational awareness” among public health departments is needed to better support and fund equitable sexual health services statewide and foster better access to CSHCN services.

o Public Health funding distributions should consider tribal entities for MCH/CSHCN funding, along with local jurisdictions.

 

System Strengthening and Quality Improvement - There are specific recommendations for process improvements for programs and services. A cross-cutting process improvement would be to improve capacity to market health information to the public.

 

Health departments are expert networkers and collaborators, however, there are additional opportunities to collaborate with healthcare and social service providers and other leaders to improve the design of MCH/CSHCN services and health outcomes.

 

Workforce Development – Public health professionals need continued support to perform well. They are dedicated and hardworking and compassionate, many wear multiple hats, and “do more with less”. Resources such as the CDC Workforce Development can help provide a framework for a strong and sustainable public health workforce. For example, during the COVID pandemic many of the MCH/CSHCN employees jumped in and took additional roles such as working on a COVID hotline, providing administrative supports to the State Epidemiologist, performing COVID contact tracing, and providing COVID resources and information regarding the MCH/CSHCN populations, among many other duties. Although, this pandemic and its health consequences are humbling, this pandemic is a public health issue and staff were open to learning new skills in order to help the Utah citizens. Utah is working on actively promoting health equity and addressing social determinants of health through strategic partnerships and investing in evidence-based programs. We are assessing our recruitment strategies to increase diversity of staff who serve the community.

 

3. Community Themes, Needs and Strengths Assessment

Stakeholders, community members, parents, adolescents, and caregivers were asked questions like: "What is important to improve MCH/CSHCN?" "How is MCH/CSHCN provided here?" and "What assets do we have that can be used to improve MCH/CSHCN and what are the gaps? Main themes included: Strengths/Assets, Mental Health, Affordable Care/Health Insurance, and Access to Care.

 

Key Needs - Participants identified top priority issues, such as specific MCH/CSHCN topics or services, but they also described issues that are systemic and overarching. Top concerns are listed next, but in no particular order as they are clearly interrelated issues.

 

Top Concerns -

Mental Health – Mental health, including perinatal depression, depression, anxiety, and suicide were top concerns in all domain areas with the exception of the infant domain. Specific recommendations for mental health include:

o   Expanding mental health and substance use services for women, children, adolescents, and men/fathers.

o   Increase awareness of ACEs and need for parent and provider education.

o   Address high rates of perinatal depression and the barrier of stigma when talking to providers.

o   Address substance use and pregnant women (Opioids/Methamphetamine) is a significant problem, especially in some rural areas counties.

o   Expand the effort to increase the number of school counselors.  

o   Youth Suicide, especially among LGBTQ youth needs to be addressed, stigma and bullying reduced.

 

Violence/Abuse/Neglect – Violence, primarily family violence, was a priority concern in all five domains. Types of violence include intimate partner violence, child abuse and neglect, lack of parental involvement, and bullying of children and adolescents.
Specific recommendations for addressing abuse and neglect include:

o   Expanding parenting education.

o   Increasing access to affordable and quality childcare.

o   Increasing awareness of ACEs among parents and providers.

o   Addressing school and cyber bullying.

 

Access to Care/Health Insurance – Access to care related to affordability, including affordable health insurance, was a key issue for women, infants, and CSHCN domains. It was not noted as a priority for children and adolescents but was a particular concern of parents with CSHCN. There is strong support among stakeholders for ‘universal’ type of insurance coverage. However, they think they are the only ones. “This is Utah” is a sentiment used implying that this [universal/equitable] health coverage will never happen. There is hesitancy to voice their true feelings on this matter.
Specific recommendations for addressing access to care include:

o   Recognize and leverage broad support for universal healthcare or Medicaid expansion among stakeholders (professionals and parents).

o   Leverage partnerships to expand access to CHIP, Medicaid, and other health insurance options.

o   Policy changes paired with outreach to vulnerable populations to alleviate fears of immigration problems.

o   Streamline and speed up eligibility processes for CSHCN health insurance and disability services. Parents of CSHCN describe very long wait times to get into specialty providers, which delays critical services during their child’s developmental milestones. For example, they have been on waiting lists for 8-10 years.

o   Increase funding and support services for children with special healthcare needs.

