A strong workforce is the backbone of public health. To best serve the MCH population, the Title V and public health workforce must include personnel with MCH subject expertise and strong program leadership. Michigan’s MCH programs include a range of personnel, including public health consultants, epidemiologists, departmental specialists, program managers, and division directors who carry out the state’s MCH work. Assessment of workforce trends and the evolving MCH landscape help to identify areas of need, as discussed in the Needs Assessment Update. Throughout the COVID-19 pandemic, state and local MCH staff rapidly adapted to a remote work environment and identified ways to effectively coordinate and deliver MCH services. Additional information related to the MCH workforce is included in the 2020 Five-Year Needs Assessment.

Title V and MCH Staff

A core group of MDHHS staff work on Title V as well as other MCH programs and initiatives. Key positions that support Title V include the following:

• Director, Division of Maternal and Infant Health, serves as Title V MCH director and leads other key maternal and infant health programs including Title X Family Planning, Maternal Infant Health Program, Early Hearing Detection and Intervention, infant safe sleep, and the Michigan Perinatal Quality Collaborative.
• Director, Children’s Special Health Care Services Division, serves as Title V CSHCN director and provides oversight for the CSHCS program and policy, customer support, quality improvement, contract management, and the Children with Special Needs Fund.
• Director, Family Center for Children and Youth with Special Health Care Needs, leads a statewide comprehensive family resource center utilizing a family-centered care model, in which all Family Center staff are parents of a child(ren) with a special health care need.
• Director, Division of Child and Adolescent Health, provides leadership for programs and services related to child, adolescent, and school-based health; early childhood; teen pregnancy prevention and teen parent support; home visiting; the Title V local MCH (LMCH) program; and oral health.
• CSHCS Policy and Program Development Section Manager, provides oversight to staff responsible for policy, medical transition services, specialty clinics, contracts, insurance premium payment benefit, and billing assistance.
• CSHCS Transition Specialist, provides resources and technical assistance to families, providers, local health departments, and Medicaid Health Plans to help adolescents transition from pediatric to adult health care.
• Title V MCH Block Grant Coordinator, coordinates all activities related to the Title V block grant, including oversight of grant application and annual reporting activities across the department.
• MCH Nurse Consultant and Public Health Consultant, two positions that provide oversight, contract management, and technical assistance to the Local MCH (LMCH) program which administers Title V funding to all 45 local health departments (LHDs).
• MCH Epidemiology Section Manager, manages several MCH epidemiology staff and provides epidemiologic analysis and interpretation to inform and guide MCH program leaders and policy makers about population health.
• Child, Adolescent & School Health (CASH) Epidemiologist, provides epidemiological and data support to child, adolescent and school health programs along with support to the Title V program, including needs assessment activities and annual reporting.

Four of these positions are currently supported by Title V funding to provide administrative support to the Title V block grant. The MCH nurse consultant position is the only administrative position fully funded by Title V. The block grant coordinator, public health consultant, and CASH epidemiologist are supported through blended funding (e.g., Title V, state general funds, other federal funds) as the positions have responsibilities in addition to Title V.

Title V funding is also used for MCH and CSHCN programmatic positions. Title V supports an Oral Health Coordinator assigned to Detroit Public Schools, a public health consultant and a nurse consultant for the Childhood Lead Poisoning Prevention Program, part of an Oral Health epidemiology position, part of a Home Visiting epidemiology position, and staffing for the Family Center. Title V funding also supports epidemiology staff who oversee Michigan’s PRAMS.

Many other MCH staff, including managers, program staff, epidemiologists, public health consultants, and budget and contract specialists, support Title V activities and implementation of Title V state action plans as part of their broader work, but without Title V funding for state-level staffing. Local health departments can also use Title V funding to support critical MCH positions in their community (e.g., public health nurse, health educator, epidemiologist, etc.).

