Delaware completed our comprehensive Title V Five-Year Needs Assessment in 2020.  This FY 2023 Application/FY 2021Annual Report application is our third year into the 2021-2025 grant cycle.

 

Last year, Delaware reconvened our Title V team to prepare for the likelihood of emerging and shifting priorities due to the impacts of the COVID-19 pandemic on Delaware’s maternal and child health population.  We had just finished our Five-Year Needs Assessment, but the COVID-19 pandemic had impacted our MCH population, and we felt the need to keep it on our radar.  Our Title V team knew that we would need to assist our partners and help address their needs.  The first goal of our Title V team was to use a data-informed method to identify and prioritize Delaware’s top health issues as a result of the pandemic, related to the health of women, infants, children and youth, including children and youth with special health care needs.  Additionally, keeping the pandemic in mind our team aimed to incorporate stakeholder and public input into finalizing any modifications to the priority areas by population domain for action planning. The Needs Assessment Steering Committee was responsible for reviewing and understanding the data, canvassing and surveying our MCH team for emerging issues and concerns they are observing from the data, and identifying priority areas of concern from the national health areas.

 

Through our 2020 Needs Assessment process, MCH created detailed and specialized Health Infographics for each of the 15 National Performance Measures.  The aim was to provide our stakeholders and partners with a snapshot of Delaware’s health status as it related to each measure.  Information such as Delaware’s goals and objectives, Delaware’s baseline data, how Delaware compares to our neighboring states as well as nationally, and more.  This year, MCH amended these Health Infographics once the  2019/2020 NSCH data was released.  Below is a picture of a few of our Health Infographics.  All of our Title V and Needs Assessment information, including our health Infographics, is found in one central location, our DEThrives website (https://dethrives.com/title-v.  We encourage all of our stakeholders and partners to check back often for updated information and resources.

 

 

As reported last year, part of the Title V Maternal and Child Health (MCH) Block Grant, Delaware developed another graphic for our partners to use as an additional resource.  This colorful snapshot is a glimpse of Delaware’s Title V, five-year State Action Plan to address our priority needs.  Our Plan is organized by the six reporting domains, which includes five MCH population domains (Women/Maternal Health, Perinatal/Infant Health, Child Health, Children and Youth with Special Health Care Needs (CYSHCN), and Adolescent Health). The sixth domain addresses state-specific Cross-cutting/Systems Building needs.

 

This State Action Plan offers an at-a-glance snapshot for the public, our partners, and our stakeholders to better understand our five-year plan. This report identifies the priority needs within each of the six domains, the program objectives, key strategies and relevant national and state performance measures for addressing each objective.  Provided below is a picture of our colorful State Action Plan that can be utilized by our partners.

After reviewing the available data and convening as a team, we determined the best course of action would be to survey our partners for input in their specialized maternal and child health population domain.  We wanted our partners to know that Title V is committed to improving our ability to support programs continuing to address the MCH population during the pandemic.  We aimed to better understand how our stakeholders were adapting to the ongoing challenges of the pandemic and we wanted to be more informed of the ways that our partner’s programs were adjusting to address COVID-19 related response needs.  In addition, we felt that we should be closely looking into the impacts of COVID on service delivery and the modifications our partners have made due to the pandemic in their particular fields.  We were hopeful to find out what options have been the most impactful.

 

Additional evaluation activities included an effort led by the SSDI Project Director in working with Forward Consultants for this ongoing Title V Mini Needs Assessment process.  Together, we modified our 2020 Needs Assessment Professional Stakeholder Survey.  Our finalized objectives for our Mini Needs Assessment were:

• Gauge the impacts of the pandemic on our partners within each health domain
• Learn how our partners were adapting to the ongoing challenges of the pandemic
• Be more informed of the ways each program is adjusting
• Support programs that continue to address the MCH population
• Identify ways MCH can better support our Title V funded partners with technical assistance

 

Our team knew that we wouldn’t be removing any priorities previously selected as a result of the 2020 Needs Assessment and new five-year grant cycle.  Rather, we would be addressing additional priorities that rose to the top.  Therefore, we chose to keep our original Professional Stakeholder Survey that was utilized during the 2020 Five-Year Needs Assessment and modify it to include questions pertaining to the COVID-19 pandemic.  Additionally, we selected to utilize the previous survey in an effort to compare data from one survey to the next.

