The needs assessment is an ongoing, data-driven, collaborative process that includes state officials, families, service providers, community organizations, LHD staff, policymakers, and supplemental funding agencies, as well as support personnel and other stakeholders. The key guiding principles with which KY develops all MCH programs, while prioritizing MCH populations, are health equity and implicit bias, community input and engagement, data driven decisions, evidence-informed best practices, collaborative efforts with agencies, and stakeholders and systems as well as transparency and accountability.

 

MCH seeks ongoing input from consumers and families through a variety of surveys, meetings, and outreach activities at the program level of work. Annually, MCH data are derived and analyzed from multiple data sources and evaluated annually and quarterly over a 5-year period.

 

Pediatric mental healthcare access, substance abuse among women who are pregnant, or who may become pregnant, health equity, access to health care for KY’s CYSHCN population, and workforce requirement and retention remain the ongoing needs of MCH and OCSHCN in KY.

 

In FY22, KY MCH and OCSHCN continued to participate in program reviews, data analysis, and evaluations as part of an ongoing annual needs assessment process. These analyses included data review, surveys such as the Behavioral Risk Factor Surveillance System (BRFSS) and PRAMS, advisory board reviews, and regional meetings at the program level, ongoing review of logic models, program plans and processes are evaluated as per program standards. Program information is used to inform ongoing modifications to annual strategic planning. Analysis of quantitative data is reviewed monthly for many MCH programs. When possible and appropriate, these monthly and other periodic reviews are compiled and incorporated into cumulative reports for Title V.

 

The CFR program polled the local coroners how the state program could support them to improve the quality and quantity of local scene investigations. This resulted in additional items being added to the SUID kits to remove local procurement barriers.

 

MCH has included the parent and consumer voice in survey assessment and educational material review primarily within the home visitation and early intervention programs. Additionally, consumer input from providers of services is sought during advisory meetings and ongoing program consultation or technical support. The Program Support (Epidemiology) Branch continues the evaluation and dissemination of data as a function of providing timely and up-to-date reporting for programmatic compliance and effectiveness.

 

Quantitative and qualitative data reports were provided to a variety of stakeholders, legislators, and public health leaders across the state in FY22. This information is often utilized in data presentations to improve awareness of the state of health outcomes impacting mothers and babies. Historically, this data was presented at a variety of venues such as the annual MCH Conference, and other annual and regional conferences. This program year, we were able to resume hosting as well as attending live meetings to present data and varied reports. In addition, webinars continued to be held on KY TRAIN, the state’s online workforce training system, related to maternal and child health topics. Ongoing pediatric and perinatal webinars are added periodically for stakeholders and providers. MCH is also currently working on an MCH learning series, a format tailored to specific audiences. The format would be designed for both remote and in-person, when possible, and would consist of webinars, lectures, trainings for MCH staff, LHD employees, providers, teachers, clients, and other stakeholders.

 

Emerging and Ongoing Needs

 

As we emerge from the pandemic into a post-COVID-19 landscape, we are learning more about what shifts were temporary and what shifts are here to stay. Parallel to emerging from COVID-19, KY has recently experienced severe weather-related emergencies that have demanded the resources and response of state and local personnel and which have displaced and otherwise negatively impacted various people throughout KY. Health equity, access to mental healthcare, workforce issues, and virtual/remote service delivery are among the changes that will remain part of the fabric of our public health landscape for years to come. Key needs that have emerged this program year and are ongoing are:

 