MDHHS Hiring Practices

To recruit and retain qualified staff, MCH programs work with MDHHS Human Resources to post positions through the State of Michigan job postings website and Indeed.com, in addition to sending out job postings through MCH listservs. To help the workforce deliver services that are informed by equity-related knowledge and practices, MDHHS developed the Diversity, Equity, and Inclusion (DEI) Plan recognizing that a “diverse workforce will be an essential asset for developing and providing health and human services that are culturally proficient to address existing and emerging health and social issues.” The DEI plan is being implemented in the areas of Leadership, Culture and Climate, Recruiting and Hiring, Training and Professional Development, and Service Delivery. Beyond but inclusive of MCH, MDHHS launched mandatory “Introduction to Health Equity” and “Systemic Racism” online trainings in 2019 for all staff. The Office of Race Equity, Diversity and Inclusion (REDI) was created in 2020 “to address racial, health, social and wealth disparities, that impact both internal and external partners”. In 2021, MDHHS implemented a new requirement that all MDHHS position postings include a Valuing Diversity and Inclusion competency in the posting questions as well as a standard set of DEI interview questions.

Beginning in 2019, Diversity Hiring Team (DHT) trainings were rolled out to individuals in two cohorts with the goal of applying a Diversity, Equity, and Inclusion (DEI) lens to various phases of the hiring process. Cohort members participated in a series of DHT trainings. The goal was for DHT alumni to assist hiring managers with the process of screening, interviewing, scoring, and selecting job candidates in an equitable way to ultimately have a workforce that is more reflective of the diversity of the state. The Office of Human Resources provides assistance to MDHHS program areas that are aligning hiring protocols with the DHT approach.

In April of 2019, MDHHS Office of Workforce Development and Training (OWDT) partnered with Children's Services Administration (CSA) to create an Anti-Racism Transformation Team (ARTT). This process began with a Planning and Design Task Force (PDTF) which organized the team and its training. Training was provided to equip the CSA ARTT with the knowledge and skills needed to create a structural intervention that includes strategies to break down barriers and create anti-racist and anti-oppressive structures, policies, practices, and procedures within the child welfare system. Since the creation of the first ARTT at MDHHS, three additional ARTTs have gone through the same process. The Michigan Child Support ARTT began the PDTF process in October 2021, followed by the Jackson County ARTT and Kent County ARTT in January 2022.

In 2022, the MDHHS Diversity, Equity, and Inclusion (DEI) Council’s Recruitment, Hiring and Retention Action team introduced the MDHHS Toolkit for Managers: Recruiting, Hiring, and Retaining a Diverse and Inclusive Workforce. The toolkit provides practical information, tips, and resources for integrating DEI into hiring and retention processes. The toolkit is available for all managerial levels and work areas.

Training and Professional Development for MCH Staff

Opportunities and training needs for Title V and MCH program staff, including family leaders from the Family Center, are continuously assessed to identify areas for professional development. Many staff development activities have built upon core concepts introduced through the Health Equity Learning Labs and Guiding NEAR (neuroscience, epigenetics, ACEs and resilience) trainings that began in 2018. The Learning Labs focused on health equity education and how to assess policies, programs, and hiring practices through a health equity lens. Several MCH equity initiatives have grown out of those initial trainings, as discussed below.

The Guiding NEAR training was designed for emerging leaders to work with stakeholders to design programs and services that interrupt the trajectory of adversity for Michigan residents. The current NEAR Collaborative is coordinated by MDHHS and focuses on addressing policies, practices, and norms within hiring and program recruitment, implementation, and evaluation. The NEAR Collaborative also designed a Trauma-Informed Road Map for State Systems which is included in the 2021 report. In the fall of 2022, MDHHS hosted the first Trauma Informed Home Visiting training series.

As Michigan’s Title V MCH lead, the Division of Maternal and Infant Health (DMIH) provides training, technical assistance, and workforce development activities to support the MCH workforce and health equity. Activities include the following:

• Training and consultation to internal staff and partner networks on equity principles and strategies.
• Clinician training throughout the state on implicit bias with a focus on the use of best practices to enhance the patient-provider relationship (e.g., Medicaid Health Plan partners and health systems).
• Training and consultation to the MCH workforce in local communities through Regional Perinatal Quality Collaboratives (RPQCs). RPQCs are required to address health inequities, the social determinants of health and disparate outcomes.
• On-demand trainings and resources are available on the DMIH webpage for use by anyone visiting the website (e.g., internal staff, partner networks, community members).
• Discussions and opportunities for peer sharing occur through quarterly Mother Infant Health and Equity Collaborative meetings.
• Maternal Infant Health and Equity Updates are shared on a regular basis (at least twice monthly) via a listserv that is distributed to over 11,407 primary contacts and an additional 2,000 individuals through secondary sharing by MDHHS programs and professional organizations. The listserv reaches a broad array of state and local partners, including practitioners and parents.
• In August 2022, MDHHS hosted a Public Health Nursing 101 Conference, with 72 registrants from 22 Local Health Departments, representing nine of Michigan’s 10 Prosperity Regions. Participants attended seven sessions, including The History of Public Health Nursing, MI Public Health Law, Practice & Policy, a Public Health Nursing Leaders Panel Discussion, and The Importance of Self Care. The conference was well received, and two additional Public Health Nursing 101 Conferences were held in April 2023.

