Needs Assessment Update

The South Dakota MCH and CYSHCN Programs completed their statewide five-year needs assessment in May 2020 but continue to carry out ongoing needs assessment activities.

Ongoing Data Collection and Needs Assessment Activities

As part of the ongoing needs assessment, the Office of Child and Family Services (OCFS) data team compiles the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children needs assessments. This WIC needs assessment is completed yearly in the community health offices statewide, and results were looked at collectively over the last year to identify statewide needs, assets, and weaknesses.  Strengths and weaknesses were identified, but more importantly, the need to improve the process and utilization of these needs assessments was recognized. This process led to the development of the Strategic Community Outreach and Outcomes Plan (SCOOP), being implemented in the community health offices statewide.

The Sanford Patient Navigation Program surveys families of children with special healthcare needs as well as their affiliated professionals to gain ongoing perspective of the needs faced by this population and the professionals that provide services to them. This information is used by the CYSHCN Program to continue shaping the Patient Navigation Program to fill gaps in services and improve outcomes for these children and their families. In 2022, the program began to evaluate the impact of adding a nurse practitioner to the program on health outcomes for patients as well as the mental health of their caregivers. Post surveys were completed in August 2022 and presented a new challenge in program evaluation. As the program grows and evolves, participation has become more fluid, making it difficult to capture participant responses as a cohort, as some had been in the program much longer than others.  In addition, the level of involvement of participants is also becoming more fluid as the program grows and services are tailored to meet the needs of each individual patient. The program is also seeing a new demand for cost-savings data as we look for ways to make the program financially sustainable long-term. Following the second cohort surveys, the decision was made to move away from surveys, and conduct final, in-person interviews of no more than twelve volunteer families who had been in the program a minimum of one year. The interviews will take place in spring 2023. Following completion of the interviews, a final report on family perceptions will be provided. The program will continue to collect data through the Care Coordination Management Tool filled out by the program’s care team to document day to day services provided and outcomes achieved through these services.

The South Dakota Newborn Screening Advisory Committee provides support and recommendations to the South Dakota Department of Health (SD DOH) Newborn Screening Program regarding programmatic decisions. The group convenes on an annual basis to receive updates on the status of the newborn screening program and to discuss the addition of new disorders to the South Dakota panel of disorders. The advisory committee consists of newborn screening stakeholders and partners, including pediatric specialists, laboratory personnel, nurses, pediatricians, and family and community members interested in learning about newborn screening. In 2023, a need was recognized to create a formal process to nominate new conditions to be added to the state’s Newborn Screening panel. The Newborn Screening Coordinator worked with other states and the SD DOH Communications Team to create an online form that can be used to nominate a condition for addition to the panel. A subcommittee is also being formed to review nominations and recommend or deny a nomination based on established criteria. The subcommittee has representation from medical and laboratory professionals and specialists, Medicaid, Department of Health, Statewide Family Engagement Center Birth to Five pillar, and parent representatives.

South Dakota DOH began reviewing child deaths from age 1 up to age 13 in 2020. Prior to this, only post birth hospitalization infant deaths (all cause, all manner) were reviewed statewide.  Child Death Review’s (CDR) two multidisciplinary teams located on the east and west side of the state use a common data collection tool, the National Center for Fatality Review and Prevention’s Case Reporting System. Findings, including risk and protective factors and Social Determinants of Health (SDoH) are documented for each death reviewed which inform upstream prevention recommendations.  CDR data is shared with state partners and disseminated within their networks.

The SD DOH formed a Maternal Mortality Review Committee (MMRC) in 2021 to review maternal death cases and determine leading causes of maternal mortality in South Dakota. A maternal mortality abstractor was hired and has access to the necessary medical records from the three major health systems in the state. In addition, the abstractor can analyze data collected from the health information exchange, vital records, WIC, and Medicaid. The first case review meeting was held in October 2021. The SD MMRC is also participating in the Texas Discrimination and Social Determinants of Health (DASH) pilot study to assess discrimination and social determinants of health as a factor in maternal deaths.

The SD DOH launched a new electronic health record (EHR) in January 2022. The record hosts data from family planning, community health, and nurse home visiting. Additional data linkages with WIC data, the Health Information Exchange, and the SD Immunization Registry will also be possible through this EHR. The MCH epi has been involved with the creation of questions for the EHR that address social determinants of health.

