Texas recognizes the value in developing the Texas MCH and CSHCN workforce and enhancing MCH capacity at DSHS. To better serve MCH populations, address and adapt to the changing needs in the state, and improve health outcomes, the Title V workforce in Texas strives to maintain optimal subject matter expertise and staffing infrastructure.

The Maternal and Child Health Section (MCHS) is housed within the Community Health Improvement Division (CHI) at DSHS. The CHI Division includes MCH, Health Promotion and Chronic Disease Prevention (HPCDP), Environmental Epidemiology and Disease Registries, and Vital Statistics. MCHS consists of the MCH Unit (MCHU), MCH Epidemiology (MCHE), The Newborn Screening Unit, and the Health Screening and Oral Health Unit. The MCHU is where the core functions of MCH programs are housed. Areas within this Unit include Child and Adolescent Health Branch, the Healthy Texas Mothers and Babies (HTMB) Branch, and the Office of Injury Prevention. The Child and Adolescent Health Branch houses the CSHCN Systems Development Group (SDG) as well as Child and Adolescent Health programming. The HTMB Branch houses all Maternal/Women’s Health and Infant/Perinatal Health programming and expertise. Key positions in the MCHU include the Title V MCH Unit Director and the State CSHCN Director/ Child and Adolescent Branch Manager. Key positions within MCHS include the State MCH Director and the Block Grant Administrator.

The HTMB Branch within the Unit is led by the State Breastfeeding Coordinator/MCH Nurse Consultant and includes the Maternal Mortality and Morbidity (MMM) Nurse, the Women’s and Perinatal Coordinator, and the Perinatal and Infant Coordinator. Regional Population-Based activities are implemented across the state in communities through DSHS regional staff and are coordinated through the MCH Regional Programs Administrator. Child Health and Adolescent Health Coordinators work closely with the state Child Fatality Review Team coordinator and CSHCN staff on programing and surveillance activities.

The Child and Adolescent Health Branch is led by the State CSHCN Director and includes the CSHCN SDG. The CSHCN SDG oversees the implementation of the CSHCN Title V performance measure activities. The CSHCN SDG includes the Texas Title V CSHCN Director and four full time Program Specialists. Three team members have Masters level degrees in public health and education. Staff who are parents of CYSHCN participate in the development of programmatic activities and decision-making. Title V funds a health care benefit program administered by 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/or regional DSHS staff. CSHCN SDG staff serve as subject matter experts for contractors and provide technical assistance, education and resources. Program staff lead and facilitate the Medical Home and Transition to Adulthood Learning Collaboratives and participate in other statewide initiatives including the planning committees of the Baylor College of Medicine Annual Chronic Illness and Disability: Transition from Pediatric to Adulthood conference and the Texas Primary Care Consortium, Texas Council for Developmental Disabilities, Policy Council for Children and Families, and Community Resources Coordination Groups Statewide Workgroup. The CSHCN Director and the State CSHCN Health Coordinator are members of the Texas Children with Medical Complexity (CMC) Collaborative Improvement and Innovation Network (CoIIN) team led by Boston University.

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

Manda Hall, M.D. was named the Associate Commissioner for the Community Health Improvement Division at DSHS in September 2017. In this role, Dr. Hall oversees and provides strategic direction to four Sections within the Division: Maternal and Child Health, Environmental Epidemiology and Disease Registries, Vital Statistics, and Health Promotion and Chronic Disease Prevention. Prior to this position, Dr. Hall served as the Texas Title V MCH Medical Director for nearly two years, and the Children with Special Health Care Needs Director for over three 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. Dr. Hall was recently elected to serve as President of the Association of Maternal and Child Health Programs (AMCHP) for 2021-2022. Before her role as President, Dr. Hall served as the AMCHP Region VI Director from 2017 to 2020 and served on the Legislative and Health Care Finance Committee, and Conference Planning Committee. She graduated in May 2014 as a fellow in the Maternal and Child Health Public Health Leadership Institute at the University of North Carolina at Chapel Hill and the Texas Health and Human Services Executive Leadership Academy in 2017.  She is a faculty member of the DSHS Preventative Medicine and Public Health Residency Program.