Since its inception in 2018, the Maternal Infant Health Summit has centered its keynote and breakout sessions on health equity. The conference provides a unique opportunity for multidisciplinary collaboration, convening national and statewide stakeholders working to improve maternal, infant, and family health. The inclusive opportunity provides a stage to exchange innovative ideas and stories, while uplifting families and communities as changemakers and leaders. For example, the 2021 and 2022 Summits included presentations on Advancing Black Maternal Health, Rights and Justice, Integrated Infant Mental Health, Birth Justice, the Role of Doula and Midwifery Care, and Using Your Power and Privilege. Over 600 attendees participated in both the 2021 and 2022 Summits. Attendees indicated that their areas of interest were health equity, disparities in birth outcomes, structural racism, and implicit bias. Attendees in 2021 indicated a greater interest in inclusivity especially when discussing family make-up, LGBTQ+ families, and male engagement, all of which received increased focus at the 2022 event. The 2023 Summit will offer an array of learning opportunities for the MCH workforce that center health equity and justice. The Summit will be held in-person in June 2023, with the theme “Taking Action Today for an Equitable Tomorrow.” The planning team is building on the momentum of the past two years, with a focus on moving attendees from learning into meaningful action. Additionally, to support access to doula services statewide and in support of Michigan Medicaid’s new coverage of doula services, DMIH will provide doula related education and training content at the 2023 Summit. Resources will also be available through DMIH to support individuals statewide to obtain MDHHS approved doula trainings to further expand Michigan’s doula workforce.

The CSHCS Division, which serves as Michigan’s Title V CSHCN lead, established a Health Equity Workforce Development Committee which produces a monthly virtual bulletin board for state and local CSHCS staff. The virtual bulletin board content includes diagnoses that CSHCS families live with and through every day; disparities that different communities face; and awareness days to honor and acknowledge different cultures and health conditions. The virtual bulletin board is shared with LHD CSHCS partners across the state.

In FY 2022, CSHCS also participated in Boston University’s Care Coordination Academy which provided an opportunity for CSHCS professional development. Through participation in this national, HRSA-funded program, CSHCS learned about care coordination best practices including tiering for complexity and social determinants of health assessments, and the use of evidence to measure system improvements. The CSHCS team included CSHCS and Medicaid staff as well as family, LHD, and university partners. The focus of the project is children with medical complexities.

Building upon Michigan’s participation in the Care Coordination Academy and the work around children with medical complexity, CSHCS was invited to participate in Project ACCELERATE (Advancing Care Coordination through Evidence; Leveraging Existing Relationships Around Transforming PracticE). The project teams include MCH Title V Directors, Medicaid Medical Directors, and patient advocates. The goal is to review the latest Patient-Centered Outcomes Research Institute (PCORI) supported findings for enhanced care coordination for CYSHCN.

The Division of Child & Adolescent Health (DCAH) also serves an important role within Michigan’s Title V program. Training, professional development, and other activities that support the MCH workforce include the following:

• The DCAH convenes an internal Health Equity and Social Justice (HESJ) Workgroup composed of 26 members who are focused on individual growth and consciousness around race and equity issues, with the intention that as MCH professionals grow and are more aware of equity and social justice, their work will be authentically impacted. Agendas focus on topics such as implicit bias and structural racism in healthcare.
• The DCAH provides technical assistance and program support to all 45 local health departments through the Local MCH (LMCH) program. Support ranges from administrative aide in implementing the LMCH program to identification of best practices for specific MCH program areas or performance measures.
• School-based mental health services and staffing for Child and Adolescent Health Centers (CAHCs) expanded through an annual $4 million investment from MI Kids Now funding. This funding will allow each CAHC to fund a full-time mental health provider and increase availability of mental health services for youth throughout the state.
• The FY 2023 state budget included an additional $25 million to start up to 100 school based/linked health centers (Child & Adolescent Health Centers) in new and existing counties in Michigan. These additional dollars will support primary care, nursing and mental health services in new schools and community locations. DCAH provides support and technical assistance to these centers across the state.
• In January 2023, the Michigan Home Visiting Initiative announced training opportunities that include individual trainings on NEAR, HOPE (Healthy Outcomes from Positive Experiences), and Strengthening Families. Those training sessions are planned for February, May, and August 2023.

