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, and the Office of Injury Prevention (OIP). MCHS key positions include the State Title V MCH Director and the Block Grant Administrator.

MCHU houses the MCH programs’ core policy development and program implementation functions. Areas within this Unit include the Healthy Texas Mothers and Babies (HTMB) Branch and the Child and Adolescent Health Branch (CAHB). HTMB has all Maternal/Women’s Health and Infant/Perinatal Health programming and expertise. CAHB includes the CSHCN Systems Development Group (SDG) as well as Child and Adolescent Health programming. MCHU’s key positions include the MCH Unit Director/State CSHCN Director, the HRMB Manager, and the CAHB Manager.

The State Breastfeeding Coordinator/MCH Nurse Consultant leads MCHU’s HTMB Branch and supervises the Maternal Mortality and Morbidity (MMM) Nurse, the Women’s and Perinatal Coordinator, and the Perinatal and Infant Coordinator.

CAHB’s three 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 provide 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 on the 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 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’s 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. The project’s goal is to provide internal and external MCH data users with tools so they can obtain needed data whenever they need it.

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 90 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 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 (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.

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 23 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 also 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.

In February 2022, Audrey Young was selected as the MCHU Director. Ms. Young previously served as the CAHB manager and the State CSHCN Director since June 2019. Prior to that position, Ms. Young was the Unit Coordinator overseeing initiatives including TexasAIM and worked with the DSHS Office of Health Care Delivery Redesign as a Health Policy Analyst. Ms. Young holds a MPH in Health Policy and Management from Texas A&M University. Ms. Young continues to serve as the State CSHCN Director.

In February 2019, Michelle Cook, PhD, MPH was named CHI’s MCHE Director. Previously, Dr. Cook established the American Association of Nurse Practitioners’ research department 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 UT 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 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 master of science in Public Health Nursing from the UT at 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.

Kim Beam serves as the MCH Regional Programs Administrator. Mr. Beam has 10 years’ experience in regional and community-level public and population health work and supporting maternal and child health through program planning/development, implementation, and evaluation in PHR 6/5S. Most recently, he served as the DSHS’ MCH team lead in PHR 6/5S working with a comprehensive team to develop, implement, and report Title V Block Grant activities. He was also responsible for the regional office training development of MCH team members. Additional areas that he 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 MPH 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 AMCHP.

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.

Rhonda Stokley, DDS, serves as both Public Health Dental Director and Health Screening and Oral Health Unit Manager. Dr. Stokley has been with DSHS for 6 years and has over 13 years of state service. She has private practice experience and also served 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.

Jia Benno is the Office of Injury Prevention Manager in the Maternal and Child Health Section. In this role, 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 the past four 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. Jia’s areas of expertise are injury and violence prevention.

Title V Block Grant Performance Measures learning needs are addressed through the monthly MCH Learning Consortium and quarterly MCH Regional Showcase. 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. Expected conference abstract deadlines are tracked to alert staff when to prepare abstracts. 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 catalogued in the State Systems Development Initiative (SSDI) grant deliverables spreadsheet.

MCH attended the May 2022 Maternal Mortality Review Information Application (MMRIA) User Group meeting to network with national partners and learn ways to further maternal mortality review and prevention. Staff apply lessons learned to the Texas Maternal Mortality and Morbidity Review Committee operations and other prevention programs.

Title V Block Grant funds support the NBS Program. NBS screens for genetic conditions using blood spots, as required by Texas Health and Safety Code, Chapter 33 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 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 response to geneticist shortages, the DSHS Genetics Summer Internship Program supports medical student interns for general and agency workforce enhancement. Baylor University College of Medicine genetic counseling students participated in the 2022 Genetics Conference to support a genetic counselor shortage.

NBS’ Texas Early Hearing Detection and Intervention (TEHDI) Program is dedicated to identifying newborns and young children who are deaf/hard of hearing as early as possible with the goal of providing appropriate intervention services 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 Management Information System (MIS) over the previous two months. TEHDI uses these same criteria to evaluate birthing facilities for newborn hearing screening program certification when a facility is up for  certification review.

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 identified 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. Registry data are used for many different reasons including cluster investigations, looking at the occurrence and patterns of birth defects, prevention and family outreach, access/proximity to services studies, mortality and survival studies, causes of birth defects studies, 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 MCH Section strives to identify Texans’ oral health needs and provide resources to meet those needs. The OHIP 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.

OHIP 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. OHIP 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 OHIP to track prevalence and extent of oral disease trends and the presence of dental sealants.

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 OIP, 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. Five National Child Passenger Safety Certification Trainings were held in FY22 allowing technicians to review certifications and enhance the workforce.

Texas Title V recognizes staff accomplishments, leadership, and workforce development efforts. In May 2022, Dr. Cook graduated from the AMCHP New Directors Leaders Cohort. NBS’ Director Karen Hess, Medical Director Dr. Debra Freedenberg, and Endocrine Manager Michelle Shaffer contributed to an abstract submitted to the Association on Public Health Laboratories’ Newborn Screening Symposium: “Congenital Hypothyroidism Detection in Texas: A Ginormous Study of T4 and TSH as Primary Analytes”.

In May 2022, AMCHP offered their 2022 conference virtually due to COVID-19. Approximately 20 Texas Title V team members participated in the online conference and several team members were recognized.

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), Federally Qualified Health Centers (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. Eighty percent of the plans noted they use 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’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 an 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 continue to increase over time as awareness and utilization of the CHW workforce grows.