Dr. Kelly Fegan-Bohm, MD, MPH, MA is the Medical Director in the Community Health Improvement Division. Dr. Fegan-Bohm attended undergraduate school at University of Texas at Austin where she graduated with a degree in Human Biology in 2006.  She received her Master’s in Exercise Physiology from UT Austin in 2007. She then 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 in Public Health. She completed her pediatric residency at Doernbecher Children’s Hospital in Portland, Oregon, in 2014 and her Pediatric Endocrinology Fellowship at Texas Children’s Hospital in 2017. She then worked as an assistant professor at Texas Children’s Hospital in the Pediatric Endocrinology Department with a focus on clinical care and Quality Improvement initiatives for children and young adults with diabetes. 

Jeremy Triplett is the Maternal and Child Health (MCH) Section Director at the Texas Department of State Health Services (DSHS) and serves as the MCH Title V Director for the State.  Jeremy’s career has spanned over 22 years and has included work with the Texas Workforce Commission as a Lead Economist and Statistician who prepared, analyzed and disseminated labor force statistics, as the Operations Manager for Health Benefits programs at DSHS, and as the MCH Unit Director.  Mr. Triplett earned his Bachelor of Arts degree in Psychology from St. Mary’s University in 1998, where he learned about public health and being a servant leader in the community.  Jeremy has spent his career working in the public sector and is committed to improving the health and safety of Texans across the state.

Michael Spencer was selected as the MCH Unit Director in the MCH Section in May, 2019. Mr. Spencer previously worked at DSHS from 2007 to 2014, and was the Title V Administrator for three years in the Office of Title V and Family Health. Mr. Spencer also worked at the HRSA’s Maternal and Child Health Bureau in Rockville, MD as a Public Health Analyst and Title V Block Grant Project Officer.  Prior to returning to DSHS, Mr. Spencer also served as the MCH Bureau Director and Title V MCH Director for the Maryland Department of Health. Mr. Spencer has a Master’s Degree in Social Work from Tulane University, a Bachelor’s Degree in English from Purdue University, and a Bachelor’s Degree Journalism from Indiana University. 

Audrey Young was named the Manager of the Child and Adolescent Health Branch and the State CSHCN Director in the MCH Unit in June 2019. Ms. Young had previously served as the Unit Coordinator overseeing initiatives including Texas AIM, and worked with the DSHS Office of Healthcare Delivery Redesign as a Health Policy Analyst. Ms. Young holds a Master of Public Health in Health Policy and Management from Texas A&M University. 

Dr. Michelle Cook was named the Director of the MCH Epidemiology Unit at the Texas Department of State Health Services in February, 2019. Previously, Dr. Cook established the research department at the American Association of Nurse Practitioners where she expanded research services, standardized data collection, and executed the nurse practitioner research agenda. She was also the Behavioral Risk Factor Surveillance System coordinator in both Texas and Michigan. Dr. Cook received her PhD in epidemiology with a minor in biostatistics from the University of Texas Health Science Center and her MPH in epidemiology from the State University of New York at Albany.

Julie Stagg, MSN, RN, IBCLC, RLC, is the Healthy Texas Mothers and Babies Branch Nurse Manager, TexasAIM Program Director, and State Breastfeeding Coordinator at the Texas Department of State Health Services, 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 Master of Science in Public Health Nursing from the University of Texas at Austin. She has 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.

MCH Texas Title V recognizes staff accomplishments, leadership, and workforce development efforts. The Title V Block Grant supports DSHS regional staff across the 8 PHRs to plan, implement, and evaluate population-based programs in their communities to address Title V National and State Performance Measures. Title V supports 90 full-time employees throughout the PHRs, boosting the MCH infrastructure throughout the state. Staff in the regions are in a unique position to collaborate with others in assessing local needs and identifying potential solutions that reflect the values and cultural make-up of communities.

