MCH Population Needs
MDPH conducts a comprehensive statewide needs assessment every five years and in interim years engages in activities to ensure that needs assessment is an ongoing process. Below are examples of efforts to monitor and assess the continuing needs of the MCH population in Massachusetts.
COVID-19 Community Impact Survey: Parents of CYSHN and Youth with Disabilities
In fall 2020, MDPH conducted the COVID-19 Community Impact Survey (CCIS) to better understand the immediate and long-term health needs of Commonwealth residents during the pandemic, including social and economic consequences. There were over 33,000 adult respondents to the survey, and over 3,000 youth (ages 14-24) respondents. MDPH is using and sharing these data to create new, collaborative solutions with community partners.
In November 2021, CCIS released data about the specific needs of parents of children and youth with special health needs (PCYSHN) during the pandemic. About 786 respondents were screened as PCYSHN using the MCHB definition. These data illuminate the toll of the pandemic on this population, and that certain groups – including but not limited to parents with disabilities, parents of color, parents under age 35, parents in rural counties, and parents who speak a language other than English – bore a disproportionate burden. Economic security was a major concern for PCYSHN; they were 45% more likely to report job loss, reduction of hours, or leave than other parents. Family caregivers experienced increased mental and behavioral health needs and faced significant barriers accessing healthcare; during the first 6-8 months of the pandemic, nearly 1 in 4 PCYSHN delayed healthcare and nearly half reported persistent poor mental health. Technology needs (25% of respondents) were also cited as a concern.
About 640 youth with disabilities (21% of the ~3,000 youth respondents) completed the CCIS. Youth with disabilities reported being deeply concerned and having been significantly impacted by the pandemic, especially youth of color and LGBQA youth. Many had been asked to take on more adult responsibilities, including providing financial support to their families (28% of youth with a mobility disability and 23% of youth with a cognitive disability). Youth with disabilities were 3 times as likely to be worried about basic needs compared to youth without disabilities. The pandemic has had a significant impact on mental health with 3 of 4 youth with any disability reporting feeling sad or hopeless every day for 2+ weeks. More than twice as many youth with disabilities (46%) reported 3+ PTSD reactions during COVID-19, compared to youth without a disability (22%).
Due to the large sample size of the survey, CCIS provides a unique source of data on the challenges faced by caregivers and youth in Massachusetts and validates some of the anecdotal data that programs have received. Additional information about the CCIS process and findings can be found in the Overview of the State and the State Action Plan Narrative by Domain.
COVID-19 Disparities Community Evaluator Project
MDPH is contracting with the Tufts Interdisciplinary Evaluation Research (TIER) team to conduct a series of community-based evaluation projects with funding from the CDC National Initiative to Address COVID-19 Health Disparities Award. TIER will hire and train a cohort of Community Evaluators in community-based participatory research to help design and implement evaluation projects and translate findings into program and policy recommendations. The projects are focused on understanding and addressing the effects of COVID-19 on Massachusetts residents, and on making sure that people directly affected by COVID-19 are part of both the evaluation process and public health response.
Three initial projects have been selected and will be executed in FY23. These projects include collecting qualitative data from pregnant people and parents of youth aged less than 5 years from specific communities with lower COVID-19 vaccination uptake to understand barriers and facilitators to COVID-19 vaccination among pregnant people and parents deciding whether to vaccinate their young children; evaluating community acceptance of a new telehealth kiosk being used to provide a safe, easily-accessible, and confidential space for community members to access health and other social services; and diving deeper into some of the qualitative data from the CCIS to learn more about how frontline workers in restaurants and childcare settings have been impacted by COVID-19.
Perinatal-Neonatal Quality Improvement Network (PNQIN) COVID-19 Vaccination Survey
The Perinatal Neonatal Quality Improvement Network of Massachusetts (PNQIN) aims to improve rates of delivery of COVID-19 vaccinations to pregnant and postpartum people and their families by addressing health systems barriers to effective vaccination counseling and provision. In October/November 2021, PNQIN administered a provider survey to better understand barriers to COVID-19 vaccination for pregnant and postpartum people.
