NJDOH has identified through the State Health Assessment, the State Health Improvement Plan, and the Department’s Five-Year Strategic Plan, the need to improve the public health workforce in the areas of access to care, quality improvement, systems integration, and population health management. MCH workforce development and capacity are also a priority for the Division of Family Health Services (FHS). Without an adequately trained MCH staff, vital Title V services and functions would not be provided to meet the needs of the current and future MCH population. Recognizing the value of experienced and trained staff, the FHS has taken action to improve the capacity of the MCH workforce despite a long-standing hiring freeze.

The FHS implemented the development of succession planning to assure essential functions were considered in long-term planning. During this past fiscal year, cross-training of staff was implemented to assure the ability to maintain key roles in the event of short-term staffing shortages. Changes in the workforce funded by Title V have been quite minimal, reflecting the long-standing MCH priorities and core functions of staff.

The majority of FHS staff concurred there was a need for training to help them effectively conduct return on investment (ROI) analyses of MCH programs. As a result of the NJDOH’s paradigm shift toward results-based accountability, additional training is needed for staff to become skilled in collecting data appropriate for accountability documentation and to develop accountability metrics to better calculate the ROI for MCH programs tied to public health outcomes. FHS also recognized the need for incorporating the perspectives of families and family representatives into the MCH workforce under the broader umbrella of systems integration. Continued family involvement in health transformation is essential for effective program and policy development related to newly aligned systems.

Given the diversity of our state, cultural competency trainings continue to be provided to staff as an essential component of their continuing education activities. Other available opportunities have been pursued through trainings offered at national conferences including AMCHP, the MCH Epidemiology Conference, and the MCH Public Health Leadership Institute. Departmental trainings have been offered on ethics, grant writing, and grants management. Opportunities to supplement staffing through student internships, special temporary assignments, fellowship programs, and state assignees have also been successful. Recruitment and Retention of qualified TVP staff are ongoing goals of NJ TVP. NJ remains in a hiring freeze with exemptions made for critically needed positions, including those within Title V.

Moreover, TVS expresses interest in participating in Phase Two of the National MCH Workforce Development Center’s newly redesigned 2022 Learning Journey which will be hosted by the University of North Carolina at Chapel Hill (UNC). TVS seeks to learn new evidence-based tools and get equipped with new sets of skills, needed to increase TVP workforce capacity in leadership, team management, data mining, and dissemination. Moreover, TVS will take the opportunity to learn novel techniques in drafting strong grant proposals that create equity and diversity in state partnerships. TVS is dedicated to improving NJ’s current health systems by implementing cross-cutting activities aimed at improving the health of our children, youth, women, families, and communities. TVS is coordinating with UNC to plan the 2022 Learning journey, this opportunity will further enhance staff skills in health equity and continue to promote an environment of continuous learning.

In January 2022 the Division of Family Health Services added a Diversity, Equity, and Inclusion Manager to the team. Ms. Rajneet Goomer holds this title as well as the NJEIS Operations Manager. Ms. Goomer leads with a DEIB lens and is reviewing all aspects of NJEIS to assure we are equitably meeting the needs of all families and children in the system as well as building capacity regarding cultural competence and DEIB within the workforce at all levels. She will begin to work within the division to build capacity amongst programs and again assure a DEIB lens with all decisions and actions taken.

In the summer of 2022, NJ TVP will host two Title V summer interns and one Graduate Student Epidemiology Program (GSEP) intern.

The Title V interns will work together on 2 projects:

1. Project 1: The interns will assist in identifying organizational partners and recruiting stakeholders for an STI workgroup. The interns will design the data collection instruments to be used with the STI workgroup members who will include community members, key stakeholders, and service providers, then collect and analyze the data from them to assist in developing a statewide strategic plan to address the increase in STI rates among adolescents.
2. Project 2: Interns will be offered the opportunity to partake in standardizing the NJ FIMR case identification process. The interns will work closely with maternal and child health epidemiologists within the department to conduct a comprehensive literature review aiming at identifying techniques to support the standardization of the case identification process and communicate findings and recommendations for action to maternal and child health epidemiologists, DOH Leadership and other stakeholders (e.g., Maternal and Child Health Consortia).

The GSEP intern will work closely with maternal and child health epidemiologists within FHS to evaluate the NJ Health Women Healthy Family Initiative (HWHF). More specifically, the intern will collaborate with the assigned mentor to evaluate specific measurable outcomes related to preconception, pregnancy, and birth outcomes and their alignment with the overarching goals of the HWHF initiative. The intern will gain ample experience in program evaluation.

MCH Workforce Training and COVID-19

The NJDOH has created a vulnerable populations plan, which encompasses epidemiology in high need areas, areas where individuals are more susceptible to contracting COVID-19. Additionally, the NJ COVID-19 vulnerable populations plan includes a list of populations deemed vulnerable to COVID-19, that includes racial and ethnic populations, immigrants, limited English proficiency, homebound, seniors, homeless, disabled populations, migrant workers, Orthodox Jewish populations, pregnant and nursing mothers, underinsured and uninsured, undocumented workers and substance abusers. Many of these vulnerable populations face an increased risk of exposure to COVID-19 as many experiences higher rates of unemployment; are more likely to work in essential, low-income jobs that do not allow telework; and do not have health insurance or paid sick leave through employers. Racial and ethnic minority groups, seniors, people with low socioeconomic status, the homeless, those with substance use disorders, pregnant women, and/or those with certain underlying medical conditions such as heart disease, diabetes, obesity, and smoking are also at increased risk of contracting COVID-19 and/or experiencing severe illness from COVID-19. Other populations such as immigrants, migrant workers, undocumented workers, limited English proficiency, homebound, and disabled populations traditionally do not access health care on a routine basis, thereby increasing their risk for severe disease. In addition, distrust of medical and governmental entities, anti-vaccination sentiments (particularly in Orthodox Jewish populations), and disparities in vaccine coverage may impact achievement of high COVID-19 vaccination rates in these population groups.

