The Texas Department of State Health Services (DSHS) recognizes the value in enhancing the Texas maternal and child health (MCH) and children with special health care needs (CSHCN) workforce capacity. To better serve MCH populations, address and adapt to the state’s changing needs, and improve health outcomes, the Texas Title V workforce strives to maintain optimal subject matter expertise and staffing infrastructure.

The MCH Section is one of four sections housed within DSHS’ Community Health Improvement (CHI) Division. The MCH Section consists of the MCH Unit (MCHU), MCH Epidemiology (MCHE), the Newborn Screening (NBS) Unit, the Health Screening and Oral Health Unit, the Injury Prevention Unit (IPU) the MCH Operations Team, and the MCH Section Team. This organization is the result of MCH restructure change approved by agency executive leadership in October 2022. The MCH Section Director, Lori Gabbert Charney, also serves as the State Title V MCH Director. The MCH Operations Team houses the Block Grant Coordinator and the Financial Analyst who support Texas Block Grant functions for the MCH Section.

MCHU houses the MCH programs’ core policy development and program implementation functions. Areas within this Unit include the Maternal Mortality and Morbidity (MMM) Operations Branch, the Maternal & Infant Health Branch, and the Child and Adolescent Health Branch (CAHB). The MCH Regional Programs Administrator is also in the MCHU. CAHB includes the CSHCN Systems Development Group (SDG) as well as the Child and Adolescent Health Group. Key positions in MCHU include the MCHU Director; the MCH Senior Nurse Advisor, Julie Stagg, who also serves as the State Breastfeeding Coordinator; and Kim Beam who serves as both the Child and Adolescent Health Group Manager and the State Delegate for Texas.

CAHB’s 4 Child Health and Adolescent Health Coordinators work closely with the state Child Fatality Review Team coordinator and CSHCN staff on programing and surveillance activities. CAHB includes the CSHCN Systems Development Group (SDG) which oversees the CSHCN Title V performance measure activity implementation. CSHCN SDG includes 4 full time Program Specialists including many who maintain master’s level degrees in public health and education.

Staff who are parents of children and youth with special health care needs (CYSHCN) participate in MCH programmatic activity development and decision-making. Title V funds a health care benefit program administered by Texas Health and Human Services Commission (HHSC) which includes Family Support Services. Case Management and Family Support and Community Resources are provided to CYSHCN and their families through community-based contractors and Public Health Region (PHR) staff. CSHCN SDG serves as subject matter experts for contractors and provides technical assistance, education, and resources. CSHCN SDG leads and facilitates the medical home and transition to adulthood learning collaboratives and participates in other statewide initiatives including the following planning committees: the Baylor College of Medicine Annual Chronic Illness and Disability planning committee, the Transition from Pediatric to Adulthood conference planning committee, and the Texas Primary Care Consortium planning committee. MCH also participates in the Texas Council for Developmental Disabilities, Policy Council for Children and Families, and Community Resources Coordination Groups Statewide Workgroup.

MCHE provides centralized epidemiologic, data, research, and reporting support to all MCH programs. MCHE has the capacity to provide MCH epidemiologic, data, research, and reporting support for Title V program areas including expert statistical analysis, data management, performance measure reporting, geographical/spatial analysis, research studies and consultation, and program evaluation and monitoring. Please refer to supporting documents for key MCHE presentations and contributions, and application narrative section III.E.2b.iii.a MCH Epidemiology Workforce for additional details.

Texas is one of 4 states participating in the Association of State and Territorial Health Officials’ (ASTHO) Linking Pregnancy Risk Assessment Monitoring System (PRAMS) and Clinical Outcomes Data Multi-Jurisdiction Learning Community.  Learning Community members discuss data linkage best practices and key items such as data linkage ethics. MCHE will link Texas PRAMS data files to birth and Texas Health Care Information Collection inpatient research data files utilizing patient identifiers to study individual-level factors and behaviors related to Severe Maternal Morbidity (SMM). MCHE is also participating in the Council of State and Territorial Epidemiologists (CSTE) Data Science Team Training Program to develop data dashboards for MCH domains.