 

Part of this survey included additional questions for our Title V Partners of the various ways Title V is able to provide technical assistance.  The Division of Public Health (DPH) coordinates and collaborates with many organizations and other state agencies to implement activities that address grant goals and objectives.  Title V was concerned about how we can better support our partners.  We asked for various ways Title V could provide technical assistance to our partners to be better responsive to their needs.  We listed the different ways Title V could provide technical assistance and requested they rank their most pressing needs.  We supplied examples such as:

• Provide data
• Assist with data to apply for resources
• Strategic planning
• Disseminate information via social media outlets
• Guide a grant writing process

 

Another focus Title V wanted to gain a pulse on due to the pandemic, were Social Determinants of Health (SDOH) on Delaware’s MCH population.  Our aim was to see if the women, children, adolescents, and families in Delaware’s unmet needs have changed since the beginning of the pandemic.  We understand that poor health tied to unmet social needs is a widespread problem and these factors impact a person’s physical and mental well-being, along with their ability to access quality health care.  Title V is making an effort to ensure that Delaware has it on the forefront of all our activities.  Our Professional Stakeholder Survey included questions pertaining to the top three most important things that women, children and families need to live their fullest lives in our community.  In addition, we canvased our partners to learn what are the top three greatest unmet needs of women, children and families in Delaware.

 

Interestingly, when asked about SDOH, employment was listed most often as a SDOH that women, children, and families need to live their fullest lives.  However, it was not considered as much of as an unmet SDOH in the survey respondents’ communities.  Both food security and child-care were listed as among the top three SDOH-related responses that women, children, and families need to live their fullest lives as well as SDOHs that are unmet in communities.

 

Our Title V team requested Forward Consultants complete an in-depth analysis of the results of this Mini Needs Assessment and compare to the results of the Five-Year Needs Assessment results.  Our team was specifically interested in understanding any differences or likenesses that resulted when comparing the stakeholder responses in selecting important NPMs pre-COVID and post pandemic.  Specifically, we asked if anything stood out that would lead us to deviate from our current course and wanted to justify any changes.  Interestingly, there were no major differences in NPM-related responses in either survey.

 

As a result of our Title V team meetings, internal review of data and Professional Stakeholder Survey and analysis, our Title V team determined that Well-Woman Visit and Adolescent Well Visit will continue to be top priorities for MCH to focus on even through the pandemic.  Through the priority of Adolescent Well Visit, we will continue to incorporate mental health in addition to physical activity.

 

We learned that our Title V funded partners ranked “provide data” as either the first or second choice by 60% of Title V partners.  Conversely, assistance with strategic planning was considered to be the first or second most important need to be addressed by only 20% of Title V partners.  Therefore, our Title V team decided that our SSDI Project Director would work with our CDC Epidemiologist to continue with a previous goal identified prior to the pandemic.  We would pursue including data relevant to the MCH population on the State Action Plan Snapshot created last year.  Our intentions were for our partners and stakeholders to be able to view Delaware’s data in one document.  This would also include previous year’s data, so our partners can track the information from year to year.  We understood that we would face additional challenges that might arise, such as repetitive display of data, partner agencies not allowing us to use the data publicly and, obtaining the perfect conduit for partners accessing the data.