The survey was sent to providers from 40 birthing hospitals; 42 providers across 38 birthing hospitals responded. Results indicated that there is large variability in provider-types who counsel pregnant and postpartum patients on vaccination status, including physicians, midwives, nurse practitioners, nurses, and medical assistants. Only 30% (n=33) of institutions reported that their providers receive training on how to counsel pregnant and postpartum patients about COVID-19 vaccination, while 92% (n=36) of responding providers indicated that their institution was interested or potentially interested in receiving virtual training for providers. Providers also cited provider time and energy, patient vaccine hesitancy, misinformation, absence of onsite vaccination, and inconsistent messaging as barriers to COVID-19 vaccination for pregnant and postpartum patients. PNQIN will use results of this survey to develop strategies to support facilities to implement protocols for COVID-19 vaccination of pregnant and postpartum people and their families.
PNQIN Family Engagement Survey
PNQIN is developing a Hospital Family Engagement Collaborative Practice Survey for NICU/Special Care Nursery and Obstetrics and Gynecology teams to assess hospital and patient family engagement definitions and practices. As of April 2022, PNQIN has conducted a narrative literature review of validated survey instruments (e.g., Family Voices and the MA Family Engagement Framework) and is working with the Betsy Lehman Center to revise and import the survey questions into REDCap. The survey will be administered to all birthing hospitals and findings will inform opportunities for improvement and support decision making around specific topics for learning collaboratives or technical assistance that will be offered to interested hospitals.
WIC & Breastfeeding Needs Assessments
An annual needs assessment identifies WIC-eligible populations in all 351 cities and towns and guides the statewide distribution of funds. In 2020, 197,444 women, infants, and children were eligible for WIC, compared to 203,077 in 2019, reflecting the decrease in the state’s number of births. Among those eligible in 2020, 48.5% of women, 82.2% of infants, and 52.6% of children participated in WIC. Local WIC agencies use needs assessment results for outreach plans to engage and enroll eligible families.
Center for Birth Defects Research and Prevention Strategic Planning
The Center for Birth Defects Research and Prevention (CBDRP) initiated a strategic planning process and engaged a consultant to lead this process. The purpose of the Center’s Strategic Planning process is to: 1) refine the Center’s mission and vision; 2) update its goals and objectives; 3) identify opportunities to: a) add new activities, b) enhance/strengthen current activities; and 4) create and/or strengthen Center collaborations. As a first step, small group discussions were held with Center Epidemiologists, Center Trainees (current and former), the Center’s Medical Record Abstractors, Center’s Research Study Staff, external collaborators, and advisory committee members; while individual meetings were held with the Center leadership, leadership in other BFHN Divisions, and Bureau leadership. Discussion topics include assessment of the Center’s strengths and weaknesses; emerging issues or trends in science, public health or technology that present opportunities for the Center; leadership opportunities for the Center; and identifying ways that the Center can strengthen the advancement of health equity through the work its does. A total of 29 interviews with 42 individuals were held during the Fall of 2021 and a summary report is being drafted. The final strategic plan will include an implementation plan, as well as a monitoring and evaluation plan.
MDPH has identified the following emerging public health issues and Title V capacity and resources to address them.
Staffing Challenges
Like many industries across the country, state and local MCH programs and organizations are experiencing tremendous challenges in hiring and retaining staff. At the local level, programs such as WIC and home visiting struggle to appropriately staff client-facing services, limiting their ability to meet the needs of families. This challenge is experienced at MDPH as well, where many staff have left the Department or state service over the past year, leading to a loss of institutional knowledge and necessitating additional staff time and resources to fill vacancies. BFHN is leveraging this as an opportunity to recruit and hire new staff with a racial equity lens and using a healing-centered approach. More information about these hiring efforts can be found in the discussion of the racial equity priority in the Crosscutting domain. In addition, see MCH Workforce Development for information about efforts to strengthen the MCH workforce.