 

Access to Care/Due to limited care – A variety of types of care were described as very limited and sometimes non-existent. This was the top concern for the CSHCN domain, where specialty medical care is extremely limited, especially in rural areas, and developmental screening is not comprehensive. Mental health and behavioral health services were described as very limited and as a system that is not nearly robust enough to meet the needs. Other programs and services that are wanted and needed, but limited in scope include family planning, sexual health education for youth, quality and affordable childcare and afterschool care, school nursing, dental care, and training for parents/parenting skills. Specific recommendations for public health funding include:

o   Conducting more assessments to build case for funding and demonstrate return on investment.

o   Increase visibility of important services, such as Medicaid, CHIP, CSHCN, Home Visiting, and many other MCH services need to be much more visible statewide.

o   Leverage partnerships to find innovative ways to fund programs.

o   Increase advocacy efforts for public health funding, specifically for MCH/CSHCN programs.

o   Investments into more care coordination statewide can help link people to needed CSHCN and MCH care.

o   Services need to be culturally and linguistically appropriate to be accessible to all, especially underrepresented minorities and families who may have mixed immigration status.

o   Need more OB/GYNs, Pediatricians, Psychologists, and counselors in rural areas.

o   More telehealth services needed in rural areas, especially for CSHCN, ABS treatment, and others.

o   Need more rotations of specialists to rural areas for CSHCN

o   Need more school nurses so school nurses can be the first line of defense for youth. Nurse to student ratio is extremely low.

 

Programs valued/wanted by participants - Based on the types of priorities described by survey participants, the following table shows specific health programs or services valued by participants from the MCH/CSHCN online survey (N=1,892) and lists specific health issues or topics, not systems issues, such as health insurance and broader social issues.

Priority Issues and Service Needs of MCH/CSHCN Participants

Domain	Priority Issues – Specific to health services or topics
Women/ Perinatal	Mental Health (perinatal depression), access to family planning, domestic violence, parenting skills, substance use, immunizations
Infant	Immunizations, abuse/neglect, developmental delays, environmental exposures (e.g. air quality), nutrition, breastfeeding
Child	Depression, abuse/neglect, parental involvement, immunizations, childcare, after school care, school nursing, nutrition/overweight, dental care, air quality
Adolescent	Depression and anxiety, suicide, sex education, drug use, vape/tobacco, social isolation, abuse/neglect, overweight, alcohol, school nursing, physical activity
CSHCN	Access to CSHCN services/specialty care and screening, autism services, care coordination, early intervention, parent support, mental health, developmental screening, abuse/neglect, suicide, bullying, community and recreation opportunities

Results of Online Surveys: Top 10 Ranked Issues by Domain

Women/Maternal Health - A total of 1,025 people answered questions about maternal health in the online survey. The majority were women (88.5%), 87.0% were white, 9.2% Hispanic/Latino, and 2.0% Asian American/Asian. Less than one percent of participants were Black or African American, or American Indian, Native American, or Alaskan Native respectively. Participants were likely to be older than 25. Ranking by age group did not differ among ages 25+, but those younger than 25 were more likely to be concerned about alcohol use during pregnancy, 25 – 34 also ranked male/father involvement, and folic acid use to prevent birth defects. The majority of participants reported their primary role as a clinician or public health professional 64.4%, while 35.6% identified as a parent or community member. The majority of respondents, 82.8% were urban dwellers, compared to 17.2% rural. The top 10 issues for this domain are:

Infant/Perinatal Health - A total of 638 people answered questions about infant health in the online survey. The majority were women (85.9%), 87.1% were white, 9.7% Hispanic/Latino, and 1.6% Asian American/Asian, American Indian, Native American, or Alaskan Native, and 0.6% were Black or African American. The sample suggests that non-white participants were underrepresented when compared to the overall population. Rankings did not vary much by age group. The majority of participants reported their primary role as a clinician or public health professional, 66%, while 34% identified as a parent or community member. Priority rankings were similar in these groups with the exception of neonatal abstinence/withdrawal made the list for health professionals, but not community member/parents. The majority of respondents, 84.6%, were urban dwellers compared to 15.4% rural. The top 10 issues for this domain are:

Child Health - A total of 812 people answered questions about child health in the online survey. The majority were women (85.1%), 85.0% were white, 13.1% Hispanic/Latino, and 1.6% Asian American/Asian, 0.6% American Indian, Native American, or Alaskan Native, and 0.4% were Black or African American. The sample suggests that when compared to the overall population, non-white participants were underrepresented. Rankings did not vary much by age group. The majority of participants reported their primary role as a clinician or public health professional, 62.6%, while 37.4% identified as a parent or community member. The majority of respondents, 83.0%, were urban dwellers, compared to 17.0% rural. The top 10 issues for this domain are:

Children with Special Health Care Needs - A total of 423 people answered questions about the health of children with special health needs in the online survey. The vast majority were women (81.9%), 89.9% were white, 7.2% were Hispanic or Latino, 1.3% were Asian American/Asian, only 0.3% American Indian, Native American, or Alaskan Native, and 3.6% were Black or African American. The sample suggests that non-white participants were underrepresented, with the exception of African Americans or Blacks, who were slightly overrepresented. Rankings did not vary much by age group with the exception of those under 25. In this group, oral/dental health ranked #1 and violence, abuse and neglect #2. The majority of participants reported their primary role as a clinician or public health professional 71.5%, while 28.5% identified as a parent or community member. The majority of respondents, 82.7%, were urban dwellers, compared to 17.3% rural. The top 10 issues for this domain are:

Adolescent Health - A total of 609 people answered questions about adolescent health in the online survey. The vast majority were female (79.7%), 87.8% were White, 8.2% were Hispanic or Latino, 1.6% were Asian American/Asian, only 0.4% were American Indian, Native American, or Alaskan Native, and there were no Black or African American respondents. The sample suggests that non-white participants were underrepresented and African Americans or Blacks were not represented at all. Rankings did not vary much by age group with the exception of those under 25. In this group, oral/dental health ranked #2 and teen pregnancy ranked 8th. The majority of participants reported their primary role as a clinician or public health professional, 72.3%, while 27.7% identified as a parent or community member. The majority of respondents, 82.0%, were urban dwellers, compared to 18.0% rural. The top 10 issues for this domain are:

Strengths and Assets - Strengths and assets were discussed commonly and over 100 community resources were named specifically by stakeholders, some small, some large. Quality and caring providers were lauded, there was recognition that many services are provided well despite limited resources. Rural and urban participants described a sense of community and demonstrated significant collaboration and coordination among agencies and organizations that support the public’s health and maternal and child health. Communities have found innovative ways to overcome challenges, such as transportation in rural areas, coordination for CSHCN, and addressing intergenerational poverty through coalitions.

 

Forces of Change - Forces of change are identified by asking questions such as "What is occurring or might occur that affects the health of our community or the local public health system?" or "What specific threats or opportunities are generated by these occurrences?" Some forces of change are noted below.

 

COVID-19 Pandemic - The most notable force of change is the COVID-19 pandemic, which emerged in the latter part of this assessment in Spring of 2020. While consequences of this disruptive force are not fully understood, there are some emerging concerns and opportunities to consider:

• With people isolating at home, fewer women and children may be accessing well-child, prenatal visits, dental, and other preventive healthcare.

• With children isolated at home, not attending school, child abuse and ACEs may go undetected.

The economic downturn caused by the pandemic will put pressure on public health programs, we anticipate a larger proportion of the population will become eligible for programs like Medicaid, Baby your Baby, Early Intervention, WIC, and others.

• Multiple programs in MCH and CSHCN have experienced budget reductions and more are likely in coming months in reaction COVID-19 related economic crisis. These cuts are driven by a desire of Utah lawmakers to prioritize balancing the budget, which negatively impacts health and social services.