 

Through this mini-Needs Assessment and Stakeholder Survey, we sought to answer the identified need of our partners; how we could better support our Title V funded partners with technical assistance.  This year our SSDI Project Director was able to schedule regular meetings with our two-Family Health Systems (FHS) epidemiologists to begin the task of compiling all MCH data into one central location.  Both epidemiologists, Khaleel Hussaini, CDC assignee epidemiologist, as well George Yocher, FHS epidemiologist, are also members of our Title V team.  Our goal was to gather and organize Delaware’s data pertaining to each National Performance Measure as well as all the National Outcome Measures.  This data sheet was created as a result of the survey, where 60% of our Title V partners requested MCH provide data as a way to support and assist them with their needs.

 

We hope this MCH Performance Measure data sheet supports our partners and our stakeholders with the very important maternal and child health work they do.

 

 

In the future, Title V may pursue an app for our Title V information.  We feel that our partners, stakeholders and the public will be in favor of having Delaware’s data readily available via an application on their phone.  We believe finding all maternal and child health resources in one place would be beneficial to their work.  Our plan is to begin with displaying the data on our colorful State Action Plan Snapshot first, and then we will research pursuit of an app.

 

This year, we again reconvened our Title V team throughout this year to assess the health needs of our population, Title V’s program capacity, as well as Delaware’s partnerships and ability to collaborate and coordinate efforts.  When possible, our team has met in person throughout the year to review the most recent state and national data that was specific to Delaware’s MCH populations.  Our team used the Behavioral Risk Factor Surveillance System (BRFSS); Youth Risk Behavior System (YRBS); National Immunization Survey; National Survey of Children’s Health (NSCH); Pregnancy Risk Assessment Monitoring Systems (PRAMS); and Delaware Health Statistics (birth records, death records, hospital discharge data).

 

Our Title V team met periodically to review Delaware’s State Action Plan.  We reviewed all previously selected Strategies, Objectives, and ESMs for each of our Priority Needs.  Collectively, we determined which Strategies and ESMs have been successfully completed.  In addition, our team also identified new ESMs that could be incorporated into Delaware’s State Action Plan moving forward.  These new ESMs were added to the Plan to continue to strengthen Delaware’s maternal and child health population.

 

Delaware’s Title V team also reviewed our State Action Plan based on guidance received from the National Center for Education in Maternal and Child Health.  Delaware received the MCH Evidence Center’s annual Evidence-based/informed Strategy Measure report for the 2022 Application/2020 Annual Report.  Based on these findings, Delaware began conversations and used the suggestions to find ways to strengthen our ESMs by linking them to effective, science-based practices and to measure our progress in ways that tell how Delaware Title V is advancing each National Performance Measure.

 

As the Title V agency, DPH operates a comprehensive array of programs and services to promote and protect the health of Delaware’s mothers and children, including children and youth with special health care needs.  Within, DPH, the Family Health Systems section houses many of these programs, as described within the application.  However, the capacity to support the MCH population extends throughout all sections of the Division, including services such as the WIC program, immunizations and lead testing through State Service Centers and supports for healthy lifestyles (physical activity, nutrition, tobacco cessation), to name a few.  An overview of DPH’s partnerships, collaborations and coordination surrounding our programs and services for the MCH population is summarized below.

 

The Delaware Title V MCH program can meet the needs of women, mothers, infants, children, CYSHCN and adolescents through partnerships, collaboration, and coordination with other entities.  Delaware benefits from the commitment and engagement of its stakeholder community.  Delaware has many advisory boards, councils, and coalitions that our MCH program works with to extend the reach of Title V, guide our work and expand on the overall capacity to support mothers, children and families.  Two of the largest groups of partners coming together around MCH issues in Delaware are the DHMIC and Family SHADE.