Inflation and Cost of Living
The rising inflation and cost of gas, food, and other goods in Massachusetts and across the country are adversely affecting families served by Title V. As result of the COVID-19 pandemic, many people in Massachusetts were already struggling with important basic needs, like housing, food, medicine, technology, and childcare. The recent infant formula shortage has added additional stress and hardship for families. Title V programs will support families in accessing concrete supports to meet these needs and assess the impact of public benefits and programs that promote economic stability, including Paid Family and Medical Leave, the Earned Income Tax Credit, and Supplemental Security Income benefits. The WIC program will continue to play a critical role maximizing the number of families with young children who have access to food resources for which they are eligible.
Early Identification of Developmental Delays
There are increasing concerns in Massachusetts about the impact of the COVID-19 pandemic on developmental delays and the early identification of delays. Findings from a fall 2020 needs assessment, conducted by the Association of University Centers on Disabilities and CDC, found that early childhood programs across the country report that the pandemic has greatly affected early identification of developmental delays and disabilities among children birth to age 5 years. Title V is well-positioned to respond to this issue through its priority to strengthen the capacity of the health system to promote mental health and emotional well-being, using NPM 6 to monitor developmental screening. Key strategies include scaling the Learn the Signs Act Early Developmental Milestone Checklist Program to WIC clinics statewide and working with state and community partners to promote understanding of infant and early childhood mental health, effective social emotional screening and follow-up in pediatrics, and services and referrals.
Agency and Program Capacity
Organizational Structure, Leadership, and Staffing
MDPH is part of the Executive Office of Health and Human Services (EOHHS), where legal, human resources, and information technology are centralized. The EOHHS Secretary reports to the Governor. The Bureau of Family Health and Nutrition (BFHN) within MDPH is the Title V Agency, with overall responsibility for the Title V program and funding. The BFHN Director is also the Title V Director, a senior manager who reports to the Associate Commissioner of MDPH. A sister Bureau, the Bureau of Community Health and Prevention (BCHAP) also includes MCH-related programs. BFHN and BCHAP work closely on many initiatives, including the Needs Assessment and annual Title V reporting. The Childhood Lead Poisoning Prevention Program and Office of Health Equity are also significant components of Title V and reside in the Bureau of Environmental Health and the Office of Population Health, respectively.
Over the past year, BFHN experienced significant leadership changes. The former BFHN Deputy Director, Aaron Beitman, left MDPH in November 2021. Stephanie Doyle joined the Department in March 2022 as the BFHN Deputy Director of Strategy and Implementation and Snaz Pierre became the Administration and Finance Director. Further information about the Title V Partnership senior management team and their qualifications is provided in Attachment 2.
The organizational charts for BFHN and BCHAP are below and show the divisions and programs within each bureau. A MDPH organizational chart is attached, which shows the location of BFHN and BCHAP within the Department.
As of June 2022, approximately 174 full-time equivalent (FTEs) employees throughout MDPH work on Title V Partnership programs, with 94 FTEs paid from Title V Partnership funds. There are approximately 80 FTEs working on MCH programs but paid through other federal grants. In addition, BFHN employs 14 parents of children and youth with special health needs for the EI Parent Leadership Project, Family TIES, and Universal Newborn Hearing Screening Program. Additional details about how parents, families, and youth are involved in Title V programming are provided in the State Action Plan, Family Partnerships, and Attachment 3.
The share of total BFHN staffing supported by Title V is slightly lower (54% versus 57% last year) due to successful efforts to cost-share staff with other federal discretionary grants. These totals and percentage distributions may continue to change during FY23 as efforts continue to bring the Title V budget into a more secure long-term equilibrium. The staff support may also be affected by the loss or reduction of federal discretionary grants, including ARPA funding.
Partnerships, Collaboration, and Coordination
MDPH builds, strengthens, and sustains partnerships with other organizations to better serve the MCH population and expand the capacity and reach of the Title V program. MDPH collaborates with families, public and private sector entities, federal, state and local government programs, clinical providers, academia, and public health organizations. The Family Partnerships section and Attachment 3 describe Title V’s partnership with families. Attachment 4 describes partnerships with external organizations and MCH programs within MDPH. These partnerships, collaboration, and coordination give depth and effectiveness to the MA Title V program and are integral to daily operations.
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