In early 2023, following an RFP process, the OCFS contracted SLM Consulting, LLC to coordinate the 2025 MCH statewide needs assessment. SLM Consulting is a public health consulting firm located in Sioux Falls, SD and has experience working with OCFS and co-lead the 2020 MCH needs assessment. Through initial conversations with SLM Consulting, the MCH Program has laid out a broad timeline for the 2025 needs assessment. Planning will take place in late summer/early fall 2023, full implementation in 2024, and data analysis/priority setting in 2025.

Noted Changes in Health Status

In May 2023, the Public Health Emergency relating to the Covid 19 pandemic ended. MCH staff had been mostly pulled from Covid work in mid-2022 due to declining Covid cases and data collection and monitoring was turned over to Infectious Disease staff as DOH Epidemiology. The DOH website page dedicated to Covid has since been paired down and the dashboard is now updated monthly as opposed to weekly.  The covid.sd.gov page was removed entirely.

The SD Department of Health continues to monitor the state’s severe rise in syphilis cases. As of spring 2023, syphilis cases have increased over 1713% above the five-year median. Congenital syphilis cases are also on the rise in South Dakota, increasing 2200% over the five-year median.  Due to the sharp rise, the MCH Program has been partnering with the DOH Office of Disease Prevention to launch a media campaign to raise awareness of congenital syphilis and direct the public to available resources. The campaign is geared toward both males and females aged 25-39, with an emphasis on women of child-bearing age. Efforts are focused on the counties with the highest numbers of cases and include a mix of social media, radio, and signage.

South Dakota has also seen a sharp rise in suicide cases. Provisional data from South Dakota Suicide Prevention (SDSP) shows suicides in the state have been on the rise since 2011, with 2021 showing the highest recorded number of suicides since tracking has been in place. SDSP data shows suicide is the leading cause of death in SD among ages 10 to 19. The data also shows the SD American Indian suicide rate is 2.5 times higher than the SD White suicide rate for 2011-2020. The MCH adolescent domain has made mental health and suicide prevention one of their top priorities. The adolescent domain leader leads a workgroup comprised of stakeholders in the areas of medical consultation, Helpline Center, Department of Social Services, DOH Injury Prevention, University of South Dakota, and Lutheran Social Services. The group promotes evidence-based programs and practices that increase protection from suicide risk, promote positive youth development, and develop and disseminate equitable and accessible Suicide Prevention education material, resources, and messaging. The women’s domain is also focused on mental health and substance misuse and provides depression screening in the community health offices.

The 2022 infant formula shortage brought leadership from WIC, MCH, and Community Health together weekly to discuss changes and updates to the situation. The WIC team also created an emergency channel on Microsoft Teams to communicate updates in real time. The community health staff was integral in keeping leadership updated on what they were hearing from the families in the clinic and communicated the needs expressed by families as well as locations where families were able to locate formula throughout the shortage. They also communicated misinformation they were hearing in the clinic, prompting the DOH to create social media posts to address misunderstandings and provide accurate information.

Title V Program Capacity

The MCH Title V Program has made recent efforts to expand internal staffing, so each domain leader can focus on one domain population. The goal of this change is to expand the capacity of each domain leader to address MCH priorities and emerging health issues for their domain through strategic partnerships, networking, and oversight. These efforts have continued into 2023 as the program continually reviews and evaluates staffing capacity. There are currently vacancies within the Title V Program, including key leadership vacancies in the women’s health and child health domains. The MCH and CYSHCN Directors have been working on a restructure to fill these positions, as well as create new positions to increase capacity to address emerging needs as they arise. 

A noted change in SD’s broader MCH service delivery began in November of 2019, when the Office of Child and Family Services (OCFS) embarked on a process to assess its structure and staffing to identify opportunities to better meet client needs and deliver services more efficiently across the state. This includes gaining a better understanding of the public health services and supports most needed in communities across South Dakota and identifying and evaluating the viability of current service delivery models. To guide this project, OCFS worked with several consultants from Health Management Associates (HMA), and a project team comprised of OCFS and division leadership, central office staff members, and regional manager representatives.  As a result of this assessment, several changes were proposed.