DSHS’ PHR staff implement regional population-based activities in communities across the state and coordinate with the MCH Regional Programs Administrator. The MCH Regional Programs Administrator serves as the key MCH liaison between DSHS central office and PHRs and works to enhance the technical competence of regional staff. The MCH Regional Programs Administrator’s role is to improve regional activity alignment with Title V MCH Block Grant objectives. The Title V Block Grant supports PHRs across the 8 regions to plan, implement, and evaluate their communities’ population-based programs to address Title V National and State Performance Measures. The Title V Block Grant supports 162 full-time employees throughout PHRs, boosting Texas’ MCH infrastructure. PHRs are in a unique position to collaborate with others to assess local needs and identifying potential solutions that reflect values and cultural make-up of communities.

In September 2017, Manda Hall, M.D. was named CHI’s Associate Commissioner. In this role, Dr. Hall oversees and provides strategic direction to 4 Sections - Maternal and Child Health, Environmental Epidemiology and Disease Registries, Vital Statistics, and Health Promotion and Chronic Disease Prevention (HPCDP). Prior to this position, Dr. Hall served as the Texas Title V MCH Medical Director for nearly 2 years, and the CSHCN Director for over 3 years. Dr. Hall received her Bachelor of Science degree in Biology from Lamar University and her Medical Degree from Texas A&M University Health Science Center College of Medicine. She completed her Internal Medicine/Pediatrics residency and an Allergy and Immunology fellowship at the University of Alabama at Birmingham. In 2021-2022, Dr. Hall served as the Association of Maternal and Child Health Programs (AMCHP) President. Before her role as President, Dr. Hall served as the AMCHP Region VI Director from 2017-2020 and served on the Legislative and Health Care Finance Committee and Conference Planning Committee. In May 2014, she graduated as a fellow in the Maternal and Child Health Public Health Leadership Institute at the University of North Carolina at Chapel Hill and, in 2017, the Texas Health and Human Services Executive Leadership Academy. She is also a DSHS Preventative Medicine and Public Health Residency Program faculty member.

Kelly Fegan-Bohm, MD, MPH, MA is CHI’s Medical Director. Dr. Fegan-Bohm attended undergraduate school at University of Texas (UT) at Austin where she graduated with a Human Biology degree in 2006. In 2007, she received her master’s degree in Exercise Physiology from UT Austin. She attended medical school at UT Health Science Center in San Antonio where she graduated in 2011 with her medical degree as well as a Master’s Degree in Public Health (MPH). In 2014, she completed her pediatric residency at Doernbecher Children’s Hospital in Portland Oregon and, in 2017, her Pediatric Endocrinology fellowship at Texas Children’s Hospital. She then worked as a Texas Children’s Hospital assistant professor in the Pediatric Endocrinology Department with a focus on clinical care and quality improvement initiatives for children and young adults with diabetes. As Medical Director for CHI, Dr. Fegan-Bohm serves on the Maternal Mortality and Morbidity Review Committee and the Texas Diabetes Council and is a core faculty member for the DSHS Preventative Medicine Residency. She also administers the DSHS Federally Qualified Health Center (FQHC) Incubator Program, which distributes funds to health centers across the state to expand access to care at current FQHCs and FQHC look-alikes, as well as providing funds to health centers working to achieve FQHC or FQHC look-alike status in the future. These funds have expanded access to primary care, including women's and children's health care, dental care, and mental health care across the state.

In December 2021, Lori Gabbert Charney, MPAff was named CHI’s MCH Section Director. Ms. Gabbert Charney attended undergraduate school at University of Texas (UT) at Austin where she graduated with a Government degree in 1997. In 2010, she received her Master’s Degree in Public Administration (MPAff) from UT Austin’s LBJ School of Public Affairs. She has over 24 years of state service, worked in HHSC’s Medicaid CHIP Services for the last 10 years, and, since 2017, served as the Director of Strategic Projects under the Deputy Associate Commissioner of Program Enrollment and Support. She has experience working with families and CSHCN to assess needs and implement programs such as the STAR Kids transition from fee-for-service to managed care. Ms. Gabbert Charney served as a Texas Legislative Budget Board budget and program expert for eight years and has extensive experience working with the legislature and various partners and stakeholders throughout the state. Ms. Gabbery Charney is also serving as interim CSHCN Director.