• Continued access to prenatal care.
• Further attention to substance abuse among women who are pregnant and who may become pregnant and neonatal abstinence syndrome.
• Increased focus on emotional and mental health to all populations.
• Increased utilization of telehealth for clinical and mental health services and telecommunication by MCH staff as remote work continues.
• Workforce development needs: recruitment and retention efforts, trainings continue to be virtual and/or via remote learning, personnel pay and classification work.
• Improved capacity for enrollment and linkage to other services utilizing electronic platforms continue to be utilized.
• Continued emphasis on health equity, diversity, and inclusion at the program level.
• Program development, advisory council work and further collaboration with the KY DPH Office of Health Equity.
• Local schools' post-COVID protocols, response to a statewide teacher shortage, and attention to mental health in schools.
• Attention and response to statewide shortage of social workers.
• Mission and further development of the School Health Program within MCH; hiring of additional staff to serve those needs.
• Reestablishing contacts and connections for some MCH and OCSHCN programs to essential in-person services.
• KY Medicaid unwinding and preparation of the end of the federal public health emergency.

 

FY22 saw a continued utilization of virtual platforms and stakeholder meetings for information sharing and communication. As a response to pandemic restrictions, which continues, MCH has become a regular convener, attender, or leader of multiple stakeholder meetings. This has led to an increase of cross-collaboration for population outreach, service provision, virtual educational opportunities, improved communications, linkage of many stakeholders with shared purpose or mission, and an increase in workforce regardless of the employing agency to meet state capacity needs.

 

While most, if not all staff have now resumed their regularly assigned duties, many state employees continue to work remotely, mainly due to remodeling many offices within DPH, including MCH. HANDS, Kentucky Early Intervention Services (KEIS), (formerly First Steps), and many of our nutritional programs have returned to full in-person services. Many OCSHCN and other clinical services that are essential to in-person care have done so as well. Many of KY’s schools returned to full in-person instruction.  Given the anticipated effect of the pandemic on both state and local budgets, MCH anticipates budget reductions may occur. The impact of the pandemic will likely be felt for years to come, affecting the well-being of our workforce and local communities, especially LHDs.

 

MCH continues to review program plans and initiatives with a lens to reduce health disparities/inequities and to guide LHDs to include these efforts in annual planning for work within the MCH best practice packages. The OCSHCN Racial Equity Committee created weekly e-newsletters to educate staff and interactive resources to provide a framework and tools to incorporate a lens of equity in patient care and daily life. The Racial Equity Media Club began meeting virtually in February 2022 with the use of podcasts, articles and books creating rich discussion and a space for employees to normalize racial equity across the state and engage in meaningful and powerful discussions.  The OCSHCN Racial Equity Committee to proactively work to advance racial equity using the Government Alliance for Race Equity (GARE) Racial Equity toolkit. OCSHCN has also incorporated the Inclusive Language Guidelines and the Readability Calculator for all forms of communication to ensure that resources are accessible to a reading level no higher than eighth grade.

 

Emergency response plans were updated to include lessons learned throughout the pandemic response. COVID-19 and the subsequent natural disasters KY has faced the past couple of years have demonstrated the need to have readily available and up-to-date plans and procedures for staff to pivot on a moment’s notice. The demand for state government and its agencies to shift and readjust quickly has been great and KDPH and MCH has responded accordingly, professionally and to a high standard.

 

Workforce shortages in the areas of nursing, rural health, social work, and teaching continued to persist in FY22. Efforts are being made to address these workforce shortages such as compensation adjustments, education, and other incentive programs. While MCH and OCSHCN also continue to address workforce challenges, KY does have the agency capacity to meet ever-changing needs. Workforce education and training continue to be top priorities. In many areas, due to the need to quickly respond to various emergencies over the past two years, KY MCH and OCSHCN will emerge stronger as a result.  

 

Priority Updates

 

Mental health has emerged as a greater need now more than ever of our clients, mothers and families, as well as children in our schools. In addition, mental health of our providers and caregivers also is of utmost concern. This, along with other factors such as compensation and physical demand, has driven many away from the profession. In the coming year and beyond, the mental health of the populations in which we serve and of our employees needs to be one of our critical priorities. MCH continues to meet the ever-changing needs of women and children throughout the state through innovative practices, use of technology, and up-to-date reporting.