Implementation of the proposed changes to the organization and structure of the OCFS began in 2021. These changes include moving from a seven-region structure for local services to a four-region structure. Within each region, a leadership team was assembled including nurse, dietitian and billing/operations leads who work collaboratively with the Public Health Manager to implement both OCFS and region wide strategies.

The goal of this reorganization was to:

• Deliver the right care at the right time - staff each working at highest scope of practice
• Build capacity and autonomy for regional and local responsiveness
• Prioritize and lean into the “gap-filling” function of OCFS
• Reduce overall costs of service delivery model
• Develop and commit to an OCFS-wide long-term strategy with the tribes, and other specific populations, to address health inequities

Following implementation of the new structure, challenges with service delivery continued to be noted across the state. OCFS leadership worked to identify the context of these challenges by reviewing data, looking at client feedback, and asking for staff perspective in meetings and through an OCFS staff survey. Primary challenges noted were staff workload, lack of adequate communication, and need for additional education, training, and development opportunities.

To address the ongoing challenges, the decision was made in 2023 to redesign the WIC and Community Health Services (CHS) to provide for adequate staffing and supervision, by removing WIC service delivery staff from CHS and relocating them under WIC central leadership. Previously, nurses were providing both WIC services and CHS services.  The two programs will continue to share spaces but will carry out different duties and report to their respective leadership. This change allows CHS staff to focus on public health nursing, expand current services, and embrace new opportunities as they arise. The OCFS restructure will move toward a hub and spoke model for both WIC and CHS that maximizes resources at 11 hubs in the state and allows for designated areas of outreach using mobile units.

The CHS offices will focus on a case management model, reaching eligible populations for services, allowing for flexibility in how work is conducted, and enabling accountability for performance. The four regions created in the previous restructure will be condensed to three service areas, Northeast, Southeast, and West-Central. Core services provided will be MCH, immunizations, and school health services. This change allows the MCH program to provide increased training and development opportunities to CHS staff, as well as incorporate new services for the MCH population.

Title V Partnerships and Collaborations
 

Title V programs have built strong partnerships both within and outside the DOH to collaborate on key programs and initiatives that impact priority populations. The physical presence of the OCFS 74 community health offices serves as a major asset throughout the state. These offices carry out coordinated programs, services, and outreach that are funded through a variety of federal, state, and local public health funding streams. These offices serve as the “local” health department and in many rural and underserved communities this “staying” power builds trust and partnerships.

Opportunities to strengthen partnerships lie with three groups: community-based and faith-based organizations that are directly supporting priority populations; nine American Indian tribes within the borders of SD; and family engagement organizations to expand the reach of Title V investments which aim to improve health and wellbeing of SD families. Strategies will be developed and prioritized in the action plans for the coming year to sustain or cultivate engagement. Specific health equity partnership development strategies will be assessed on utility and feasibility.

Throughout the needs assessment process, 27 long standing partners were identified representing all sectors including tribal health systems and programs. Most of these partnerships are defined as “formal” meaning they have a contract, MOU or historical working relationship with the DOH. The MCH team also identified 17 emerging partners, the vast majority of whom were informal (meaning non-typical) partners that represent emerging needs. These partners tended to represent the infants, children, and adolescent domains.

Maternal Child Health Bureau Investments: Bright Start Home Visitation Program includes OCFS as both grantee and implementing agency for the MIECHV program. Bright Start uses the Nurse Family Partnership (NFP) model in fifteen sites covering all 66 counties in SD. The Bright Start Home Visitation Project Director will be actively engaged with the workgroup implementing strategies under NPM 1 and NPM 5.

The State Systems Development Initiative (SSDI) grant has awarded a new five year grant cycle in 2022 to SD that coordinates with and directly supports the work of the MCH Title V Block Grant. SD’s SSDI grant supports an epidemiologist focused on maternal and child health, the South Dakota PRAMS, and facilitation of the identified SPM to better coordinate and disseminate data.

Other Federal Investments Administered in the DOH OCFS: South Dakota MCH populations are also supported, and SD’s MCH Block Grant reach is expanded through additional grants within the broader OCFS.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves participants through 74 community health offices across the state. The program works cooperatively with the Cheyenne River, Rosebud Sioux and Standing Rock tribal reservations to ensure every county in South Dakota has access to WIC services. From October 2021 to September 2022, WIC served an average of 13,736 participants per month

Rape Prevention Education Grant (RPE) aims to decrease sexual violence by funding community-based organizations who use the public health approach to decrease sexual violence risk factors and increase sexual violence protective factors. The Sexual Violence Project Specialist for the South Dakota Network Against Family Violence and Sexual Assault will engage as an active partner on SPM 1 workgroup.