• With people at home including providers, CSHCN clinics services and home visits have been put on hold, only allowing for telehealth. Not providing in person visits limits the ability for screening, assessments, diagnosing and comprehensive care.

• Telehealth is becoming more accessible and reimbursable, meaning more specialty care and mental health care may be available. This is a timely opportunity, especially for rural areas.

 

Attitudes toward Medicaid and the Affordable Care Act - Efforts to repeal or dismantle the affordable care act continue at the national level and in Utah, efforts to expand Medicaid have had limited success. However, there may be growing support for access to health insurance through Medicaid and the Affordable Care Act as more jobs are lost due to the pandemic.

 

Immigration Policy - Immigration policies at the national level continue to tighten and may prevent immigrants from accessing services for which they are eligible.

 

Racial Justice Movement - Given the findings in this report about addressing social determinants of health and need to address health disparities, especially among underrepresented minorities, it is important to acknowledge the recent protests in Utah and around the country that bring attention to systemic racism. This indicates a new level of consciousness among the populace about racism and by extension provides an opportunity to broaden the discussion and momentum to better address social determinants of health.

 

Recommendations - Recommendations from the University of Utah Division of Public Health from the Utah Maternal and Child Health Statewide Needs Assessment, 2020 report, to the Utah Department of Health were used to guide the selection of State and National Performance Measures that will address some of the top MCH/CSHCN priorities. Other recommendations included: UDOH should continue organizing for success with its partners and formulate goals and specific objectives with key metrics. While UDOH should focus on specific MCH/CSHCN priorities to make concerted progress, they should consider addressing broader issues that are barriers to improvement, such as the funding issue. This may require more effort in the areas of public health advocacy and policy. Partnerships could strengthen this effort.

 

In addition to MCH/CSHCN focused SPM and NPMs, UDOH should work with partners to:

1.   Address social determinants of health and intergenerational poverty.

2.   Improve access to healthcare and affordable health insurance.

3.   Better fund Children with Special Healthcare Needs and leverage new telehealth efforts.

4.   Address family violence, abuse, neglect and increase affordable childcare, and

5.   Work across sectors to expand needed mental health services.

The Utah Department of Health (UDOH) is one of many state agencies in the structure of Utah’s Government. The Bureaus of Maternal and Child Health (MCH) and Children with Special Health Care Needs (CSHCN) are housed in the Division of Family Health and Preparedness (DFHP), one of four Divisions in the UDOH. MCH/CSHCN are the lead agencies responsible for the administration of Title V activities.

During most of the past year, leadership at the Utah Department of Health remained stable. In March 2020, Governor Herbert made a variety of adjustments to UDOH as a result of COVID. The Governor appointed an Acting Executive Director, General Jefferson Burton and Acting Deputy Director, Richard Saunders to support the existing Executive Director, Dr. Joseph Miner, with day to day COVID related matters. In August 2020, the Governor appointed Richard Saunders as Interim Executive Director of the UDOH with Dr. Miner as the Chief Medical Advisor to the UDOH and to the Executive Office of the Governor through the end of the year. Both Deputy Directors Marc Babitz, MD and Nate Checketts (Medicaid Director) remain in their positions.

The Division of Family Health and Preparedness (DFHP) is headed by Director Paul R. Patrick. The Bureau of Maternal and Child Health is headed by Bureau Director, Lynne Nilson and the Children with Special Health Care Needs is headed by Bureau Director, Noël Taxin.

The attached organizational chart outlines the Senior Level Directors and Managers of the Utah Department of Health (UDOH) and DFHP. Additionally, Deputy Director, Curtis Burk, supporting DFHP Director Paul Patrick, left employment. Lastly, the CSHCN Bureau moved from the 40-year location of 44 North Mario Capecchi Drive to join the DFHP at the Highland building location.

The MCH and CSHCN Bureaus collaborate with other state agencies, key partners and private organizations on a regular basis to address ways to improve the health of women, infants and children in the state.