 

Women/Maternal Health

 

The focus remains to improve the percent of women receiving annual preventive health visits, focusing on improving women’s health across the life course. By doing so, KY hopes to improve pregnancy outcomes, as well as reduce maternal and infant mortality rates. MCH was successful in development of a well-woman best practice package which was launched this past year This event corresponded with KY’s health department media outreach efforts to promote COVID-19 vaccination for pregnant women. The focus of the prenatal program is to continue and to improve collaborations with local providers, FQHCs, and birthing hospitals to provide culturally competent, evidence-based care and referral for individual needs.

 

Perinatal/Infant Health

 

The NPMs focused on breastfeeding remained a constant.  Outreach and technical assistance were limited in scope and volume. As a result of the pandemic, nutrition services saw an increase in WIC enrollment mainly due to the economic decline and less of a need for face-to-face enrollment. Job loss and the additional stress placed on families heightened the need for mothers and families to seek government services. Critical health assessments that had historically been performed during in-person WIC appointments were limited, thereby decreasing the ability to identify risk factors and provide nutrition information for clients. These assessments, which are now being held virtually or over the phone are more critical than ever to determine positive outcomes for clients.

 

In 2022, MCH continued to address safe sleep to infant mortalities through its Infant Mortality (IM) Packages.

 

• Safe Sleep for Community Partners: 30 of our 61 local and district health departments provided safe sleep activities and education to local health care providers, birthing clinics, hospitals, and priority MCH populations in their service areas to prevent SUIDs.
• Child Fatality Review Team and Injury Prevention: All 61 Kentucky health departments provide activities to educate about preventing child abuse, injuries, fatalities, and child safety.
• Prevention of Pediatric Abusive Head Trauma: 23 health departments encompassing 53 of 120 counties in Kentucky provide activities that focus on prevention and awareness. Community partnerships of note have been local Departments of Corrections, Family Courts, DCBS, student babysitter groups, and many others who have committed to work with Kentucky to increase awareness and prevent abuse.
• Cribs for Kids for Community Partners: 21 health departments distributed 1,158 cribs to families in need of a safe sleep environment for their infant after receiving a total of $69,249.61 as a 50% match from their local community partners. These partners included school children who collected funds to sponsor a crib, MCOs, church groups, a first responder, and numerous local businesses and civic organizations.

 

These four Packages empowered LHDs to provide much needed education about evidence-informed best practices for protecting infants and children. The Package components were provided to local hospitals and other healthcare providers, local government agencies and businesses, first responders, and families in all their forms in a variety of venues to maximize positive community impact across Kentucky.

 

The innovations the LHDs used in their outreach to benefit the IM domain is reflected with the packages listed above. Package activities at the local level included media campaigns with creative ads showing up on retail shopping carts and in movie theater onscreen previews. Drive through education as a local community baby shower, which included pre and post testing and community sponsored prizes (e.g., a car seat, a crib, etc.) were exceptionally well attended. Safe Sleep and child safety education, materials, as well as prevention and promotions supplies have become institutionalized in many local hospitals and corrections facilities as an intrinsic part of their discharge processes and reflect the collaborative efforts of Kentucky’s LHDs.

 

Child Health

 

In 2022, there continued to be a great deal of work performed around the obesity and nutrition NPM to promote physical activity and healthy nutrition throughout FY22. To address Kentucky’s standing as having one of the highest rates of obesity in the country, two school-based program Packages were implemented:

 

• Coordinated School Health, in which healthy nutrition and physical activity policies are encouraged, while providing related education and activities to staff and students.16 LHDs devoted resources to establishing and strengthening this program in their school districts and their local schools.