 

MCH’s finest collaboration is the Delaware Healthy Mother & Infant Consortium (DHMIC).  The DHMIC pursues the health of women, infants and families through a life course approach.  The DHMIC approach includes planning with the community, thinking holistically about women’s health and addressing inter-generational health.  The DHMIC supports a continuum of services promoting optimal health from birth throughout the lifespan, from one generation to the next.  Formed as a statewide vehicle to address infant mortality, the consortium includes approximately 20 Executive Committee members, including two representatives from the House of Representatives, two representatives of the Delaware State Senate (one selected by each caucus), a representative from the Governor’s office, a representative from the Department of Services for Children, Youth and their Families (DSCYF), the Secretary of the Department of Health and Social Services, and 15 additional members approved by the Governor who represents the medical, social service and professional communities as well as the general public.  These additional representatives come from the State Senate, DPH, hospital systems, universities, faith-based communities, and more.  The DHMIC invites over 150 partners and stakeholders to the quarterly meetings.

 

In August 2019, the consortium developed a three-year strategic plan with one-year and three-year objectives. The DHMIC Goals are:

• The DHMIC will provide statewide leadership and coordination of efforts to prevent infant mortality and improve the health of women of childbearing age and infants throughout Delaware.
• All programs will be carried out through the lens of improving health equity, the use of the life-course approach, enhancing data collection and use of quality improvement to achieve stated goals.  These initiatives will also be designed and carried out through the lens of culturally and linguistically appropriate services (CLAS) in achieving a reduction in premature birth and infant mortality in Delaware.
• The DHMIC will select a “champion” for each key initiative.

The four focus areas are: Well Woman Care/Life Course Perspective, Maternal Morbidity/Mortality, Social Determinants of Health and Continue Emphasis on Reducing Preterm Birth and Infant Well Being.

 

Due to the ongoing challenges with the pandemic and the comfort level and ease of partners to meet in person, we held our 2022 Annual DHMIC MCH Summit virtually on April 26, 2022.  For 16 remarkable years, DHMIC has been making good on its promise to provide statewide leadership coordination of efforts to prevent infant mortality and improve the health of women of childbearing age and infants throughout Delaware.  The Delaware Healthy Mothers and Infants Consortium (DHMIC) and the Department of Health and Social Services (DHSS), Division of Public Health (DPH) organize this event.  The summit brings together leaders in the area of family health to discuss new approaches to enhance the health of women, children and families of all ages.  Developed around the theme “Listening. Connecting. Inspiring Change,” the DHMIC summit integrates a full agenda of educational, advocacy, networking, and story-sharing opportunities to mobilize participants to better understand the reasons why - and the ways how - they can leverage their professional, personal, and community service resources to decrease racial disparities in maternal and infant health. 

 

The Summit reached another historic reach this year, with over 450 attendees, including health care professionals, community influencers, policymakers, faith community leaders, and concerned citizens to be empowered on critical topics by leadership from DHMIC, Delaware Thrives, and the Delaware DPH, along with local and national experts from various fields who are committed to ending racial and ethnic health disparities.  A summary of the agenda follows:

Keynote presentations

• Understanding and Effectively Addressing Inequities in Health — David R. Williams PhD, MPH, Florence and Laura Norman Professor of Public Health, Chair, Department of Social and Behavioral Sciences; and Professor of African and African American Studies and of Sociology, Harvard University Transforming and Empowering Women in Birth - Jennie Joseph, LM, CPM, Founder and President of Commonsense Childbirth Inc. and Creator of The JJ Way®
• Black Maternal Awareness Resolution - Delaware Representative Melissa Minor-Brown
• Panel Discussion: Addressing Black Maternal Health in Delaware from a Community and Provider Lens
• Postpartum Revolution - Angelina Spicer, Stand-Up Comedian and Activist

 

As in the past, we put out a call for the Summit looking for bold ideas, bold new programs, or a bold new approach to improving the health of women, men, infants, and families, calling them “Delaware Thrives! Community Voices Breakout Sessions.”  Participants were encouraged to submit a short description of their organization and/or program and a facilitator was assigned to each room to ask questions and engage the participants in a dialogue.  The following topics were covered virtually in breakout rooms on the conference platform:

• Women’s Emotional Wellness – Focus on the Needs and Barriers for Hispanic and Latina Women in Delaware
• Be Empowered: Resources, Programs and Tools for Women
• Urgent Maternal Warning Signs Hope
• Healthy Women Healthy Baby Zones

 

Not only are the organizations/programs featured during the DHMIC 2022 Summit rich with content, featuring the breakouts also establish the foundation for consistent dialogue around these organizations/programs as DHMIC partners and ultimately result in greater awareness of and support for the DHMIC mission. 