In May 2023, Dyanne Herrera-Vasquez, PhD was promoted to MCH Epidemiology Director. Dyanne has worked in the maternal and child health epidemiology/analytics area for about eight years in both Texas and Arizona. She has also held manager/director roles in Tennessee and Arizona. Prior to coming to DSHS, she was the STD Epidemiologist/Surveillance Director in Tennessee and led initiatives to improve the data they were reporting to their community partners and CDC.

Julie Stagg, MSN, RN, IBCLC, RLC, is the HTMB Nurse Manager, TexasAIM Program Director, and State Breastfeeding Coordinator, where she provides expertise and coordination for public health policies, programs, and initiatives to improve women’s maternal, perinatal, and infant health. Ms. Stagg completed Maternity Nursing clinical nurse specialty core curriculum before receiving a MS in Public Health Nursing from UT Austin. She worked to promote the health of women and children for over 25 years in hospital, outpatient, community, non-profit, mental health, and public health settings.

In January 2022, Karen Hess became MCH Section’s NBS Screening Director. Ms. Hess previously served as Genetics Branch Manager within NBS and held this job for over 7 years. Ms. Hess spent almost 9 years as the DSHS Vaccines for Children program manager. Ms. Hess has over 26 years of experience working on public health and media relations issues and holds a Bachelor of Arts degree from Abilene Christian University in Advertising and Marketing with additional course work in Public Health.

In January 2016, Rhonda Stokley, DDS, began serving as both Public Health Dental Director and Health Screening and Oral Health Unit Manager. Dr. Stokley has been with DSHS for 7 years and has over 14 years of state service. She has private practice experience and serves Texas by providing dental care for adults with special needs. In 2005, she received her Doctor of Dental Surgery degree from Louisiana State University Health Sciences Center School of Dentistry.

In October 2022, Jia Benno became the Injury Prevention Unit Director.  She oversees the EMS and Trauma Registry, Texas Violent Death Reporting System, Child Passenger Safety Program, and Child Fatality Review Program. Prior to joining Texas DSHS in January of 2022, she spent 4 years at the Louisiana Department of Health where she served as the Mortality Surveillance Epidemiology Manager. In this role, she oversaw Louisiana’s National Violent Death Reporting System, Child Fatality Review, Sudden Unexpected Infant Death case registry, and many other injury and violence prevention programs. Jia completed her Public Health and Epidemiology training from Tulane University in New Orleans.

In February 2023, Rhyne Perkins became the new Maternal and Child Health, Director of Operations. Rhyne has a Bachelor of Arts in Biology from the University of Texas at Austin and a Masters of Healthcare Administration from Texas Women’s University. Rhyne has experience as a Project Director at the Texas High Education Coordinating Board, and as a Health Plan Manager with the Texas Employee Retirement System. She also spent over ten years as the Senior Advisor/Project Manager at the Health and Human Services Commission where she led senior level project work with local health authorities, value added services, and primary care services to help manage population health.

Texas Title V recognizes staff accomplishments, leadership, and workforce development efforts. Dr. Savannah Larimore and Dyanne Herrera-Vasquez from MCH Epidemiology both completed the Association for Maternal and Child Health Programs (AMCHP) Leadership Lab. In the Maternal & Child Health Unit, Susan Bareis also completed the AMCHP Leadership Lab. Julie Stagg co-authored "Statewide Perinatal Quality Improvement, Teamwork, and Communication Activities in Oklahoma and Texas” which was published in Quality Management in Health Care.