Kim Beam serves as the MCH Regional Programs Administrator in MCHU. Mr. Beam has 10 years of experience in regional/community-level public and population health work and supporting maternal and child health through program planning/development, implementation, and evaluation in Public Health Region (PHR) 6/5S. Most recently, he served as the DSHS’ MCH team lead in PHR 6/5S working with a comprehensive team to develop and implement activity plans and reporting under the Title V Block Grant.  He was also responsible for the training development of team members working in MCH within the regional office.  Additional areas that he has coordinated and supported within the PHR 6/5S include activities in health promotion (tobacco control and prevention and obesity prevention), suicide prevention, and child fatality review. He has a Master’s degree in Public Health from Texas A&M University and a Bachelor’s degree in Psychology from Arizona State University. Additionally, Mr. Beam serves as Texas' Family Delegate to the Association of Maternal and Child Health Programs (AMCHP).

The MCH Regional Programs Administrator serves as the key MCH liaison between DSHS central office and the DSHS regional offices, and works to enhance the technical competence of regional staff. The MCH Regional Programs Administrators role is to improve the alignment of regional activities with the Title V MCH Block Grant objectives.

Learning needs associated with Title V Performance Measures are addressed through the monthly MCH Learning Consortium, regular Meet the Subject Matter Expert (SME) webinars and the quarterly MCH Regional Showcase. Staff utilize resources for independent learning available through MCH Navigator, CDC’s 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 2021 AMCHP conference was offered virtually in August 2020 due to COVID-19. Approximately 20 Texas Title V team members participated in the online conference and several team members were recognized. Dr. Manda Hall was officially named AMCHP President for 2021-2022, and she also served as moderator for a Plenary Session titled “Leading During Change”. Claire Niday, the MCH Child Health Coordinator, was nominated and selected as the 2021 Emerging MCH Professional Award for Region VI. The award was presented by AMCHP to recognize current and future leaders under age 45. The award recognizes outstanding state or local MCH professionals whose work has made substantial contributions to the state’s MCH program, their state’s MCH outcomes, or made other significant contributions to promoting and protecting the health of women, children, and families in their state. It recognizes an individual’s capacity to perform above and beyond expectations, using creativity and innovation to address pressing MCH challenges, and their emerging and future leadership potential.

To bolster statewide efforts to improve awareness of developmental milestones, Texas submitted a response to a request for application to the Centers for Disease Control and Prevention’s Act Early Ambassador program. Due to Texas’ size, two Ambassadors are allowed for the state. The State Child Health Coordinator applied to become the second Ambassador for Texas. In this role, MCH co-leads a Deputy Ambassador program as part of a FY21 Act Early Response to COVID-19 grant as well as pursuing an individual work plan to integrate Act Early materials into the state’s early learning strategic plan. Designation as Texas’ Act early Ambassador will continue through FY22.

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

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

The Association of State and Territorial Health Officials (ASTHO) was funded by HRSA to work on the Alliance for Innovation on Maternal and Child Health project.  ASTHO included Texas in a series of state stories to highlight state strategies for utilizing promotores or community health workers (CHWs) to improve access to care and continuity of care for pregnant women and children.

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 a target 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 utilization of CHWs in Texas. CHWs are employed by community-based clinics through DSHS 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 Managed Care Medicaid/Children’s Health Insurance Program (CHIP) health plans. Most of the plans (80%) noted that they utilize certified CHWs to improve services and access to care. 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 contractor for Texas Health Steps (Children’s Medicaid) enrollment broker operations, employs CHWs as outreach counselors. Under an 1115 Medicaid waiver, Texas funded 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 outreach and cultural linkages between communities and delivery systems; 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/or high‐risk patients and serve as members of Health Home interdisciplinary teams. The number of certified CHWs in Texas continues to increase over time as awareness and utilization of the CHW workforce grows.

