The Arkansas Department of Health (ADH) conducted a training needs assessment among employees in January 2020. The findings revealed a need for the agency to increase high-quality training opportunities for staff on the following topics: community public health, outreach/health improvement, diversity, and health equity.  

In 2021, each MCH domain conducted virtual stakeholder meetings to report on Title V progress and reassess needs. The following paragraphs describe the findings.

To conduct a needs assessment for the Women’s Maternal Health Domain, the Title V MCH Program invited stakeholders to virtual meetings on November 2, 2021 and March 24, 2022. Participants included staff from the ADH Title V Program, the University of Arkansas for Medical Sciences (UAMS), the Arkansas Minority Health Commission and the Arkansas Department of Human Services’ (ADHS) Division of Medical Services. Participants were asked to select the identified priority needs from the 2020 Title V Women’s Maternal Health Needs Assessment they believed were still ongoing needs. The respondents selected one or more of the following priority needs:

• Access issues
• Medicaid expansion for postpartum coverage for one full year
• Mental health disorders

To conduct a needs assessment for the Perinatal Domain, the Title V Perinatal Domain invited stakeholders to a virtual meeting on December 9, 2021. Participants included staff of the ADH Title V Program, ADH Women, Infants, and Children (WIC), Arkansas Home Visiting Network, Arkansas Infant and Child Death Review, Arkansas Minority Health, Baptist Health Medical Center, and Arkansas Children’s Hospital (ACH). Stakeholders attended the interactive domain meeting, with IdeaBoardz being a well-liked method to gather anonymous real-time stakeholder input and feedback. Participants were asked how to help families served by existing programs. Collected feedback included the following:

• Provide education regarding next steps for follow-up care and connection to family-to-family support services
• Provide nutrition education and food benefits
• Think critically about ways to decrease burdens to service access
• Engage through families through information
• Provide more outreach to qualifying families
• Use local organizations to circulate information about programs, services, and events

Key program strategies to achieve MCH block grant objectives were reviewed with the stakeholders, and 100% of participants agreed the activities were achieving the desired results.

A Child and Adolescent Health Stakeholders meeting was held on October 7, 2021. A total of 33 evites were sent to partners from numerous Arkansas organizations: ACH, Arkansas Advocates for Family and Children, Arkansas Foundation for Medical Care, UAMS, WIC, and ADHS. All 17 participants (100%) ranked overweight and obesity as the top priority on the needs assessment. Activities including increased physical activities and additional nutrition education will be the focus for all school-age children. The second ranked priority is tobacco use including vaping (36%). Mental health education and screening (33%) emerged more strongly within the school-age children due to COVID-19 pandemic.

To conduct a needs assessment for the CSHCN Domain, the Title V CSHCN Program invited 78 stakeholders to a virtual meeting on October 13, 2021. Participants included CSHCN and ADH Title V staff, First Connections/Early Intervention, pediatricians, Arkansas Disability Coalition’s Family 2 Family, Centers for Exceptional Families, ADE’s Early Childhood Special Education, Arkansas Transition Services, the Arkansas Chapter of the American Academy of Pediatrics, and ACH. Thirty-one stakeholders attended the interactive domain meeting, with IdeaBoardz used to gather feedback. Participants were asked to select the identified priority needs from the 2020 Title V CSHCN Needs Assessment they believed were ongoing needs. Twenty-nine respondents selected one or more of the following priority needs:

• Understanding, financing, accessing, and navigating the health care system including Medicaid — 79% (selected by 23 out of 29 attendees)
• Finding respite care — 52% (selected by 15 attendees)
• Transportation — 52% (selected by 15 attendees)
• Accessing specialists and services — 48% (selected by 14 attendees)
• Technology issues with Internet access and computer use — 31% (selected by 9 attendees)

Key program strategies to achieve block grant objectives were reviewed with the stakeholders, and 100% agreed the activities were achieving the desired results.

Arkansas’s Title V Partnerships and Collaborations

Arkansas’s Title V CSHCN Program is housed in the ADHS Division of Developmental Disabilities (DDS). The year closed with 24 full-time employees, including a parent consultant, a medical records supervisor, one extra-help position, three area managers, and one nurse manager. One registered nurse retired in February 2021, one in August, and another at the end of 2021, leaving 10 registered nurses on staff to begin calendar year 2022. At the close of 2021, 11 nurses and CSHCN staff were stationed in some of the 13 community-based offices located in Huntsville, Berryville, Fort Smith, Mena, Prescott, Hope, Mountain View, Little Rock, North Little Rock, Pocahontas, Harrisburg, Jonesboro, and Marshall.

UAMS is a centralized point of referral for all medically complicated patients and provides medical and health education for the entire state. Except for communities on the eastern border that depend on the city of Memphis, Tennessee, all state communities relate to UAMS and Little Rock hospitals as sources of highly specialized medical care. UAMS's regional programs provide family medicine residency training in communities around the state. These programs have improved the distribution of PCPs. Family physicians provide most of the state's medical care and are by far the most numerous specialty practitioners in Arkansas. Specialists in obstetrics, pediatrics, internal medicine, surgery, and others have practices in the more urban communities.

The MCH program continually works with partners to meet the health care needs of Arkansans. Changes are often driven by the planning of the larger institutions and agencies. An example is the partnership with ACH. The ADH partners with ACH to provide home visiting services statewide and through other programs addressing teen suicide, injury prevention, Infant and Child Death Review (ICDR), infant hearing, and newborn screening.

A third ACH satellite clinic is now open in Springdale in Northwest Arkansas. The clinic is in the fastest growing area of the state and allows more CSHCN access to pediatric specialty care. As part of this partnership, MCH plays a significant role in ACH’s community health needs assessment and the Natural Wonders Partnership Council.

The 83 general hospitals in the state provide the bulk of in-patient care. The ADH works closely with these local providers to ensure that standards of care are met. Apart from this agency regulatory relationship, the ADH also partners with the Arkansas Hospital Association (AHA) on issues of common interest at the systems level, including the development of the breastfeeding toolkit for hospital use, the state’s Infant Mortality Collaborative Improvement and Innovation Network initiatives, and Arkansas’s Maternal and Perinatal Quality Outcomes Review Committee.

The MCH program and Medicaid work together on multiple projects, including management of high-risk pregnancies, teen pregnancy, promoting the use of long-acting reversible contraceptives, providing colposcopies, and data sharing. The formal agreement between Medicaid and MCH is a Memorandum of Understanding (MOU) between the ADH and ADHS. 

Changes in Organizational Structure and Leadership

Arkansas’s Secretary of Health, Dr. José Romero, announced in April 2022 that he had accepted a position with the Centers for Disease Control and Prevention (CDC). Dr. Jennifer Dillaha now serves as Director of the Arkansas Department of Health, and Renee Mallory serves as Interim Secretary of Health.

ADH Title V MCH Leadership:       

 ADHS Title V Leadership:
 

Emerging Public Health Issues

The most prominent public health issue in 2021 was the COVID-19 pandemic. The ADH was the lead agency in responding with information, frequently updated guidance, and regulations, vaccine distribution, investigation, and tracking. Details regarding COVID-19 in Arkansas can be found on the ADH website at COVID-19 Arkansas Department of Health.

Maternal mortality is an area of increased focus in Arkansas. In the 2021 Arkansas Maternal Mortality Review Committee’s (AMMRC) Annual Report, the AMMRC recommends extending Arkansas Medicaid maternal coverage from the current coverage of 60 days postpartum to one year postpartum. The committee’s review found that nearly half (47%) of pregnancy-associated deaths in Arkansas in 2021 occurred between 43 days and one year after delivery.