Title V learning needs are addressed through routine staff discussions at the unit, section, and individual level to identify and meet workforce needs. In May 2023, 10 DSHS MCH staff attended the AMCHP Annual Conference both in-person and virtually. From May 2023 to August 2023, 15 Maternal and Child Health Unit staff participated in the Certified Texas Contract Developer Course to enhance their skills developing and reviewing scopes of work, evaluating responses, negotiating proposals, and awarding contracts.  Speakers included Dr. Benjamin Hoffman – the American Academy of Pediatrics president-elect- and local researchers and CFRT members. In December 2022, MCH hosted the TexasAIM Summit. Over 200 providers and community members attended. Summit topics included a patient panel discussion, information on the Perinatal Psychiatric Health Network, and how to improve maternal health in Texas. In February 2023, MCH funded the Texas Collaborative for Healthy Mothers and Babies Summit. Over 250 providers and community members attended, as well as 11 MCH staff.

In Oral Health Improvement, two staff attended the National Oral Health Conference this year for continuing education courses, workshops, and to present a poster and a roundtable discussion. Staff also attend webinars throughout the year on a variety of oral health topics. The program was accepted into the Consortium for Oral Health Systems Integration and Improvement (COHSII) Learning Collaborative in 2022. This ongoing project brings together eight state oral health programs and their local clinic partners. The goal is to assess and improve systems-level capacity for integrating oral health care and primary care for pregnant women, infants, children, and adolescents, including those with special health care needs. Staff utilize independent learning resources available through MCH Navigator, the Centers for Disease Control and Prevention’s (CDC) Public Health 101 Series, the Georgetown National Center for Education in Maternal and Child Health (MCH Evidence), Kansas University’s Community Toolbox, and other resources.

The Health Screening and Oral Health Unit within the MCH Section strives to identify Texans’ oral health needs and provide resources to meet those needs. The Oral Health staff include central office staff and 5 Regional Dental Teams (RDT) each consisting of a dentist and registered dental hygienist. The regional teams are based in San Antonio, Houston, Lubbock, Tyler, and Midland. This unit conducts statewide oral health surveillance, including a Basic Screening Survey (BSS) of 3rd grade children and Head Start students. This is a weighted survey using probability proportionate to size sampling methodology. Health Screening and Oral Health is the only program that conducts oral health surveillance of this type in Texas. The surveys are conducted every 5 years and the information acquired allows DSHS to track prevalence and extent of oral disease trends and the presence of dental sealants.

In FY23, Health Screening and Oral Health Unit staff attended a Prevent Blindness Childhood vision screening training on aspects of childhood vision that affect children. This led to the creation of a Strabismus and Amblyopia presentation (please see Supporting Documents) to further educate the team. RDTs also provide oral health education and preventive dental services including limited oral evaluations, fluoride varnish, and dental sealants for qualified students. RDTs have portable dental equipment and travel to schools, Head Starts, and other programs to provide services and conduct surveillance. Texas Title V continues to identify opportunities to collaborate on the shared goal of improving the health of mothers and children.

Within IPU, CFRT team trainings are offered to build capacity to review child deaths across Texas and come up with actionable recommendations to decrease future deaths. Staff participate in collaborative meetings with PHRs to discuss CFRT efforts and areas of improvement. These meetings build capacity in other DSHS staff about how to improve community communication and corresponding work. The IPU team regularly presents at and attends workshops, trainings, and conferences. These opportunities to share data and information with peers and stakeholders are critical for building relationships and increasing community data reporting for CFRTs.

MCHE leadership sends opportunities from newsletters to staff for awareness. MCHE has a formal process for staff interested in attending any annual conference or training opportunity. New staff receive and are active in the development of their professional development. Trainings are also catalogued in a State Systems Development Initiative (SSDI) grant deliverables spreadsheet. Staff regularly attend both virtual and in-person trainings and development opportunities that support continuing epidemiological education.

