Established In January 2020, the Early Childhood and Family Support Division (ECFSD) continues to evolve under the leadership of Tracy Moseman, who began as the Division Administrator (DA) in August 2022.  The ECFSD is one of 12 divisions in the Department of Public Health and Human Services (DPHHS).  To learn more about DPHHS go to: https://dphhs.mt.gov/AboutUs/index.

The ECFSD mission: “To better coordinate existing services for children and families” aligns with the DPHHS mission “Serving Montanans in their communities to improve health, safety, well-being, and empower independence.” 

In early 2023, ECFSD leadership determined it would be beneficial to split the Early Childhood Services Bureau (ECSB) into two bureaus: 1) Child Care; and 2) Early Childhood Services.  The Child Care Bureau is charged with ensuring that all families in need of childcare are aware of the resources to aide in selecting a provider as well as offering financial assistance.  The ECSB, which includes the Prevention and Early Intervention Unit, focuses on quality childcare services to ensure all children are cared for in an enriching environment that meets their physical, emotional, and social needs.

Additionally, ECFSD leadership recommended that the Fiscal Bureau include only staff responsible for the fiscal operations. The Fiscal Bureau is responsible for 30 funding streams, exceeding $84 million, which support over 20 programmatic activities through contracts.  The contracts range from childcare providers; head start programs; universities; County Public Health Departments; healthcare providers; hospitals; community-based organizations; Tribal Health Departments; and middle and high schools.  Data collection and data analysis staff were moved into their own bureau, due to the importance of their separate responsibilities, and the Business Systems/Operations Bureau (BSOB) was formed.  The BSOB is home to staff responsible for managing ECFSD data systems and providing epidemiological support. 

In response to the ongoing challenges in hiring a qualified administrative assistant, the ECFSD leadership team made a proposal to DPHHS leadership to reclassify the position as an executive assistant with supervisory duties. This was approved.  A new FCHB Administrative Assistant has been hired, and will begin supporting the bureau on July 31, 2023.

In November 2020, the ECFSD 2020-2025 Strategic Plan was finalized by Bloom Consulting. The Strategic Plan provided Guiding Principles and Goals, Objectives, and Strategies to guide the work being done by the ECFSD programs.  Over time, the ECFSD has experienced internal structural changes and been awarded new funding streams.  This has led to new programs and partners. The result adds new challenges for recruiting qualified individuals, as well as retaining current staff.  To learn more go to: https://dphhs.mt.gov/ecfsd/.

In August 2023, Bloom Consulting will conduct Phase 2 ECFSD Strategic Planning, which will includes addressing this guiding principle:  “We are committed to staff and workforce development to support professional growth and ensure our programs are administered innovatively and effectively.”  In preparation for the Division Strategic Planning event, each Bureau sponsored their own Strategic Planning opportunities. Bloom’s strategic planning will incorporate all the Bureau led Strategic Planning outcomes.

In June 2023, Yarrow, LLC lead the Family and Community Health Bureau (FCHB), through several activities. This included a SWOT Analysis that identified these FCHB priority areas:  Programmatic Development, Data & Modernization, Staff & Culture, and Communications.  Staff also drafted Objectives and Strategies for each priority area. After the ECFSD Strategic Planning, FCHB staff will regroup and further define these Staff & Culture objectives:  

Objective 3.1: Recruitment - Successfully recruit and hire for open positions within three months.

Objective 3.2: Workplace Culture - Achieve a XX% staff retention rate by DATE.

An additional outcome of the FCHB planning process is to assess the current structure and organization of the bureaus programs, funding, and staff. An outcome of this process may be the addition of another section to the Bureau, to ease the burden caused by an uneven distribution of programs in the existing sections and to better align programs, funding, and staff within the Bureau.

The ECFSD Leadership Team created the ECFSD Workforce Development Policy and Procedure (WDPP), which outlines expectations for all the ECFSD positions and encourages individualized professional development.  The WDPP aligned with TALENT, a State of Montana performance management resource that allows for each agency to develop agency-focused goals. The goals serve as a springboard for state employees to develop activities to track in alignment.  DPHHS identified these organizational goals:

1. Increase Efficiencies (examples:  Digitization, Workflow Improvements, Business Process, Identifying Issues, Continuous Improvement)
2. Improve Customer Service (examples: Decreasing Wait Times, Decreasing Error Rates, Customer Satisfaction Survey Results)
3. Support a Strong, Healthy, and Resilient Culture (examples: Improved Recruitment/Retention, Employee Recognition, Professional Development, Continuous Improvement)
4. Improving Quality of Care (examples: Care Coordination, Quality Measures, Data-driven Decisions)
5. Improve the Well-Being, Independence, and Self-Reliance of Montanans (examples:  Increased Education and Training Programs, Increased Participation Preventive Services/Programs)

Examples of Goal #3 professional development activities range from: attending online classes offered by the University of MT School of Public Health; experienced supervisors mentoring new supervisors; and participating in Public Health and Safety Division training opportunities. Several staff elected to create a Program Desk Manual, which could be described as “everything you wanted to know about the program but were afraid to ask.”

The TALENT expectations have evolved to require all staff to review their progress twice a year, with their supervisor.  Program work performance is also discussed at reflective supervision meetings held a minimum of twice per month with the immediate supervisor.   These meetings are viewed as opportunities to identify emerging training needs, troubleshooting challenges, or to provide feedback on quality improvement endeavors.