 

In the domain of CYSHCN, a key partnership group is Family SHADE (Support and Healthcare Alliance Delaware).  Family SHADE is a collaborative alliance of family partners and organizations committed to improving the quality of life for children and youth with special health care needs, and their caregivers, by connecting families and providers to information, resources and services in addition to advocating for solutions to recognize gaps in services and supporting its member organizations.  Delaware believes in the provision of supports and services to families of children with special healthcare needs that foster (1) empowerment and not dependency; (2) equity and equality; and (3) an individually defined quality of life.  In addition, caregivers must be viewed as experts in regard to their children within a context of self-determination and family culture.  Effective family support of CYSHCN requires a multi-faceted, family-centered approach.  Family SHADE works with committed partner organizations (either formal organizations or parent groups) to ensure that parents, siblings and extended families have the resources, information, and social and emotional support to care for children with special needs.

 

Family SHADE promotes the Learning Communities as well as promoting access to high quality health care, including having adequate health insurance that reduces barriers to primary and specialty care which continues to be of most importance to women, children, and families to live their fullest lives.  Family SHADE continued to utilize their website as well as regularly monthly scheduled Networking Breakfast meetings which continued to be held virtually in year two of the COVID-19 pandemic.  Family SHADE continued to distribute a Family Knows Best Survey (FKBS) on a quarterly basis to maintain awareness of the gaps in services throughout the state.

 

DPH recently contracted with our new vendor, Parent Information Center (PIC), to execute the Family SHADE project with a revitalized approach.  PIC implemented the Family SHADE project through the utilization of a cultural and linguistic competent and clearly defined values, behaviors, attitudes, policies, structures, and practices.  PIC began their process of establishing their Family SHADE approach through a collective impact approach which would consist of management and implementation of Family SHADE.  This is accomplished through PIC’s significant experience with community collaborations and working with stakeholders on collective goals and fostering partnership.  The collective impact approach is predicated on transparency and collaboration to achieve common goals.  As the backbone organization for Family SHADE, PIC has provided the needed support, connections and transparency to support Maternal Child Health Block grant (MCHB) and mini-grantees to achieve a common agenda.  As the backbone support organization, PIC has provided administrative support as well as technical assistance to structures developed as part of the Family SHADE program.  This approach includes:

• Family SHADE Advisory Board
• Family Leadership Network
• Learning Communities for National Performance Measures
• Mini-grantees
• Organizations serving CYSHCN and other community partners

 

The DHMIC and Family SHADE represent two of the largest groups of partners coming together around MCH issues, but there are many other advisory boards, councils, and coalitions that our MCH program works with to extend the reach of Title V, guide our work, and expand the overall capacity to support mothers, children, and families.  For example, the Help Me Grow Advisory Committee, convened by DPH, consists of representatives from organizations across the state.  Similarly, the Home Visiting Community Advisory Board pull together home visiting and partnering programs from across the state to ensure a coordinated continuum of home visiting services.  In addition, the Governor’s appointed Early Hearing Detection and Intervention (EHDI) Board was created by legislation passed in 2012.  The Newborn Screening Advisory Council, formed in 2000, helps the Division determine best practices for the program including the addition of new conditions to the Delaware panel.  Additional key partnerships and collaborations include Delaware’s Early Childhood Council (ECC), the Safe Kids Coalition, the Family Coordinating Council, the Sussex County Health Coalition, and the Breastfeeding Coalition of Delaware.

