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 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. CDPH continues to assess new needs and emerging issues. We continue to adapt MCAH activities and programs to use virtual and hybrid 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. Despite a 21% decrease in pregnancy-related mortality among Black birthing people, from 57.7 deaths per 100,000 live births in 2015-2017 to 45.8 in 2018-2020, racial/ethnic disparities persist. The rate of pregnancy-related deaths for Black birthing people is 3.2 to 3.6 times greater than the rates for other racial/ethnic groups.[1]
2. Disparities in infant mortality by race/ethnicity are significant. California’s Black infants are dying at more than twice the rate of its White infants (9.3 per 1,000 infants vs. 3.1 per 1,000 infants in 2020).[2]
3. Increased concern for emotional and mental health of children, adolescents, and young adult mental well-being.[3]
4. Increased numbers of children experiencing violence at home, with higher rates of child abuse among children with special health care needs (CYSHCN).[4]
5. Increased rates of intimate partner violence, especially in households of CYSHCN. 63
6. Increased negative impact on caregiver emotional health (e.g., feelings of difficulty and nervousness/stress).63

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 2022, there were several funding expansions in CDPH/MCAH via State General Funds:

• Expansion of the Black Infant Health program (BIH)
• Expansion of the California Home Visiting Program (CHVP)
• New staffing to focus on 1) mental and behavioral health, 2) emergency preparedness for MCAH populations, and 3) workforce development via Future of Public Health funding
• New funding to address maternal morbidity and mortality (SB65 – the CA Momnibus Act)

There have been multiple other funding expansions and policy changes in the health care 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.

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 “CDPH/MCAH Interagency Partnerships and Collaborations.”

CDPH/MCAH experienced some recent changes in Title V leadership. The Assistant Division Chief, Romeo Amian, vacated his position in 2022. His position was filled by Artnecia Ramirez in 2022. The Division’s first Title V Program Coordinator, Keerthana Rajagopal, vacated her position in 2022 and the position was filled by Emily Zadeh in 2023. The MCAH Division Chief, Diane Lindsey, left her position in April 2023 and CDPH is currently working to fill behind her.

CDPH/MCAH has a Title V Management Team that leads all Title V-related reporting and application processes, needs assessment processes, and other key Title V-related efforts. The Title V Management Team includes the following staff:

• Artnecia Ramirez, Assistant Division Chief
• Emily Zadeh, Acting Title V Director
• Sarah Leff, Title V Director for CYSHCN
• Lissa Pressfield, Child and Adolescent Health Branch Chief
• Mary Bost, Maternal Mortality/Morbidity and Local MCAH Program Support Section Chief

We continue to maintain domain team structures and engage Branch Chiefs in Title V reporting and other coordination activities. CDPH/MCAH Branch Chiefs include the following staff:

• Karen Ramstrom, 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 reframing and restructuring Title V efforts 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 MCAH 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. Fortunately, the Maternal and Infant Health Branch Chief position was filled by Dr. Karen Ramstrom in 2022. The Pediatric Medical Officer position was filled by Dr. Jaclyn Pasko in 2023.

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

[1] California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, Pregnancy-Related Mortality Dashboard, Last Modified February 2023. http://go.cdph.ca.gov/Pregnancy-Related-Mortality-Dashboard

[2] California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, Infant Mortality Dashboard, Last Modified June 2023. http://go.cdph.ca.gov/Infant-Mortality-Dashboard

[3] Czeisler MÉ, Lane RI, Petrosky E, et al. MMWR Morb Mortal Wkly Rep. June 24–30, 2020.

[4] California Department of Public Health, Immunization Branch