Overview

Family Health Services Division (FHSD) involves communities, stakeholders, and program participants, including families, in policy and program decision-making at many levels. Integrating public input into the Title V MCH Block grant is critical to assure alignment with our partners to strengthen our collective impact. Consumer input also ensures Title V efforts are effective with the populations we serve. Input on Title V performance and strategy measures is collected continuously throughout the year. Since much of the Title V work is done in partnership, community collaboratives help determine strategies, assist with implementation, evaluation, and revision of activities.

Because FHSD does not use Title V funds to fund local health departments or community-based providers, there are no stakeholders with a vested interest in Title V as a funding source. Most FHSD partners are aware of the importance of Title V funding to support FHSD programs and services provided to the community especially those who also receive HRSA/MCH Bureau funding. FHSD is continually challenged to improve current efforts to engage stakeholders, including families and consumers, in the Title V work and the importance of MCH as a field in public health.

Ongoing Solicitation of Input

Public input is solicited from stakeholders of various backgrounds throughout the grant cycle. The method/setting of collecting the feedback depend on the relationship with the person/group, context, purpose, and available resources. Examples include:

• All Title V programs engage with specific community partners in the delivery of services and implementation of activities. Some of these collaborations are formalized (e.g., MOAs and MOUs), while others are informal (e.g., partners provide content area expertise). In addition, several programs solicit feedback from partners to inform planning, implementation, and evaluation of their strategies and activities.
• MCH assessment data, priorities, strategies, performance measure trends, and outcomes are regularly presented and reviewed by stakeholders and Title V implementing partners across the State. Community partners are engaged via cross-agency/system workgroups or taskforces. FHSD convenes and/or provides leadership for some of these groups.
• Many FHSD partners participate in other needs assessment processes, and share their priorities, strengths, needs, and limitations. FHSD considers feedback provided to other organizations on similar issues and populations important information. Especially how broadly family health intersects with other public health issues, and also to avoid overburdening partners with multiple assessments.

Community Input for Overall Needs Assessment

Two community surveys–one for providers, and the other for families/community members–were administered to solicit feedback directly from FHSD stakeholders to inform the five-year needs assessment. Stakeholder input was generally favorable regarding the Title V priorities and supportive of the measures.

The provider survey was distributed to partner agencies and service-providers, via an online (Survey Monkey) format. An introductory message was sent from the FHSD Chief via email, along with the survey link, with one reminder email. The list of providers was generated collectively by Title V program leaders, and therefore reflected a broad array of partners across domains, issues, and communities. The link was open from November 2019 to February 2020, with heavy marketing in December 2019 and January 2020. The survey had three sections: 1) demographics about the participant and community(ies) they serve; 2) feedback on overall priority areas; and 3) feedback strategies within each priority area. The final email list of providers included 332 stakeholders. A total of 148 completed surveys were received, for a return rate of 45% (though the initial participants were able to forward the link to others).

The family/community survey was distributed to community members, both those who were routine consumers of FHSD services (e.g., WIC clinics) and those who were one-time participants (e.g., health fairs, community workshops, etc.). This survey was an abridged version of the provider survey, and administered via paper-pencil format. The consumer groups and community events that served as recruitment settings were determined collectively by Title V program leaders, and reflected a broad array of people across domains, issues, and communities. The survey was implemented from September 2019 to January 2020, and had three brief sections: 1) demographics about the participant; 2) feedback on overall priority areas; and 3) a space for open-ended comments. A total of 500 completed surveys were received. Surveys were administered across nine WIC clinics, nine community events, and three other FHSD program sites throughout the State.

Community Input for Specific Strategies and Measures

Provider surveys included a section for participants to take a deeper dive into the National Performance Measures (NPM) and their associated strategies/activities. For each NPM, participants were provided with the current strategies and simply asked, “Are these the right/best strategies for Hawaii to focus on in the next five years?” Then, participants were allowed to provide open-ended comments on the existing strategies, or suggest new ones. In addition, individual programs organized additional meetings and forums to encourage two-way discussion about the details of implementation and evaluation. Examples of public feedback that changed elements of the Title V five-year plan strategies follow.

NPM 1 Women’s Wellness Visits: The work for the priority is conducted in partnership with the Hawaii Maternal and Infant Health Collaborative (HMIHC), comprised of over 120 participants including physicians, clinicians, public health professionals, community service providers, insurance representatives and health care administrators. Input from HMIHC’s Pre-/Inter-conception Workgroup members shape the strategies, activities, and measures for NPM 1. Strategy measures and activities evolved over time to align with HMIHC evaluation projects currently underway.