 

As outlined in our organizational structure, our Title V program is intimately connected with federal investments, such as the State Systems Development Initiative (SSDI), Maternal and Infant Early Childhood Home Visiting (MIECHV), Early Childhood Comprehensive Systems (ECCS), and Personal Responsibility Education Program (PREP) Partners by virtue of the location of these grant programs within the same section - Family Health Systems.  In addition, we have partnered with Project LAUNCH and the Division of Substance Abuse and Mental Health in combating the opioid epidemic.  The State of Delaware created a committee bringing together the Division of Public Health, Division of Family Services, and the Division of Substance Abuse and Mental Health.  The group is made up of key leadership including all three Division Directors, two Deputy Directors and senior program directors including both the Title V Director and Deputy Director/MIECHV Project Director.  The group decided to work on three key goals, a MOU, training for direct service staff and education.

 

The purpose of the MOU stems from both The Department of Health and Social Services and The Department of Services for Children, Youth and Their Families recognizing that each has an important role to improve the lives of families impacted by substance use disorder.  The MOU was jointly developed for the agencies to:

• Work as a team on shared client cases to attain the most positive outcomes;
• Provide each client with the most comprehensive care; and
• Prevent duplication of activities.
•  

The MOU states that each agency agrees to establish a multi-disciplinary coordination committee.  The focus for the committee was training, messaging, case management, and the development of procedures.  Since the development of this MOU, it has been decided that each of Delaware’s three counties will have a committee focused on the above-mentioned items.

 

Home visiting supervisors, treatment providers, Division of Family Services administrators, supervisors, and caseworkers have come together to form the Delaware Multisystem Healthy Action Committees (MSHAC) in each county.  Since the initial kick off in September 2016, quarterly meetings in each of our three counties continue to meet and collaborate.  The charge of MSHAC is to plan how to serve families with substance use disorder better through a multi-agency approach.

 

Agenda topics for these meetings have included sharing resources and educational materials, Neonatal abstinence syndrome (NAS), updates from local treatment providers, coordination of services and referrals, substance use disorder, sober living, breastfeeding support, parent education, mental health, home visiting, related state legislation, and even walking through substance abuse specific cases in each agency. Supervisors and agency representatives are asked to refer information back to their staff of professionals who work directly with substance abuse clients and families.  Guest speakers have been invited quarterly and continue to enrich the knowledge of the committee.

 

In addition to the wide range of organizational collaborations listed above, we also value partnership with families and consumers.  As part of our Five-Year Needs Assessment process, we commissioned 12 discussion groups statewide, with a total of 92 women and men participating.  Four maternal health groups focused on questions related to women’s health.  Three groups were conducted in English and one group was in Spanish.  Four groups focused on mothers and children and youth with special health care needs.  Two of those groups were in English and two were conducted in Spanish.  Two father/partner groups were conducted.  And lastly, two preconception groups were held with African American women without children.

 

Parents continue to be engaged through the Families Know Best Surveys administered by Family SHADE.  Families Know Best is a voluntary parent advisory group. Participating families are asked to fill out monthly online or print surveys about the services they receive.  Information gained through these surveys is shared with Family SHADE organizations, policy makers and agencies statewide.

 

As in years past, Title V supported a very important activity, the Managed Care Organization (MCO) health calls facilitated by Delaware Family Voices, with the phone line provided by DPH.  These regularly scheduled calls give family members an opportunity to ask questions or discuss an issue.  On the call are representatives from various agencies and organizations, such as Medicaid, private practitioners, Disability Law Program, and Health Management Organizations (HMO) representatives, to listen and help problem solve.  These calls give families a non-adversarial venue discussion to share their concerns.  These calls are offered in both English and Spanish.  As a result, many families get a better understanding of how the system works and the providers and policymakers hear how a family is impacted by the rules and regulations.

 

In the spirit of Title V, we are committed to continuing these efforts to partner with families and consumers of our programs and services to ensure that our efforts and resources are aligned with the priority needs of Delaware’s mothers, children, and children and youth with special health care needs.