MCH Workforce Development

Nevada Title V MCH supports 11 Full-Time Equivalent (FTE) staff members and eight employees in various roles and capacities in the Bureau of Child, Family, and Community Wellness (CFCW). Candice McDaniel, MS, and Karissa Loper, MPH, served as the CFCW Bureau Chief, and Candice McDaniel served as the Nevada Title V MCH Director during most of the reporting period and provided oversight across diverse programs and sections, including MCAH. Ms. Loper accepted another position in January 2022. Kyle Devine, MSW, is the current CFCW Bureau Chief with oversight of the MCAH Section, WIC, NSIP and CDPHP. Vickie Ives, MA, serves as the MCH and CYSHCN Director and was MCAH Section Manager for most of the reporting period, and was promoted to Deputy Bureau Chief in August 2021. Mitch DeValliere, DC, served as the Title V MCH Program Manager for the MCH Unit for most of the reporting period until July 2021. The Title V MCH Program Manager position is now held by Kagan Griffin, MPH, RD, who started October 2021.

During the reporting period, the MCH unit was staffed by Eileen Hough, MPH, AHWP Coordinator, Kagan Griffin, RD, MPH, MCH Epidemiologist and PRAMS Lead Coordinator (position now vacant), and Amber Hise, RD, Maternal and Infant Program Coordinator (position now vacant). Tami Conn served as SSDI Manager, working closely with the MCH Unit and leading data efforts. Ms. Conn was promoted to MCAH Section Manager in December 2021. For much of the reporting period the RPE Coordinator position was vacant, but was filled in August 2021 by Cynthia Burboa, MPH. then by Samm Warfel in June 2022. The CYSHCN Coordinator was vacant for the reporting period but is now a state position instead of a contractor and was filled in February 2022 by Cassius Adams. Desiree Wenzel serves as the MCAH Section Office Manager.

Non-MCH funded key partners within the MCAH Section, CFCW, and other areas of DPBH collaborating on MCH-related activities include:

• PREP 1.0 FTE Coordinator, SRAE Program 1.0 FTE Coordinator, 1.0 FTE Administrative Assistant (AA) II, and 0.4 FTE Grants and Project Analyst (GPA) I
• EHDI 1.0 FTE Coordinator, EHDI 1.0 FTE Data Analyst, EHDI 1.0 FTE AA II, and 0.5 FTE Audiologist
• AFP, Health Program Specialist 1,1.0 FTE Coordinator
• AIM and ERASE MM
• SSDI
• Division of Child and Family Services staff
• Nevada WIC Program and Immunization Program staff
• Substance Abuse Prevention and Treatment Agency program staff

Partially or fully funded MCH key state partners include:

• RPE Program 0.25 FTE Coordinator through leveraged Preventive Health and Health Services Block Grant and CDC grant funds
• Community Health Nurses who provide health promotion and prevention services, care coordination, health education, and outreach to support public health in Nevada’s rural and frontier counties
• NHV Program - two sites co-funded
• Nevada Immunization Program 0.5 FTE Accounting Assistant supports MCH fiscal efforts
• DHHS Office of Analytics 1.0 FTE Biostatistician and 1.0 FTE Health Resource Analyst II who provides data support across MCAH programs
• 1.0 FTE SSDI Manager
• Primary Care Office 0.5 FTE Health Resource Analyst
• MMRC 0.5 FTE Nurse Abstractor (Ancillary costs only)

State and Division Staff Training

Nevada continues to maintain its Online Professional Development Center (https://nvelearn.nv.gov) and provide in-person classes to employees. The Development Center contains various trainings, including developing and applying logic models for planning, implementing, and evaluating programs, effective techniques for presenting data, and practical methods for making decisions. DPBH employees meet annual HIPAA and information security training requirements using the Development Center and can use it to further job-related skills. In March 2021, Nevada launched SMART 21, or Success Factors, to house additional trainings, both virtual and in-person, for employees. Employees value the continuing education offered by MCH trainings to stay current on topical MCH developments in priority areas. Additional trainings taken by MCH staff remained mostly virtual due to the ongoing COVID-19 pandemic. Other workforce development opportunities are provided to staff by various state programs, federal agencies, academic institutions, and professional organizations such as the AMCHP, Immunize Nevada, HRSA/AMCHP Technical Assistance and Regional meetings, the Nevada Public Health Association (NPHA), and through an assortment of coalition conferences. Title V MCH staff attend the Statewide MCH Coalition and Breastfeeding Coalition sponsored trainings and Project ECHO, the local Area Health Education Center (AHEC), MSRGC, NGCDD, and UNR trainings.