NPM 4 Breastfeeding: The State Breastfeeding Strategic Planning Workgroup, a subcommittee of the HMIHC, provides ongoing feedback on Title V strategies and data measures. For example, one discussion focused on measures such as ‘ever breastfed’ versus ‘exclusively breastfed through 6 months,’ and members cautioned that messaging should support all mothers and families who are breastfeeding for whatever the duration. Monthly HMIHC workgroup meetings focus on the implementation of the breastfeeding priorities.

NPM 5 Safe Sleep: Title V partnered with the state Child Care Licensing Program at the Department of Human Services (DHS) to develop a Safe Sleep Guide for Parents and one for Caregivers. The guides are used by the Child Care program to implement a policy mandate for training of all licensed child care providers on safe sleep. Based on input from child care providers and agency partners, some of the challenges to promoting safe sleep practices among Hawaii’s diverse ethnic groups may relate to long-standing cultural childcare practices. As a result, the Title V safe sleep program partnered with DHS and the state Office on Language Access to translate the safe sleep guide into several languages.

NPM 6 Developmental Screening: The Developmental Screening program organized a diverse statewide network of partners, and uses this network to gather ongoing feedback. Title V convenes partners through a Developmental Screening Workgroup with representatives from early childhood programs. Hawaii’s CSHNB Early Childhood Coordinator also works closely with the Family Hui Hawaii who conducts parent support groups. The Hui regularly conducts developmental screening with families both in their program and at community events. Most recently, the CSHNB Early Childhood Coordinator started working with the Institute for Human Services (IHS), one of the state’s largest emergency shelters for homeless individuals, recognizing that children who are living in homelessness may be more susceptible to developmental delays.

NPM 10 Adolescent Health: The Adolescent Health Unit (AHU) continues to collect input from youth, service providers, and community health workers to update its Adolescent Resource Toolkit (ART). The ART was tested with over 200 adolescents and providers at community sites such as the Youth Challenge Academy and State Personal Responsibility Education Program (PREP) service sites.

NPM 12 Transition to Adult Care: Substantial input was obtained from youth, families, and the pediatric professional community to develop key transition informational materials: The Transition Readiness Assessment Checklist (TRAC) and the My Path to Adult Health Care (PATH) handout. Input helped reduce the complexity of the materials, and improve ease of understanding and the visual design. Also, a point system was added to the TRAC to assist users quantify and qualify their transition progress.

SPM 4 Child Abuse and Neglect: CAN prevention has three primary mechanisms for community input including: 1) The Hawaii Children’s Trust Fund (HCTF) Advisory Committee (eleven private and public members); 2) The HCTF Coalition with 30 active members representing key community partners working to prevent child maltreatment across the islands; and 3) The Prevent Child Abuse Hawaii, Child Abuse Prevention Planning Council comprised of 15 active members representing the military and community-based private agencies. All of these groups serve a range of consumers and participate in their respective membership to be a voice for their communities.

Public Access to the Title V Report/Application

Users find the online access to the grant convenient, and comments throughout the year can be submitted through a return email function on the website. In past years, many stakeholders have asked for information on the programs administered by the Family Health Services Division (FHSD) with names of key program managers. In this year’s Title V report the program charts and short descriptions are included in the “Supporting Documents” that were developed in response to these requests.

FHSD developed several informational products to educate community stakeholders on the Title V priorities and to collect public input. These publications are updated to use for ongoing needs assessment to collect feedback on priorities and implementation strategies. The documents include:

• Title V Update on Priorities for Maternal and Child Health, with information on update of measures and activities for Hawaii Title V priorities and strategies, and information and data on the priorities.

• A summary of the Hawaii 5-year plan.

Staff frequently share information about their individual priorities at national conferences including the ECCS Impact Grantee Meeting, the national Coalition Against Domestic Violence Conference, CityMatCH Leadership and MCH Epidemiology Conference, and the CDCs Rape Prevention and Education Grantee Leadership Meeting.  Staff also promoted information at various statewide meetings and events including the Footsteps to Transition Fair, Special Parents Information Network (SPIN) Conference, the State Medicaid Providers Meeting, and State Early Childhood Action Strategies, and Hawaii Maternal Infant Health Collaborative.