 

The Bureau of Maternal and Child Health oversees five programs that focus on improving the health of MCH populations: the Maternal and Infant Health Program (Utah Women Newborn Quality Collaborative, Maternal/Infant Mortality Review, PRAMS, SOARS, Stepping up for Utah Babies, Power Your Life and Maternal Mental Health); the Family and Youth Outreach Program (Adolescent/Child, Oral Health, Pregnancy Risk Line/Mother to Baby, Utah Early Childhood Utah); the Data Resources Program (including SSDI); the Office of Home Visiting (MIECHV); and Women Infants and Children (WIC) Program. The MCH Bureau also contracts with and oversees 13 local health department contracts for services to mothers, children and adolescents.

 

The CSHCN Bureau oversees fifteen programs that focus on improving the statewide system of care for CSHCN and their families: Autism Systems Development Program; Baby Watch Early Intervention Program; Child Health Advanced Records Management (CHARM); Critical Congenital Heart Defect Screening; Children’s Hearing Aid Program (CHAP); Cytomegalovirus Public Education and Testing (CMV); Early Hearing Detection and Intervention (EHDI); Fostering Healthy Children Program; Integrated Services Program (ISP); Kurt Oscarson Children’s Organ Transplant Fund; Organ Donations; Utah Birth Defects Network (including Zika Surveillance Intervention and Referral Program); Utah Family Voices and Weber Early Intervention Program. The CSHCN Bureau improves the quality of life for families and children with special health care needs by monitoring occurrence, early screening, education, care coordination, transition and intervention to reach optimal health.

 

The CSHCN Bureau programs strive to coordinate care for the children and families served throughout the State. The ISP contracts with four LHD’s to provide Care Coordination in those communities throughout the State. The Bureau has internal communication methods to encourage care coordination and transition for the populations served using an electronic record called CaduRx which allows sharing of patient records in one system to ensure clear communication and follow through methods to reduce loss to follow up. Additionally, other platforms such as: Hi-Track, monthly meetings, data sharing agreements, CHARM and shared resources to create a system which flows smoothly for Bureau employees are utilized. The Bureau also has external partnerships with other State agencies which are working toward reducing redundancies, creating data sharing agreements, utilizing CHARM, quarterly meetings and working towards utilizing the cHIE electronic record in sharing records in a one stop shared resource.

 

MCH/CSHCN managers lead the work of planning, implementation, evaluation, and data analysis capacity. The graphics below show the names and titles of the Bureau’s/Programs in MCH/CSHCN and the Bureau of Health Promotion who address MCH/CSHCN issues. A blue box indicates if a program is funded (full or part) by Title V Block grant dollars.

 

Bureau of MCH - The Bureau of Maternal and Child Health oversees five programs that focus on improving the health of MCH populations: the Maternal and Infant Health Program (Utah Women Newborn Quality Collaborative, Maternal Mortality Review, PRAMS, SOARS, Stepping up for Utah Babies, Power Your Life and Maternal Mental Health; the Family and Youth Outreach Program (Adolescent/Child, Oral Health, Pregnancy Risk Line/Mother to Baby, Utah Early Childhood Utah (ECU); the Data Resources Program (including SSDI); the Office of Home Visiting (MIECHV); and Women Infants and Children (WIC) Program. The MCH Bureau also contracts with and oversees 13 local health department contracts for services to mothers, children and adolescents.

 

 

Bureau of CSHCN - The CSHCN Bureau oversees fifteen programs that focus on improving the statewide system of care for CSHCN and their families: Autism Systems Development Program; Baby Watch Early Intervention Program; Child Health Advanced Records Management (CHARM); Critical Congenital Heart Defect Screening; Children’s Hearing Aid Program (CHAP); Cytomegalovirus Public Education and Testing (CMV); Early Hearing Detection and Intervention (EHDI); Fostering Healthy Children Program; Integrated Services Program (ISP); Kurt Oscarson Children’s Organ Transplant Fund; Organ Donations; Utah Birth Defects Network (including Zika Surveillance Intervention and Referral Program); Utah Family Voices and Weber Early Intervention Program. The CSHCN Bureau improves the quality of life for families and children with special health care needs by monitoring occurrence, early screening, education, care coordination, transition and intervention to reach optimal health.