 

• Healthy People, Active Communities focuses on women of childbearing age, pregnant women, and children, providing them with education and activities concentrating on healthy nutrition choices and physical activities that promote healthy lifestyles. Many of the 23 LHDs that chose this Package partnered with their local farmers and Farmers’ Markets to create activities and events that not only educated the communities about the importance of healthy nutrition and physical activity, but provided opportunities for them to sample fresh produce, learn how to prepare it in a healthy meal, and how to grow it. Many communities created community gardens and some of the schools created them for their campuses by their students. Trail Tales was an intervention that was used very successfully this year to encourage physical activity and educate about health nutrition.

 

The Healthy Schools Team which was very innovative during those periods of virtual learning had to readjust and be innovative again after students were back to school in person.

 

Work continued regarding the child injury SPM, with collaborative work performed by many agencies around safe kids with concentration in healthy and safe homes. Social media platforms became the most efficient source for distribution of short safety videos and materials.

 

Review of strategic plan, data sets, and program policies and procedures were adapted to meet current pandemic requirements. Individual programs were expected to weekly provide updates to MCH director and monthly reporting was completed to all levels of KDPH leadership.

 

Adolescent Health

 

Mental health and risk behavior concerns persisted this past year with limited peer-to-peer engagement. Unfortunately, the usual adolescent activities were limited due to pandemic restrictions. Prior to the pandemic, KY rejoined the Child Safety Learning Collaborative to develop a targeted approach to reduce child/adolescent injury. This led to a three-prong approach:

 

1. Data review
2. Program review
3. “Zero suicide” curriculum - implemented 4-part approach

 

Much work continued around the “Zero Suicide” curriculum in 2022. Since the start of the pandemic, Kentucky has experienced an increase in the number of children who have been exposed to bullying in their communities and/or schools, as well as through social media. Because these kinds of behaviors diminish a child’s ability to develop a healthy sense of self, which would be conducive to making healthy choices through the life span, a Package was developed to address the issue at the school district level as well as in the classrooms. Bullying and Suicide Prevention for Schools and Communities concentrates on providing evidence-based programs that educate and model positive communication, kindness, resilience, and other positive interactive skills.

 

CYSHCN

 

The 2020-2025 Needs Assessment identified the needs for children with special health care needs as: ability to transition to adult care, access to education services, ongoing community access to care, addressing health literacy, and parental support. OCSHCN has continued to work on these ongoing needs during the pandemic and throughout 2022. Over the past two years, families often had to forgo care due to long waiting lists, problems scheduling appointments, issues with eligibility criteria, complex systems to navigate, childcare coordination, language and cultural barriers, transportation issues particularly in eastern KY, and economic constraints. Significant gaps still exist in accessing the needed supports to transition from pediatric to adult health care, especially for youth with complex medical needs. With the various surges of COVID-19 and subsequent natural disasters children and youth with special health care needs continued to be at an increased risk. OCSHCN continues to work with parents, teachers, caregivers, and other stakeholders in order to address the needs of children and youth across the state. Telehealth has played a positive role in addressing needs before and during the pandemic, and it will long afterwards.

 

Organizational Structure

 

The KY Executive Branch has 11 cabinets, with the CHFS being the largest. The state health agency, KDPH, and OCSHCN are organizationally located within CHFS. Administration of the Title V program occurs through the Division of Maternal and Child Health within the KDPH.

 

The foundational statute KRS 211.180, gives CHFS the responsibility and authority to formulate, promote, establish, and execute policies, plans, and programs relating to all matters of public health. This allows MCH to collaborate with LHDs to fund Title V evidence informed strategies based upon the priority needs. MCH administers many programs, regulatory services, and health promotion initiatives, which include:

 