MCH staff also participate in a wide range of conferences and professional development opportunities. For example, MDHHS hosts conferences attended by MCH staff and statewide partners, including the Child, Adolescent, School Health (CASH) Conference, Michigan Home Visiting Conference, MIH Summit, and Teen Parent Summit. MCH staff participate in the Mother Infant Health and Equity Collaborative (MIHEC). An MCH team from Michigan (including a family leader) participates in the annual AMCHP conference. The Family Center hosts an annual meeting for the Family Leadership Network (FLN). Each year, the CSHCS Division also invites a parent to attend a CSHCS Division meeting to share their family’s story with staff, which is a powerful way for staff to see the impact of their work. CSHCS provides regular workforce development opportunities for LHDs through annual meetings, regular technical assistance, monthly calls and the CSHCS LHD Advisory Council. In response to significant turnover in local health department CSHCS staff, due in part to the COVID-19 pandemic, CSHCS developed and is implementing a series of peer-led training sessions for new local staff to learn from more experienced local staff on various program implementation topics.

Staffing Structures and Workforce Financing

Michigan utilizes innovative financing mechanisms to support administrative and program staff who work on a variety of MCH initiatives. For example, administrative match is leveraged for state staff working on Medicaid-financed programs including the Child and Adolescent Health Centers (CAHCs), Local Health Department Medicaid Outreach, Oral Health, and Maternal Infant Health Program. Shared positions between MDHHS and MDE have enabled a funding structure to support staff that benefit both agencies including Michigan’s State School Nurse Consultant and a state-level Mental Health Consultant. MCH funding also supports epidemiology staff who are housed in the Bureau of Epidemiology and Population Health but directly support and work with MCH programs.

The Family Center for Children and Youth with Special Health Care Needs (Family Center) also utilizes an innovative staffing structure. The Family Center requires that all staff hired within the Family Center are parents of children with special health care needs. In addition, the Family Center has a paid Youth Consultant which improves the Family Center’s ability to provide a family and youth perspective to CSHCS programming. In FY 2022, CSHCS had one Family Center staff member participating in the MCH Leadership Lab Family Leaders Cohort. The Leadership Lab provides an opportunity for state staff to accelerate their professional development in a way that is framed by MCH Leadership Competencies and guided by adult learning principles.

Lastly, MDHHS has a unique partnership with the Michigan Public Health Institute (MPHI). MPHI is a non-profit corporation established by Public Act 264 of 1989 to advance health in the state. Services include assessment and planning, project management, program development, evaluation, and research. Several of Michigan’s MCH programs work closely with MPHI, especially through the Center for Healthy Communities and the Center for Health Equity Practice. Projects have included the 2020 Title V needs assessment, the 2020 Maternal Infant Early Childhood Home Visiting (MIECHV) needs assessment, the Preschool Development Grant Needs Assessment and Evaluation, the Early Childhood Comprehensive Systems Grant and Strategic Plan, Parent Leadership in State Government trainings, Health Equity Learning Labs, and home visiting evaluation under MIECHV and other state and federal funding streams. MPHI also partners with CSHCS and the Family Center to host online education modules for transition and parent mentor trainings. More broadly, MDHHS partners with MPHI on public health projects which have included the State Innovation Model, the Local Public Health Accreditation Program, and the State Health Assessment.

MPHI has also worked with the Maternal Infant Health Program (MIHP) within the Division of Maternal and Infant health to develop intervention-based strategies for supporting families who may have experienced Adverse Childhood Experiences (ACEs). This CDC-funded initiative focused on prevention through public education campaigns and incorporating ACEs into plans of care developed for families as well as training on ACEs and trauma-informed care for home visiting staff. Through continuous funding and support from the Michigan Health Endowment Fund, MPHI will continue to offer support for the expansion of this project within the MIHP statewide network.