 

 

Bureau of Health Promotion - The Bureau of Health Promotion oversees programs that work to reduce the leading causes of illness and death for Utahns through prevention, early detection, and management of injuries, chronic diseases and conditions and promotion of early prenatal care in community, school, worksite and health care settings. They are: Alzheimers, Arthritis, Asthma, Baby Your Baby, BeWise, Cancer Control (Breast/Cervical, Comprehensive and Genomics), Check Your Health/Health Resource Center, EPICC (Healthy Living through Environment, Policy, and Improved Clinical Care), Tobacco Prevention and Control, Violence and Injury Prevention (VIPP).

 

Local Health Departments - The UDOH provides Title V funds to LHD’s via contract. All 13 Local Health Departments work on identified MCH and Child/Adolescent identified priorities. Four of the 13 receive funds to provide CSHSN Care Coordination for families.

 

We do not track staffing or FTEs at local agencies since they are autonomous from the UDOH. It is important to note that one staff member in each area typically wears several “hats'' in his/her daily work. Each health district has a Health Officer, Nursing Director, Environmental Health Director, WIC Director and other health professionals. It is up to the discretion of the LHD to determine staffing for Title V activities.

 

Additional Workforce Capacity (not funded by Title V) - Both the MCH and CSHCN Bureaus have a productive relationship with the Office of Vital Records and Statistics (OVRS). Staff from OVRS provide timely data to many staff within Title V programs. In addition to data, staff from Vital Records are asked to participate in many MCH/CSHCN advisory groups. Staff in OVRS have been very open to adapting the birth certificate to provide Title V programs the data they need. In return, MCH/CSHCN staff participate in statewide training of birth and death certificate clerks and offer quality improvement suggestions to OVRS staff when data issues are identified.

 

Title V staff collaborate with the Office of Health Disparities Reduction (OHD) on an on-going basis. Title V staff serve on advisory committees for the OHD and their staff are members of many MCH/CSHCN advisory committees. In addition, staff from the OHD assist Title V staff with understanding issues in diverse communities, translation services, and developing culturally appropriate materials.

 

One of the CSHCN Audiologists is a member of Medicaid's Utilization Review and CHEC/EPSDT Expanded Services Committee, which meets to determine authorization for non-covered services for Medicaid recipients. The CSHCN staff serve on Medicaid committees and assist Medicaid with services and sharing of knowledge in serving children with special needs.

 

The toll-free Baby Your Baby (BYB) Hotline provides information and referrals on providers and/or financial assistance for prenatal care, family planning, well child care, nutrition services, or other related services. Hotline staff collaborate well with the community to ensure that resource and referral information is current. The hotline is viewed as a valuable resource. BYB is also the face of the Medicaid Presumptive Eligibility program. Program oversight managed by the Division of Medicaid and Health Financing (DMHF).

 

Medicaid - The Utah Department of Health houses the state Medicaid agency and Title V enjoys a strong relationship with Medicaid. Since Utah's CHIP Program, a stand-alone program, is administered by Medicaid, we are able to collaborate with the CHIP program as well. The Division works closely with Medicaid staff on pregnancy-related services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), oral health and other Medicaid-administered programs that serve mothers and children. Medicaid provides matching dollars for a number of programs that serve the Medicaid populations, such as Baby Your Baby outreach, Mother To Baby, and PRAMS. Medicaid developed a targeted administrative case management model for CSHCN clients.

MCH/CSHCN have established partnerships that help expand the work of reaching women, infants, children (including CSHCN), and families. Federal and non-federal funds are leveraged to deliver programs and services in the state. MCH/CSHCN staff maintain working relationships with Title V and non-Title V Programs to create a statewide system of collaboration.

 

The levels of cooperation with various partners can include networking, information sharing, collaboration, integration, formal contractual agreements, joint trainings or co-sponsorship of events. Most all of the programs/agencies participated in the 5-year needs assessment.