• Nutrition Services
  • Federal funded Special Supplemental Nutrition Program for Women, Infants and Children (WIC) including vendor enrollment
  • Nutrition education
  • Breastfeeding education, surveillance, and breast pump rentals
  • Medical nutrition therapy
  • Engagement with local farmer’s markets
• Early Childhood Development
  • Health Access Nurturing Development Services (HANDS), a voluntary home visitation program that supports families from pregnancy (primigravida/multigravida) through age 2 of the child
  • Child Care Health Consultation Program provides trainings and technical assistance to out of home childcare settings on health and safety
  • IDEA Part C, Early Intervention Services – First Steps provides comprehensive services for children with developmental disabilities from birth to age 3
  • Early Childhood Mental Health (ECMH) addresses social, emotional and behavioral issues for children through age 5 and various pilot programs for Help Me Grow
  • Partnership with Governor’s Office of Early Childhood and BHDID to contract with the 14 regional community mental health centers for program implementation
  • Birth Surveillance Registry (KBSR) provides surveillance for possible causes of birth defects through age 5 and linkage of children with birth defects to university genetic clinics and First Steps
  • Kentucky Strengthening Families (KYSF) focuses on enhancing the protective factors of the family
  • Healing, Empowering, Actively Recovering Together (HEART)
• Child and Family Health Improvement
  • Perinatal program provides technical assistance on reduction of early elective deliveries, presumptive eligibility, and linkage to resources
  • Maternal mortality reviews all maternal deaths, within one year of the end of the pregnancy
  • Pediatric programs include
    • Child Fatality Review and Injury Prevention
    • Coordinated School Health
    • School Health Nursing
    • Childhood Lead and Poisoning Prevention
• MCH Program Support Services provide epidemiologic support for
  • NAS Surveillance Registry
  • SUID case registry
  • Pregnancy Risk Assessment Monitoring Survey
  • Kentucky Birth Surveillance Registry with linkage to genetic clinics and IDEA Part C services
  • MCH Budget and Expenditure Monitoring
  • MMR data collection for MMR Report
• School Health Program: for consideration to be designated as a MCH branch
  • Coordination with KDE and Healthy Schools Team

 

As per the mandates and authorizations in state statute, services provided by OCSHCN include:

 

• Direct care gap-filling clinics for those children with a diagnosis on the agency’s eligibility list
• Audiology services, including hearing conservation, testing, hearing aid fittings, and programming for cochlear implants. OCSHCN administers KY’s Early Hearing Detection and Intervention (EHDI) newborn hearing screen surveillance program
• Foster care support programs, which support children with special needs in the child protective service system in collaboration with DCBS.  During FY21, the OCSHCN medically complex foster care program staff consultants were transferred from OCSHCN to DCBS
• Family to Family (F2F) Health Information Centers, aid families and professionals in navigating health care systems; information, education, training, support and referral services; outreach to underserved/underrepresented populations; health programs and policy guidance; and collaboration with other F2Fs, family groups, and professionals in efforts to improve services for CYSHCN
• Operation of the First Steps (Early Intervention) point of entry in the state’s largest region

Care for CYSHCN through its regional centers, ongoing partnerships and collaborations

DPH Leadership

 

Dr. Steven Stack became the Commissioner of Public Health in early 2020, just weeks prior to the enactment of COVID-19 emergency policies. Throughout his tenure his leadership has been pivotal in monitoring and responding to the emergent needs from the pandemic and subsequent public health emergencies.

 

Throughout the pandemic, having Medicaid, KDPH, and many other programs, under the steady leadership of the veteran Cabinet Secretary Eric Friedlander, was pivotal in the efficient response to a myriad of needs. Many MCH initiatives or staff were diverted to the pandemic response, with greatest impact on staffing being among both state level and LHD staff. This resulted in reduction of population health activities by LHDs, the infrastructure of which did not have capacity beyond pandemic response and core public health services. With the increasing need of MCH leadership staff directed to the pandemic response and program management, an additional Title V Block Grant Coordinator position was established.