Office for Victims of Crime Rural Sexual Assault Nurse Examiners (SANE) is utilized statewide to increase the opportunity for victims of sexual assault across rural SD to receive services in their communities and increase awareness of law enforcement services. The project director for both RPE and SANE grants will be actively engaged on the work group implementing strategies under NPM 1 and SPM 1.

State Personal Responsibility Education Program (PREP) is delivered through a partnership with Lutheran Social Services. PREP is being utilized statewide to educate young people on abstinence and use of contraception to prevent pregnancy and sexually transmitted infections, including HIV/AIDS. SD’s program goals are to lower both Chlamydia rates and teen birth rates among young people. The LSS Project Director for PREP will engage as an active partner on the SPM 1 workgroup.

Title V Sexual Risk Avoidance Education (SRAE) is administered through a partnership with LSS and Boys & Girls Club, SRAE is utilized statewide to educate young people on sexual risk avoidance and teaches youth to voluntarily refrain from non-marital sexual activity. The target population is 10 – 13-year-old who are considered vulnerable youth. The goals of this program are to lower both Chlamydia rates and teen birth rates among young people in SD. The LSS Project Director and Boys and Girls Club Program Coordinator will engage as an active partner on the SPM 1 workgroup.

SD Family Planning Program (SDFP) delivers statewide services through a network of 21 sites and provides services to low-income individuals to increase healthy maternal/infant outcomes. The Title X Project Director will be actively engaged with the workgroup implementing strategies under NPM 1.

Major Health Systems: Sanford Health, Avera and Monument Health, partner with MCH program staff to provide a variety of services including coordinated case management services and genetic counseling. Sanford Health provides the one children’s specialty clinic in the state and works closely with the State’s Newborn Screening Coordinator to coordinate newborn screening follow up and case management services. These health systems have representation on workgroup implementing strategies to address NPM 5 and NPM 11.

Other State Government Agencies: South Dakota Department of Social Services DOH has an MOU with SD Medicaid to provide direct healthcare services and modified case management within the 74 community health offices. The DOH and Medicaid have also established an interagency collaborative over the last year. The focus of this partnership is across all MCH domains. DSS Behavioral Health and the DOH began working together to merge resources on suicide prevention and promoting DSS’ youth suicide prevention campaign - BeThe1SD. They will engage as a new active partner on NPM 7.2 workgroup. South Dakota’s Office of Emergency Management partners with DOH’s Office of Public Health Preparedness and Response (PHPR) and OCFS in providing emergency response efforts across the state. OCFS field staff in community health offices are assigned to a Point of Dispensing (POD) site to dispense emergency pharmaceuticals in the event of a public health emergency. 

Other Programs Within the DOH:  Child Death Review (CDR) Through a Memorandum of Agreement (MOA) between DOH and member agencies, volunteer professionals across the state conduct CDR. Two regional teams, East and West River, are made up of members from law enforcement, DSS Child Protection Services, public health, hospital staff (Pediatricians, DNPs, nurses, and social workers) Emergency Medical Services (EMS), Forensic Pathology, Division of Criminal Investigation (DCI), FBI, Bureau of Indian Affairs (BIA), Indian Health System, and the States Attorney’s offices. DOH’s Office of Health Statistics and Vital Records provides data for the review process. CDR is funded exclusively by MCH dollars.

Tribes, Tribal Organization and Urban Indian Organization: Maternal and child health services are provided in a variety of ways. A few of those include partnerships with DOH; dedicated staff within a tribe; and through a partnership with the Great Plains Tribal Leaders Health Board. Tribal MCH Programs are informal, but long-standing. Partnerships with Rosebud IHS and Tribal MCH and Cheyenne River Sioux Tribal MCH are in place to provide safe sleep environments to American Indian families in need each year. The needs assessment team also noted an emerging partnership with the Sisseton Wahpeton Oyate MCH staff, who will serve on the workgroup addressing NPM 1.