 

The following programs are housed within the MCH/CSHCN Bureaus and staff in these programs collaborate regularly to assess needs and implement programs to improve the health of MCH/CSHCN populations:

 

Programs funded by HRSA Maternal and Child Health Bureau:

• State System Development Initiative (SSDI)
• Maternal, Infant and Early Childhood Home Visiting (MIECHV)
• Early Childhood Systems of Care (ECCS)
• Mother to Baby (MotherToBaby, a service of the non-profit Organization of Teratology Information Specialists
• Utah Birth Defects Network
• Autism Systems Development Program
• CHARM
• Utah Parent Center, Family to Family, Health Information Center
• University of Utah Medical Home Portal and Utah Children's Care Coordination Network
• Integrated Services Program
• Early Hearing Detection & Intervention Program
• Central, San Juan, Southeast and Tri County Local Health Departments

 

Other programs funded by Health and Human Services/CDC/USDA/Department of Education:

• Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM)
• Maternal, Infant and Early Childhood Home Visiting (MIECHV)
• Sexual Risk Avoidance Education (SRAE)
• Personal Responsibility Education Program (PREP)
• Pregnancy Risk Assessment Monitoring System (PRAMS)
• WIC
• Universal Newborn Screening Hearing Grant
• Early Hearing Detection & Intervention Surveillance Grant
• Birth Defects Surveillance Grant
• Baby Watch Early Intervention

 

Collaboration and partnership with Local Health Departments (LHD) enables the State to become more aware of needs and issues affecting MCH/CSHCN populations and creates a unified focus at the local level. Staff from LHDs and the MCH/CSHCN programs have a strong and long history of working together and have a strong collaborative partnership with each other. LHD Health Officers, Nursing Directors, WIC directors, and Care Coordinators were very involved in the MCH/CSHCN Needs Assessment. LHD Contracts are in place and focus on NPM/SPM objectives and evidence-based strategies. MCH/CSHCN staff meet with nursing directors, health officers and care coordinators on a regular basis to support their efforts to improve outcomes for MCH/CSHCN populations.

 

Title V collaborates with other UDOH programs to address the needs of the MCH/CSHCN populations. Title V dollars are allocated to VIPP to address child and adolescent health as it relates to injury, suicide, and healthy relationships. Dollars are also allocated to the EPICC program to address healthy eating and physical activity in children and adolescents. The Baby Your Baby program provides education about pregnancy and assists women with presumptive eligibility for Medicaid. Staff in VIPP and EPICC are involved with the implementation of NPM/SPM activities. The Division of Medicaid and Health Financing, also housed in the UDOH, works with both Bureaus to ensure the health needs of Title V populations are met. The Office of Vital Records works closely with Title V staff to provide timely birth and death data for assessment and reporting. Title V programs are in the same Division as the Office of Primary Care and Rural Health which enables us to work together more closely.

 

The Indian Health Board liaison, who is housed in the Executive Director’s office of the UDOH educates staff regularly on how to coordinate services and approvals with Utah tribes. The Indian Health Advisory Board (IHAB) also participated in focus groups on the five-year needs assessment, informing UDOH on health and cultural needs specific to the Indian American population. The MCH Bureau Director meets at least yearly with the Indian Health Board and updates them on activities and progress of the Block Grant in regards to their population. This past year multiple meetings were held with the IHAB as part of the Needs Assessment process to ensure that the needs of the Native Indian population were addressed.

 

The UDOH has a positive relationship with Community Health Centers (CHC), the Primary Care Association and the Association for Utah Community Health (AUCH). The Oral Health Program works with AUCH to provide technical assistance to their dental clinics and encourage the addition of dental clinics in other community health centers.

 

Effective partnerships with Utah’s hospital systems have been formed through the Utah Women and Newborns Quality Collaborative (UWNQC). Through UWNQC, participating hospitals regularly work on improving the care for Title V populations, an example of which is implementing the Opioid Use Disorder, hemorrhage, and hypertension safety bundles. Additionally, the Critical Congenital Heart Defects and Early Hearing Detection & Intervention Programs work with hospitals and mid- wives to improve screening rates for all newborns in the state by providing education and follow up.