The Texas Birth Defects Registry was established in 1993 by the Texas Birth Defects Act (Chapter 87 of the Texas Health and Safety Code, Birth Defects). The Registry has been in operation since 1994 and is overseen by the DSHS Birth Defects Epidemiology and Surveillance Branch (BDES). Statewide data became available in 1999. Highly-trained regional staff visits 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 that the infant or fetus has a condition covered by the registry, detailed demographic and diagnostic information are abstracted and entered into the computer for processing. The Registry ascertains cases and diagnoses up to the 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. Data from the Registry are used for many different reasons, including for cluster investigations, looking at the occurrence and patterns of birth defects, prevention and family outreach, studies of access/proximity to services, studies of mortality and survival, studies of causes of birth defects, and understanding changes over time. All information is held in strict confidence in accordance with state and federal privacy laws.

The Oral Health Improvement Program (OHIP) within the MCHS strives to identify the oral health needs of Texans and to provide resources that meet those needs. The OHIP staff include Central Office staff, located in Austin, and five 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. 

The OHIP conducts statewide oral health surveillance, including a Basic Screening Survey (BSS) of third grade and Head Start students.  This is a weighted survey using probability proportionate to size sampling methodology. The OHIP is the only program that conducts oral health surveillance of this type in Texas.  These surveys are conducted every five years and the information acquired allows the OHIP to track trends of the prevalence and extent of oral disease and the presence of dental sealants. 

The RDTs also provide oral health education and preventive dental services, including limited oral evaluations, fluoride varnish and dental sealants for students who qualify. The RDTs have portable dental equipment and travel to schools, Head Starts and other programs to provide their services and conduct surveillance. Title V continues to identify opportunities to collaborate on the shared goal of improving the health of mothers and children.

Rhonda Stokley, DDS, serves as both Public Health Dental Director and Health Screening and Oral Health Unit Manager for the Texas Department of State Health Services.  Dr. Stokley has been with DSHS for four years and has over 10 years of state service. She has private practice experience and has also served Texas by providing dental care for adults with special needs. She received her Doctor of Dental Surgery degree from Louisiana State University Health Sciences Center School of Dentistry in 2005.

Title V funds are used to support the Newborn Screening (NBS) Program. The NBS Program screens for genetic conditions using blood spots, as required by Texas law (Health and Safety Code, Chapter 33) in order to help identify infants who may have treatable genetic disorders or medical conditions. Early identification can prevent serious complications, such as growth problems, developmental delays, deafness, blindness, intellectual disabilities, seizures, and sudden or early death. 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. as well as monitoring the average statewide transit time from specimen collection to receipt in the DSHS Laboratory to ensure timely follow-up to definitive diagnosis and management of conditions.

The Texas Early Hearing Detection and Intervention (TEHDI) Program is dedicated to ensuring newborns and young children who are deaf/hard of hearing are identified as early as possible, with the goal of providing appropriate intervention services in order to prevent delays in communication and cognitive skill development. TEHDI continues to disseminate Newborn Hearing Screening Program report cards to licensed birthing facilities to communicate their performance on a set of nationally recognized benchmarks and quality indicators. The report card provides a snapshot of the birthing facility’s use of the TEHDI MIS over the previous two months. These same criteria are used to evaluate birthing facilities for newborn hearing screening program certification when a facility is up for a certification review. The certification process occurs in two cycles, the first in January and the second in July. Each facility’s certification is based on the data for the preceding six-month period.

David R. Martinez is the Newborn Screening Unit Manager. He maintains a BA from the University of Texas at Austin and has over 25 years of experience in state government. Mr. Martinez has managed programs related to medical dispute resolution where providers sought relief for payment of medical reimbursement for care injured workers in the Texas workers’ compensation system. He also managed a quality assurance program evaluating physicians in the workers’ compensation for quality of medical care and services. Currently he is responsible for expanding the Newborn Screening and Newborn Hearing screening programs for the Department of State Health Services. He is a subject matter expert for the Newborn Hearing and Newborn Bloodspot Screening programs for over 15 years.