Title V Block Grant funds support the NBS Program. Texas operates the largest newborn screening program in the nation, testing approximately 775,000 specimens per year or nearly 400,000 babies annually. The NBS Program continues to meet its annual objective of 100% follow up and case management of identified presumptive positives. NBS supports workforce development and overall infant health education in the state by informing thousands of health care professionals and expectant and postpartum parents about the importance and benefit of newborn screening and follow-up to positive tests. NBS promoted quality improvement measures by monitoring the number of unsatisfactory specimens submitted to the DSHS laboratory, following up with educational resources and monitoring the average statewide transit time from specimen collection to receipt in the DSHS Laboratory to confirm timely follow-up to definitive diagnosis and management of conditions. NBS works closely with medical specialists, advisory committees, state agencies, and community organizations to identify pertinent workforce development changes and potential needs.

In 1993, the Texas Birth Defects Act (Texas Health and Safety Code, Chapter 87, Birth Defects) established the Texas Birth Defects Registry (Registry). The registry has operated since 1994 and is overseen by the DSHS Birth Defects Epidemiology and Surveillance Branch (BDES) And statewide data became available in 1999. Highly trained regional staff visit medical facilities to review logs, hospital discharge lists, and other records to find babies with possible birth defects (structural malformations or chromosomal disorders). If the record indicates the infant or fetus has a condition covered by the registry, detailed demographic and diagnostic information are abstracted and entered in the registry for processing. The registry identifies and collects cases and diagnoses up to the child’s first birthday. Quality assurance activities are conducted throughout data collection and data processing to monitor the accuracy, completeness, and timeliness of the registry’s data.

DSHS recognizes the Community Health Worker (CHW) workforce value in serving as a key component in Texas’ response to emerging health issues. In many areas of the state, PHR staff may also be certified CHWs and often collaborate with regional or local CHW networks or training programs. Title V supports the Promotor(a) or CHW Training and Certification Program staffing and infrastructure now housed within DSHS’ HPCDP Section. Staff include 2 program coordinators, 3 program specialists, and an administrative support specialist. The Program oversees CHW and instructor certifications and certifies initial training and continuing education organizations.

DSHS partners with a range of CHW training programs, including community colleges, academic institutions such as University Health Science Centers, Area Health Education Centers (AHECs), FQHCs, CHW associations, and community-based organizations. DSHS and the approved training programs share a deep commitment to providing quality CHW education. Texas was an early leader in the nation by adopting legislation to implement a Promotor(a) and CHW statewide certification process and continues to seek ways to expand CHWs to assist Texans in accessing needed health and social services.

CHWs often share the same linguistic or cultural experiences of the individuals they serve and work to provide culturally competent services in a way easily understood by their audience. CHWs receive continuing education credit for online modules developed by HHSC related to the culturally effective health care and Culturally and Linguistically Appropriate Services (CLAS) Standards.

DSHS and HHSC continue to work to increase CHW access and impact in Texas. CHWs are employed by DSHS funded community-based clinics to facilitate access to services and improve the quality and cultural competence of primary, preventive, and screening health care services for women across the state. HHSC surveyed the state’s Medicaid/Children’s Health Insurance Program (CHIP) managed care health plans. CHWs provide health education, information, and referral, assist clients in navigating complex health and social service systems, and provide follow-up through clinic and home visits. Maximus, HHSC’s Texas Health Steps (Children’s Medicaid) enrollment broker operations contractor, employs CHWs as outreach counselors.

Under the Texas 1115 Medicaid waiver, the state funds projects to incentivize hospitals and other providers to transform service delivery practices to improve quality, health status, patient experience, coordination, and cost-effectiveness. Projects included expanding the use and integration of the CHW workforce in the Texas health care delivery system. CHWs provide services to increase access to care and facilitate appropriate use of health resources through community a delivery system outreach and cultural linkages, reduce costs by providing health education, screening, detection, and basic emergency care, and improve quality by contributing to patient‐provider communication, continuity of care, and consumer protection. CHWs provide patient navigation services to enhance social support and culturally competent care to vulnerable and high‐risk patients and serve as members of Health Home interdisciplinary teams. Texas’ certified CHW workforce continues to increase over time as awareness and utilization of the CHW workforce grows.