Annually, all employees are required to complete refresher trainings from DPHHS Human Resource (HR), and the Technology Services Division, on topics such as: The Health Insurance Portability and Accountability Act (HIPAA); safety in the workplace; and internet security.   All DPHHS Supervisors, Bureau Chiefs and DA are provided the opportunity to attend supervisor specific trainings offered by DPHHS HR.  Topics have included “ How To Complete TALENT,” “ADA Rules”, “Remote Supervision,” and “Employee Assistance Program Resources.”

In early 2022, the Department of Administration (DoA) conducted the Remote & Office Work Study (ROWS) to determine what occupational groups might be eligible for continued telework post COVID.  In September 2022, the ROWS results were released, which identified the number of days a staff person would be allowed to request partial remote work from HR.   

The 2023 Legislature recognized the workforce shortage across all State of Montana agencies, which resulted in the passage of House Bill 13.  Starting July 1, 2023, each state employee received a raise of $1.50 per hour or 4%, whichever was greater.  It also guaranteed that health insurance costs would remain level through 2025, one-time-only bonuses, and created an annual flexible holiday.  Anecdotally, ECFSD staff have expressed their appreciation of being able to work remotely and it is a factor that keeps them employed.   Plus, the benefits of HB 13 have been met favorably by all staff.

The Title V MCHBG Program, housed in the FCHB, is co-led by the Maternal and Child Health Coordination (MCHC) and Children With Special Health Care Needs (CSHS) Section Supervisors.  In their roles as the Title V Director and the Title V/CSHS Director, they supervise staff who are responsible for programs that directly support the National Performance Measure (NPM) State Action Plans (SAP). 

Recruitment is underway to fill several open MCHC Section positions, which became vacant in the last two months due to career advancements.   The open positions are: the Nurse Consultant/Grant Administrator, who oversees the Maternal Mortality Review and Prevention Program (MMRP); and the Oral Health (OH) Program Specialist; and the Primary Care Office (PCO) Program Specialist.  The MCHC Section also includes the Montana Obstetric Maternal Support (MOMS) Program Specialist, who is providing grant support to the MMRP; and the MCHBG and FICMMR Program Specialists (PS).  Yarrow, LLC and WIM, LLC are assisting the Title V MCHBG Supervisor with the day-to-day operations of the OH and PCO Programs, pending the hiring of those positions. 

In October 2022, the Title V CSHS Director/Supervisor resigned. The position was filled in December 2022, by the Newborn Screening Program Specialist (NBSPS), who was in the CSHS section for 8+ years.  The NBSPS position was vacant for a short period of time, with the hiring of the previous MAPP-Net Program Specialist who opted to return to the CSHS Section from a different DPHHS Division.  The CSHS Section, which also houses the MAPP-Net Program and the Title V Children & Youth with Special Health Care Needs (CYSHCN) Program Specialist, will be complete with the hiring of a nurse consultant.  Because of the similarity of the CSHS and MMRP nurse consultant positions, the interview panel includes both the Title V MCHBG and CYSHCN Directors.

The DPHHS Human Resources (HR) Office assists with recruitment and hiring processes, and provides onboarding training for all new hires.  In addition to the HR training, several programs have developed their own onboarding materials to support new employee training specific to program competencies, these include: CSHS, Oral Health, Maternal Review and Prevention, and the Primary Care Office.

Partnerships are key to addressing the National and State Performance Measures (N/SPM). As explained in the Overview of the State narrative, County Public Health Departments (CPHDs) are significant partners to provide health and social services to their residents. The MCHBG Program Specialist helps the CPHDs create an Operational Plan (OP) for the N/SPM that outlines their activities, evaluation plans, and goals. The MCHBG PS completes a QI review of each OP and offers state and community resources to the CPHDs.  The CPHDs that select SPM 1 or 2 are guided by the MCHBG PS to ensure that they accomplish their goals and objectives as outlined on their Operational Plan (OP).  The MCHBG PS also oversees the CPHD contracts and reporting.

The following table is a snapshot of Lead MCHC or CSHS Staff NPM expert and partners:

The FCHB programs that work directly with CPHD staff are well aware of the need to be flexible in response to the reality of the CPHD work environment.  Many staff wear multiple program hats. Also, recruiting and retaining qualified staff to work in rural and frontier communities, where the nearest airport might be 200+ miles away, presents its own unique challenges.  In calendar year 2022, the MCHBG Program Specialist provided training to eight new MCHBG/CPHD leads. And the FICMMR Program Specialist trained seven new FICMMR/CPHDs team leads.    

As highlighted in the N/SPM narratives, the CPHDs receive numerous emails promoting educational and awareness materials on MCH topics.  The 2020-2025 Needs Assessment results indicated that access to childcare services ranked as a high unmet need for all but the Adolescent domain.  It was determined that the childcare access was better addressed by the other DPHHS divisions.  Being co-located with the Early Childhood Services and Child Care Bureaus has allowed for an ease in learning about programs and materials that can be shared with the CPHDs.  Impromptu interactions between staff, combined with the monthly ECFSD Management Meetings, have proven to be invaluable for the sharing of materials with the FCHB.

In response to workforce challenges facing CPHDs and local WIC clinics, the WIC state office contracted with a registered dietitian to assist in providing coverage for staffing shortages and vacancies.  The purpose is to maintain access to WIC benefits for participants. This approach has proven to be a successful model in maintaining staffing coverage for local WIC clinics through staffing transitions.