MCAH Staff Training

In the reporting year, MCAH Section staff participated in various workforce development opportunities. As situations changed regarding COVID-19, a majority of trainings were virtual, but some were able to be attended in person. Trainings provided to MCAH staff Include:

• The MCH Director attended development opportunities and trainings in support of MCH, WIC, CDPHP, and Immunization sections and continues to be a key participant in statewide systems building initiatives such as the Nevada Pritzker Foundation, ECCE, and Healthy Start efforts, Medicaid MCH workgroups, substance use in pregnancy initiatives, MSRGC, NGCDD, and early childhood initiatives.
• The CYSHCN Director attended trainings and conferences during the reporting period, including HRSA Title V MCH meetings and AMCHP Conference, regional and Policy Committee meetings, Association of State and Territorial Health Officials (ASTHO)-Opioid Disorder, Maternal Outcome, OMNI, PRISM, Prevent Child Abuse Nevada, Community Engagement on Access to Reproductive Health, NOMHE training and Advisory Board, AIM and ERASE MM trainings, RPE, PREP and SRAE All-Grantee Meeting, Nevada Pritzker, NGCDD, CARA, NDE Health Standards Meetings, LEAHP, WMSRGN, Healthy Start and many local reoccurring meetings, including the Statewide Executive Committee to Review Child Fatality, FIMR, SETNET, Pediatric Mental Health Evaluation, MHP Advisory Committee, UNLV School of Public Health Board, MCH Research Quarterly Meetings, and Nevada Newborn Screening Advisory Committee. Numerous webinars and trainings were attended on MCH topics with a focus on health equity, Medicaid and MCH topics, ASTHO SPACECAT, CYSHCN policy and family engagement, maternal mortality, and MCH and COVID-19 topics.
• The Title V MCH Program Manager attended local reoccurring meetings including for the MHP Advisory Committee, AMCHP Policy All State meetings and the AMCHP 2020 annual conference, and IM-CoIIN SDOH meetings. The Title V MCH Program Manager also attended the Nevada Health Conference (NHC).
• The Maternal and Infant Program (MIP) Coordinator attended local reoccurring meetings, including for the Northern and Southern Nevada MCH Coalition, and the Northern Nevada Breastfeeding Coalition. The MIP Coordinator also attended several webinars and online training courses including: Addressing the “C’s in ACEs: Combatting the Nation’s Silent Crisis, PRISM Policy Academy, Wealth Inequity: Understanding the Impact of Poverty on Families’ Health, Nevada Child Abuse Prevention and Safety Virtual Conference, the AMCHP 2021 annual conference, and the Association of Public Health Nutritionists annual conference.
• The RPE Program Coordinator was vacant during the majority of the reporting period, but online training courses attended included: RPE Evaluator Meeting: Lessons learned from COVID-19, Nevada Coalition to End Domestic and Sexual Violence Economic Justice Workgroup, and Hanging Out or Hooking Up: Moving Beyond the Core Principles of Adolescent Relationship Abuse.
• The AHWP Coordinator attended several webinars and online training courses including: Practicing Adolescent-Centered Trauma-Informed Care, Cultural Competency Training hosted by DPBH, the Nevada Health Conference, Racial Equity Learning Sessions hosted by the National Network of State Adolescent Health Coordinators the Association of Public Health Nutritionists annual conference, and the AMCHP 2021 annual conference.
• The CYSHCN Program Coordinator was vacant for the reporting period, but relevant topical trainings were attended by the MCH Manager and CYSHCN Director.
• NHV agencies received training on ‘serve and return,’ a child friendly method of teaching children; Parents as Teachers; Mind in the Making; use of Nevada 211; Strengths-based Practice, home visitor safety; Trauma-Informed Care; Reflective Practice; Adverse Childhood Experiences (ACEs); recognizing and reporting child abuse; choosing your caregiver or partner carefully; family engagement; Bright by Text; Reading Aloud; library tools and resources; Welfare and Supportive Services; Liberty Dental (Medicaid); and Job Connect/Department of Employment, Training, and Rehabilitation (DETR) programs.
• The Teen Pregnancy Prevention (TPP) Program Coordinator attended the Virtual 2021 Family Youth and Service Bureau (FYSB) Adolescent Pregnancy Prevention (APP) Conference: Creating Diamonds During Times of Great Pressure, SRAE TTA Virtual Topical Training: Enhancing Purpose, Passion, and Results, PREP Topical Training Webinar: Strategies for Success: Effective Planning for Program Sustainability, Nevada Public Health Training Center: Diversity, Equity, and Inclusion Trainings for TPP Program, Virtual 2021 Nevada Public Health Association Conference: The Future of Public Health: Resiliency, Health Equity, and Empowering Change in Nevada.
• The MCH Epidemiologist attended the 2021 CityMatch training course in Epidemiology.
• The MCH Data Research Group meets twice a year providing training and collaboration opportunities, and the MCH Data Workgroup meets monthly to discuss data efforts and needs. The MCH Data Workgroup also attends PCO data sharing meetings quarterly. All MCAH staff also attend quarterly MCHAB meetings.
• The MCH team, which included the MCH Director, the MIP Coordinator, the AHWP Coordinator, the SSDI Coordinator, and the MCH Epidemiologist, attended a three-day MCH Workforce Development Center Training in person. HRSA funded subject matter experts led sessions on systems changes pertinent to innovative projects and assessment of efforts. F2F, FQHC and university partners also attended.