Great Plains Tribal Leaders Health Board (GPTLHB) advocates for its constituents to have access to health resources available in the areas of research, education, assistance, prevention, and outreach. This organization will be part of the workgroup addressing SPM 3.

Public Health and Health Professional Education Programs/Universities: SDSU Population Health Center is a formal, long-standing partner that provides technical assistance to the MCH team to develop, monitor and evaluate the program’s overall objectives. They assisted with the development, execution, and evaluation of the Needs Assessment and will continue to provide technical expertise but will also serve on the workgroup that will direct State Performance Measure 3.

USD Sanford School of Medicine (SSOM) and the MCH program have fostered a partnership as a formal and emerging partner who now leads the state’s Early Hearing Detection and Intervention collaborative. Previously the DOH led this grant. USD also houses the state’s medical school and along with SDSU jointly houses the state’s only public health program.

Community-Based Organizations: The HelpLine Center is a nonprofit organization that offers youth suicide prevention education and activities throughout the state. With this partnership the following activities are offered: 24/7 statewide crisis line – updating the database of mental health providers and emergency services in order to provide quality referrals. They will engage as an active partner on the NPM 7.2 workgroup.

Operationalization of Needs Assessment Findings

The state’s MCH leaders have taken steps to operationalize its five-year needs assessment process and findings. The seven priority needs identified in the five-year needs assessment and their corresponding NPMs and SPMs are listed in the table below.

*SPM 2 has since been replaced with SPM 3.

The MCH domain leaders have formed diverse workgroups that meet quarterly to inform and help carry out the activities in the domain action plans. Domain leaders also track their collaboration efforts utilizing the Wilder Collaboration Index and carry out ongoing evaluations of their programs. They continue to evaluate the needs of the populations they serve through surveys and data analysis.

Organizational Structure and Leadership

The OCFS provides leadership and technical assistance to assure systems are promoting the health and well-being of women of reproductive age, infants, children, and youth, including those with special health care needs and their families. OCFS provides oversite to state-employed nurses, nutrition educators and dietitians for the provision of public health services in the state.  The OCFS recently underwent a major change in leadership. The OCFS Administrator, MCH Director, Community Health Administrator, MCH Epidemiologist, and OCFS Business Operations Coordinator positions all changed hands in late 2022/early 2023. The MCH Child Domain position is currently vacant, and the women’s domain has an interim lead.

Katelyn Strasser, MPH, RN and former MCH Epidemiologist, became the OCFS Administrator in 2023. Katelyn has been with the DOH for 8 years. Samantha Hynes, MPH, MSW is the OCFS Assistant Administrator and MCH Director and has been with the DOH for 2 years. Whitney Brunner serves as the CYSHCN Director and MCH Assistant Program Director and has been with the DOH for 4 years. Other OCFS team members that work with MCH include the following:

• Rhonda Buntrock, OCFS Assistant Administrator- WIC Program Administrator
• Joel Arriolacolmenares, OCFS Assistant Administrator- Community Health Administrator
• Wade Huntington, OCFS Assistant Director of Operations
• Carrie Churchill, Bright Start Home Visiting Program Manager
• Bernadette Boes, Newborn Screening Coordinator
• Hope Kleine, South Dakota Family Planning (SDFP) Program Nurse Manager
• Nikki Krier, SDFP Nurse Consultant
• Jill Munger, MCH Nurse Consultant/ Child Death Review Coordinator, Infant domain lead
• Vacant, MCH Child Domain lead
• Sarah Barclay, MCH Adolescent Coordinator, RPE, SRAE, PREP
• Vacant, Prevention Services Manager, including Maternal Mortality and Infant/Child Mortality. This is a new/revised position.
• Amy Mattke, Pregnancy Care/Maternal Health Home, Interim MCH Women’s domain lead
• Tim Heath, Immunization Program
• Mark Gildemaster, Manager, Data and Statistics
• Fabricia Latterell, MCH Epidemiologist
• Isaac Snaza, OCFS Epidemiologist
• Caleb Van Wagoner, OCFS Health Informatics Analyst
• Tricia McNeely, OCFS Business Operations Coordinator
• EA Martin, SDSU contractor, MCH and home visiting epidemiology

The DOH contracts with an epidemiology team and has a designated MCH epidemiologist to continually analyze our available data and develop fact sheets/articles based on their findings.