Needs Assessment Update

The Maternal, Child, and Adolescent Health Division (MCAH) of the California Department of Public Health (CDPH) developed the 2020 Needs Assessment (NA) by engaging diverse stakeholders at the state and local levels, reviewing 2016-20 Title V priority needs, analyzing population-level data and indicators, reviewing evidence-based methodologies, and leveraging existing information from local MCAH programs. CDPH/MCAH has documented comprehensive, domain-specific NA efforts in the 2021-25 NA.

CDPH/MCAH is committed to strengthening public health systems and investing in programs that serve women, pregnant people, infants, children, adolescents, and families with the highest need. In response to the COVID-19 public health emergency, CDPH had to quickly assess new needs and adapt MCAH activities and programs to use virtual platforms for health education, case management and home visiting, partner meetings, and internal collaboration.

Changes in the health status and needs of MCAH population include, but are not limited to the following:

1. Increased Black infant mortality rate1-3
2. Increased concern for emotional and mental health of children, adolescents, and young adult mental well-being4
3. Increased numbers of children experiencing violence at home, with higher rates of child abuse among children with special health care needs (CYSHCN)5
4. Increased rates of intimate partner violence, especially in households of CYSHCN 5
5. Increased negative impact on caregiver emotional health (e.g., feelings of difficulty and nervousness/stress5

The changes to MCAH health status reported above emphasize the importance of implementing systems-level, community-level, and client-level interventions. This also underscores the heightened need among families of CYSHCN and underserved populations for additional support and outreach. While the Title V Block Grant priority needs remain mostly unchanged, the overall impact to MCAH population health highlights how critically important it is to continue and, where possible, expand efforts to address MCAH population needs.

Changes in Program Capacity or MCAH Systems of Care /Organizational Structure:

California continues to implement MCAH programs, implement the Action Plan, and work with local health jurisdictions to operationalize its ongoing NA process and findings. In 2021, there have been several funding expansions in CDPH/MCAH:

• Expansion of the Black Infant Health program (BIH)
• Expansion of the California Home Visiting Program (CHVP)
• Expansion of maternal mortality and morbidity review committee
• Expansion of behavioral and mental health for children, youth, and families

There have been multiple other funding expansions and policy changes in the healthcare delivery system that will also impact the MCAH population, including Children and Youth Behavioral Initiative and CalAIM, an initiative to strengthen and transform Medi-Cal.

During 2020 and 2021, one of the areas of focus within the Center of Family Health (CFH) was to define, create, and track the secondary impacts of COVID-19 on mothers and children. CFH defined and developed population-based health indicators for each population domain. This indicator list is included in the Appendix as a supporting document.

The state’s Title V partnerships and collaborations with other federal, tribal, state, and local entities that serve the MCAH population continued to expand and are included in the Appendix as a supporting document titled “Partnerships and Collaborations.”

In 2021, CDPH/MCAH recruited Diane Lindsey as the Division Chief and also created a Title V Program Coordinator role, which was filled by Keerthana Rajagopal in June 2021. CDPH/MCAH also revamped its Title V internal structure and restructured the Title V Management Team. The Title V Management team includes the following staff:

• Diane Lindsey, Division Chief and Title V Director
• Romeo Amian, Assistant Division Chief
• Kee Rajagopal, Title V Program Coordinator
• Sarah Leff, Title V Director for CYSHCN
• Mary Bost, Local MCAH Program Support Unit Chief

We continued to maintain the domain team structures, with improvements to encourage collaboration and streamline the extensive reporting burden. This enabled our Branch Chiefs to serve as change agents to drive Title V activities. CDPH/MCAH Branch Chiefs include the following staff:

• Mari Taylan, Acting Maternal and Infant Branch Chief
• Lissa Pressfield, Child and Adolescent Branch Chief;
• Mike Curtis, Program Evaluation and Data Systems Branch Chief
• David Reynen, Epidemiology, Surveillance, and Federal Reporting Branch Chief

The goal of rebranding was to establish a structure and internal process to strengthen MCAH Title V-related activities, create open communication channels, and be a catalyst for improving MCH outcomes statewide.

There have been numerous and ongoing staffing changes in the MCAH workforce at both the state and local level, with many public health practitioners retiring, promoting, or leaving for other opportunities. There have been significant long-term vacancies in CDPH/MCAH, including both the Pediatric and OB/GYN Public Health Medical Officers and Maternal and Infant Health Branch Chief position. The remaining CDPH/MCAH staff have pitched in to fill these gaps and meet the needs created by these long-term vacancies.

CDPH/MCAH is committed to proactively monitoring emerging public health issues as they arise, focusing on the following areas:

• Infant mortality rates
• Family violence and childhood adversity
• Unmet mental health care needs for mothers, children, and adolescents
• Childhood immunizations and well-visits, and public health workforce and capacity

Sources:

1. California Birth Statistical Master Files 2000-2017, California Comprehensive Master Birth Files 2018-2020; California Death Statistical Master Files 2000-2013,
2. California Comprehensive Master Death Files 2014-2020
3. Prepared by the Epidemiology, Surveillance and Federal Reporting Section, Maternal, Child and Adolescent Health Division, Center for Family Health
4. Czeisler MÉ, Lane RI, Petrosky E, et al. MMWR Morb Mortal Wkly Rep. June 24–30, 2020.
5. California Department of Public Health, Immunization Branch