 

MCH & OCSHCN Leadership Staff

 

• Connie White, MD, MS, FACOG is the Senior Deputy Commissioner for Clinical Affairs, and is Board Certified in OB/GYN with emphasis on patient education and preventive medical care
• Henrietta Bada, MD, MPH, is the MCH Division and Title V Director and is Board Certified in pediatrics and neonatal-perinatal medicine and directs all MCH programming
• Andrew Waters, MPH, is the Assistant MCH Division Director and manages day-to-day MCH operations, budget planning and administration, and functions as the MCH legislative liaison
• Matt Belcher, MPA, Title V Block Grant Coordinator, has 15 years of experience in grant writing and administration, and local community development
• Jan Bright, RN, BSN, Manager of the Child and Family Health Improvement Branch and Title V Block Grant Administrator, has 31 years of pediatric nursing experience
• Tracey Jewell, MPH, Manager of the Program Support Branch, is the senior MCH Epidemiologist with over 22 years of experience in DPH and Title V
• Nicole Nicholas, MS, RD, LD; Manager of the Nutrition Services Branch has over 23 years of experience as a registered dietician, KY WIC programs
• Paula Goff, MS; Manager of the Early Childhood Development (ECD) Branch has over 33 years of experience in ECD programs and IDEA Part C
• Michelle Malicote, RN, Program Administrator and Manager of the MCH School Health Program Lead
• Julie McKee, DMD; State Dental Director: KY Oral Health Program
• Karen McCracken, MCH Family Consultant: Early Childhood Mental Health, KY Strengthening Families, and family informed workgroups
• Vivian Lasley-Bibbs, MPH, directs the Office of Health Equity and is a Health Disparities Epidemiologist and Healthy People 2020 State Coordinator

• Ivanora Alexander, BS BME, OCSHCN Executive Director, has a 15-year history with KY’s CYSHCN program and has prior service as a rehabilitation engineer/manager designing technology for children and adults with special health care needs. 
• Edith Halbleib, JD, OCSHCN Deputy Executive Director, 26 years of experience as an attorney, with 10 years of experience as the managing director, deputy executive director, or executive director of organizations within the Commonwealth.
• Bethanie Morgan, MD, OCSHCN Medical Director, joined OCSHCN as the medical director after working as a pediatric neurologist and as a contracted provider for OCSHCN. She first worked with OCSCHN as a medical student at the University of Kentucky in 2005. Dr. Morgan has over 16 years of experience as a pediatric neurologist.
• Michelle Marra, RN, BSN, Director of Clinical & Augmentative Services, 30 years of experience as a Pediatric Nurse with over 16 years focusing on school-age children and youth with special health care needs.
• Jonathan Borden, MBA, EDD, Assistant Director of the Division of Administrative & Financial Services, has over 16 years of experience dealing with policy analysis and reporting in both the public and private sectors.
• Sondra Gilbert, Director, F2F, works with the American Academy of Pediatrics’ Section on Home Care, Midwest Genetic Network, CMC CollN, Family Voices, and Parent to Parent of KY.

Emily Allen, BS, MDIV, Procedures Development Specialist II, joined OCSHCN in June 2022, has 15 years of experience working with children and families in foster care and non-profit organizations.

Continued Partnerships, Collaboration, and Coordination

 

Partnerships with state agencies and community partners extend the reach and influence of MCH. MCH and OCSHCN strive to collaborate with federal partners and private organizations to help meet aligned agency goals and to address the priority needs of the women, children, and children with special health care needs. With a 98-plus year history of service provision, OCSHCN has developed formal and working relationships with a variety of programs providing services to children.

 

Partnerships exist with WIC, family planning, FQHCs, BRFSS, Department for Child Welfare, KDE, DBHDID, DMS, and FRYSC. In addition, KY partners with KY Injury Prevention and Research Center at UK, the predominate agency for injury prevention and the statewide injury prevention plan for children. KDPH and OCSHCN have cross collaboration to provide home visitation to medically complex children in foster care, training, workforce development, expertise, and specialty providers for gap filling services for children with special needs. These collaborations exist with KEIS, Early Hearing Detection and Intervention, and Child Welfare.