Often, members of the communities they serve, CHWs are frontline public health workers who because of their intimate understanding of the cultures, languages, and challenges of their neighborhoods are trusted by the people they serve. NJDOH in recent years has made the expansion of CHWs in NJ a strategy to address inequities in our healthcare system. One of the ways The NJDOH has worked over the past several years to improve the health of vulnerable populations within the state is to support and help sustain initiatives that involve CHWs. This work has included efforts to establish standardized training, build CHW capacity and expand the number of CHWs statewide. We plan to use this same strategy of training, deploying, and engaging CHWs to respond to COVID-19 in vulnerable populations. We will expand outreach within the NJDOH and in the field to include other social service providers, community-based organizations (CBOs), and faith-based organizations (FBOs) partners, using a regional field team structure.

CHWs reach out to vulnerable populations, educate them on services available and make critical linkages to additional social supports, activities that will be implemented as part of the COVID-19 response. Many CHWs are involved in case management as well. Knowing the value of CHWs along with their long-term use in NJDOH programming, their limited training, lack of a standardized curriculum, and difficulty recruiting, retaining, and advancing in their careers, NJDOH decided to invest, establish and build the NJDOH  Colette Lamothe-Galette Community Health Worker Institute, https://www.nj.gov/health/fhs/clgi/

Colette Lamothe Galette Community Health Worker Institute

In May 2020, NJDOH created the Colette Lamothe-Galette Community Health Worker Institute (CLG-CHWI), a program to train and certify CHWs. The NJDOH secured a grant from the NJ Department of Labor’s Growing Apprenticeship in Non-Traditional Sectors (GAINS) Program, which is the Institute’s primary funder. The Institute is named in honor of Colette Lamothe-Galette, the former NJDOH’s 1st Population Health Director, who went on to the Nicholson Foundation, where she served as a Senior Program Officer and led The Nicholson Foundation’s CHW efforts until she passed away from COVID-19 on April 4, 2020.

Through the CLG-CHWI, CHWs are hired as apprentices, allowing them to experience both classroom and on-the-job training. Training includes 144 hours of related classroom technical instruction covering 13 core competencies supplemented by 1000 to 2000 on-the-job hours, with reflective supervision. This CHW apprentice occupation is registered with the US Department of Labor (USDOL).

Community Problem and Response

COVID-19 is disproportionately impacting some communities. These vulnerable populations often have underlying medical conditions, comorbidities, and living and work conditions that make them more susceptible to COVID-19 exposure and death. CHWs often come from the communities they serve and can educate individuals on how to protect themselves, mitigate the risks of COVID-19 exposure, and access the many social supports available to these vulnerable populations. To address these social needs, CHWs will be trained in COVID-19-related competencies and social supports.

We propose building on the CLG-CHWI to train, deploy and engage more CHWs. We will do this by expanding CHW core competencies to include mental health & substance use disorder (SUD), adding new CHW specialized tracks in the form of additional training on primary actions of state and/or local public health-led efforts to address underlying conditions such as chronic disease. We will integrate CHWs in novel settings that include prisoner re-entry programs, mental health, and substance use disorders, Certified Community Behavioral Health Clinics (CCBHCs), and FQHCs who have never utilized CHWs. These novel settings have been selected due to the challenges facing these vulnerable populations. These novel settings will be a part of innovative demonstration projects where we test the Return on Investment (ROI) of CHWs and explore sustainable funding strategies with Medicaid.

Preventive and Primary Care for Children with Special Health Care Needs

NJ maintains a comprehensive system to promote and support access to preventive and primary care for CYSHCN through early identification, linkage to care, and family support. Title V partially supports this safety net that is comprised of pediatric specialty and subspecialty providers, case management, and family support agencies that provide in-state regionalized and/or county-based services. It is designed to provide family-centered, culturally competent, community-based services for CYSHCN age birth through 21 years of age, to enhance access to medical home services, facilitate transition to adult systems, and ensure health insurance coverage.  

The SPSP agencies are a significant resource for pediatric specialty and subspecialty care in NJ and are used widely by CYSHCN including Medicaid recipients. Although clients are screened for their ability to pay for clinical services, the support provided by Title V enables all CYSHCN to be served regardless of their ability to pay.  

At no charge to the families, the SCHSCM operates 21 county-based CMUs, one Family Support project, one Autism Spectrum Disorder Support Service project multiple SPSP health service grants, and a small State-operated Fee-for-Service program. State and federal collaborations among the FCCS programs and non-Title V funded programs such as the RWPD Family-Centered HIV Care Network, EIS, FQHC, medical home initiatives, Supplemental Security Income (SSI), CICRF and other community-based initiatives extend the safety net through which Title V links CYSHCN with preventive and primary care. 

State TVS, CMUs, and SPSP providers receive training from state agencies such as the NJ Department of Human Services, and the Department of Children and Families to become Informal Application Assistors for Medicaid/NJ FamilyCare programs. Additionally, staff learn about Managed Long-Term Services and Supports (MLTSS), how to obtain care through the Marketplace, and behavioral services through PerformCare. These trainings build capacity among Title V agency providers to enhance access to primary and preventive care for CYSCHN. For example, a SCHS case manager reported being able to assist a parent to problem solve a denial of home health aide services for a 12-year-old with autism and significant developmental delays by advocating on the mother’s behalf with PerformCare, her child’s school district, and her Children’s System of Care Organization. Repeated phone calls, home visits, and written appeals by the case manager supported the mother’s efforts to clarify the required information and resolve her child’s needs.