Pediatricians, Family and General Practitioners, and Obstetricians and Gynecologists

According to the May 2020 Bureau of Labor Statistics (BLS) Occupational Employment Statistics Query System, the number of Obstetricians and Gynecologists (OBGYN) per 1,000 persons in the U.S. is 0.136. For 2020, Nevada data is unavailable, but in 2018 the Nevada rate was 0.09. An absence of a full-time OBGYN exists in 10 of 17 Nevada counties: Storey, Mineral, Esmeralda, Lincoln, Eureka, Lyon, Humboldt, Nye, White Pine, and Pershing (March of Dimes, Nowhere to Go: Maternity Care Deserts 2020 Report). Nevada has 18 birthing hospitals and one birthing center.

There is evidence to suggest along with absence of full-time OBGYNs, shortages in providers appear in other counties. The Doximity September 2019 OBGYN Workforce Study developed a composite index score to assess the severity of the risk of OBGYN shortages in different metropolitan areas. Las Vegas, the largest metropolitan area in Nevada, was found to be at the highest risk for shortages in the U.S. This index considered the average age of the workforce and the average workload, based on the number of births per OBGYN per year.

The 2020 U.S. rate for Family Medicine physicians is 0.709 per 1,000 persons and 0.364 per 1,000 persons for General Internal Medicine physicians. For Nevada, the rates are 0.507 and 0.269, respectively.

The 2020 U.S. rate for Pediatricians is 0.198 per 1,000 persons, and for Nevada, the rate is 0.104 per 1,000 persons.

The Nevada Health Workforce Research Center is in the Office of Statewide Initiatives at the UNR SOM. According to the 2020 Nevada Health Workforce Research Center’s Physician Workforce in Nevada: A Chartbook Report, Nevada has the lowest number of providers per 100,000 population of any state. Nevada needs additional 244 pediatricians to meet the national average. In 2020, the number of active primary care providers, including general practice, family practice, OBGYN, pediatrics, geriatrics, internal medicine, physician assistants, and nurse practitioners in Nevada is 182.8 providers per 100,000 population compared to 241.9 providers per 100,000 persons nationally. Nevada has the lowest number of providers per 100,000 population of any state. An estimated 2,026,181 Nevadans, or 67.3% of the state’s population, reside in a federally designated primary care health professional shortage area. Three counties, Esmeralda, Eureka and Storey, have no licensed physicians.