 

MCH/CSHCN staff work closely with the Utah Division of Substance Abuse and Mental Health (DSAMH), Department of Human Services, which serves the maternal and child population statewide in the areas of child welfare, mental health and substance abuse. Recently, DSAMH staff participated on the Maternal Mental Health Policy Committee along with MCH staff working on this important issue. DSAMH staff sit on Utah’s Perinatal Mortality Review Committee to provide expertise in case reviews.

 

The Violence and Injury Prevention Program (VIPP) has developed a close working relationship with DSAMH as well. Program staff co-chair the Utah Suicide Prevention Coalition with DSAMH and work together on all suicide prevention efforts following the jointly developed activities of the Utah Suicide Prevention Plan. DSAMH staff serve on the Utah Child Fatality Review Committee and Domestic Violence Fatality Review Committee. VIPP also works with them on all prescription drug overdoses activities, such as coordinating the Use Only As Directed campaign. VIPP provides extensive data to DSAMH for use in their program planning and advises on legislative issues concerning suicide and prescription drugs, etc.

 

The Division has developed a strong collaborative working relationship with the Division of Child and Family Services (DCFS) and Child Protective Services (CPS) in a number of efforts, including providing services for children in foster care through a contract with the CSHCN Fostering Healthy Children Program (FHC). FHC is an exceptional program that ensures these children and youth receive needed medical, dental and mental health services.

 

UDOH Division representatives sit on the DCFS Child Abuse and Neglect Council, and an interagency group, Utah Prevention, to address substance use and other issues among youth. Division representatives are part of an interagency group to address youth transition issues.

Additionally, legislation passed in 2020 allows for better coordination of services with women identified as using substances during pregnancy. Staff in the MIECHV and MIHP programs have been working with DCFS on this project.

The Baby Watch/Early Intervention (BWEI) Program has a number of collaborative relationships. They worked with DCFS to develop policy and procedures for CAPTA requirements for referral of children with substantiated abuse and neglect to BWEI. Children who show potential problems are referred to BWEI. Local BWEI agencies partner with local DCFS personnel to train on the developmental screening tool and design referral procedures for children suspected of a developmental delay. 

The Baby Watch Early Intervention program has an Interagency Coordinating Council (ICC) which is an independent advisory board appointed by the governor and required by federal regulation to include parents, EI providers, agencies, and representatives from the community. The purpose of the ICC is to provide meaningful direction, assistance, and support to the lead agency.

The CSHCN Bureau, Integrated Services Program (ISP) has a number of community collaborations, including the: Medical Home Portal, Medical Home Advisory Committee and the Office of Disability Determination Services (DDS). A bilingual ISP staff works with DDS to review claims and provide outreach and referral for potential Medicaid eligible children. This ISP care coordinator/specialist provides information, referral and enabling services to families having difficulty accessing or utilizing community resources or specialty care. 

Lastly, the Autism Systems Development Program within CSHCN and Utah State Board of Education staff have collaborated on data collection to improve outcomes for individuals with autism and developmental delays, through the Utah Registry for Autism and Developmental Delays Program and the Autism Developmental Disabilities Monitoring grant. 

As a conclusion to the Needs Assessment process, a statewide in-person (with virtual capacity) summit was held on February 28, 2020. At this meeting, findings from the needs assessment, including previous stakeholder meetings, were presented. The NALT domain leaders presented their recommendations about the selection of state and national performance measures for the next five-year cycle of the Title V grant. The audience was polled using PollEverywhere to share their input about the recommendations. Participants then broke into interest areas and further developed and presented recommendations.

 

After the stakeholder summit, the NALT met to make final decisions on state priorities and performance measures. The final state priorities are as follows: Perinatal Mood and Anxiety Disorders, Access to Care, Breastfeeding, Developmental Delays, Economic Stability, Family Connectedness, Dental Care, Mental Health (adolescents), Family and Provider Connectedness/Care Coordination, and Transition.