Ongoing Needs Assessment Activities

 

Maternal Mortality Review Committee (MMRC)

The MMRC reviews all pregnancy-associated deaths occurring among Georgia residents to understand the causes of maternal mortality and identify actionable recommendations to prevent future deaths. The committee meets at least quarterly to review deaths and publishes data annually. A report on 2018-2020 data was released in 2023 and includes detailed information on pregnancy-related deaths.

Oral Health

The Basic Screening Survey (BSS) is used to obtain data on the oral health status, risk factors, and barriers to care and prevention services among kindergarten and third grade school children. The BSS was implemented during the 2022-2023 school year and the initial sample resulted in a total of 64 schools throughout Georgia in all geographic areas participating in the BSS. Results will be available within 6 to 8 months and will be used to update the 2016 3rd Grade BSS and Burden of Oral Health in Georgia Report.

 

Safe Sleep

To address the disconnect between prenatal intentions and actual safe infant sleep practices, the Safe Infant sleep program developed and tested a “booster session”, to be delivered three to five weeks after the infant is born. A safe sleep intervention that included coaching parents after the infant was born demonstrated feasibility and acceptability in helping to address challenges. The engagement of parents of newborns is a priority to assess information needs and determine what is most useful in helping parents and caregivers practice safe infant sleep.

 

Children’s Medical Services (CMS)

The CMS program developed and distributed a brief survey assessing the overall experience with services provided by the CMS program and to help determine what improvements in services and service delivery should be made. Survey responses were collected from parents/caregivers and young adults, 18 years of age and older, who have been enrolled in the CMS program for at least six months and who have engaged with their care coordinator for care coordination and/or specialty clinic services within the last six months.

 

Babies Can’t Wait (BCW)

Less than 15% of children eligible for Early Intervention (EI) services access intervention services and minority groups disproportionately enroll in EI. A University of Georgia interdisciplinary team has begun to implement an environmental scan of Georgia’s BCW system to better understand the patterns of usage across regions and demographics, barriers that interfere with enrollment, and supportive factors that facilitate enrollment. Currently, six focus groups, seven interviews, and 18 surveys have been completed.

 

Changes in the Health Status and Needs of the MCH Population

 

Maternal/Women’s Health

Maternal Mortality: The MMRC found that from 2018-2020, there were 48.6 pregnancy-related deaths per 100,000 live births among Non-Hispanic (NH) Black women compared to the 22.7 pregnancy-related deaths per 100,000 live births among NH White women. The MMRC determined all the pregnancy-related deaths attributed to hemorrhage, mental health conditions, cardiomyopathy, cardiovascular and coronary conditions, and preeclampsia and eclampsia to be preventable.

 

Well-Women Visits: The 2021 Behavioral Risk Factor Surveillance System (BRFSS) estimated approximately 72.5% of women, ages 18 to 44 years, reported visiting a doctor for a routine checkup in the past year. According to the 2017-2021 Pregnancy Risk Assessment Monitoring System (PRAMS), 59% of Georgian women of reproductive age (WRA) had seen a doctor in the past 12 months. The percentage of WRA reporting seeing a doctor in the past 12 months was greatest among NH White women and women with health insurance coverage.

 

Family Planning: From 2017-2021, PRAMS data show the percentage of women with a recent live birth who reported an unintended pregnancy has remained relatively constant around 7%. Among women who were not trying to get pregnant when they became pregnant, a plurality of women (47%) reported using low-efficacy birth control methods, followed by common methods. Use of high-efficacy birth control methods was least commonly reported among women who were trying not to get pregnant when they conceived.

 

Postpartum Care: Available PRAMS data from 2017-2021 show the percentage of women who received a postpartum visit with a health care provider remained relatively constant around 90%. Among women who did not receive a postpartum visit, the most reported topics discussed were birth control methods for use after birth (90%), mental health screening (86%), healthy habits (diet and exercise, 62%), and smoking cigarettes (64%).

 

Mental Health Evidence-Based Screenings: During the three months before pregnancy, 11% of women with a recent live birth from 2017-2021 reported having depression. Among women who reported having depression during the three months before pregnancy, 40% reported having a health care visit for depression or anxiety in the 12 months before getting pregnant. From 2017-2021, the percentage of women reported feeling down, depressed, or hopeless since their new baby was born increased by 13%. Among women whose baby was alive and living with them, 6.4% reported using counseling services for depression or anxiety since their new baby was born.

 

Perinatal/Infant Health

Infant Mortality: DPH’s standardized health data repository, Online Analytical Statistical Information System (OASIS), indicates the infant mortality rate was 6.3 per 1,000 live births in 2022.

 

Breastfeeding: In the 2018 National Immunization Survey (NIS) approximately 80.9% of infants were reported by a parent to have ever been breastfed, whole only 24.3% of infants were reported by a parent to have been breastfed exclusively through six months. The 2017-2021 PRAMS show that among women with a recent live birth, 82% ever reported breastfeeding or pumping breastmilk to feed their infant. At the time of the PRAMS survey (2-6 months after birth), approximately 42% of those women reported they were currently breastfeeding.

 

Safe Sleep Practices: According to the 2020 PRAMS data, 71.3% of mothers reported they most often place their baby to sleep on their back only. A quarter of the mothers (25.5%) reported that their baby always/often slept alone, usually in a crib, bassinet, or pack and play. Approximately 37.4% of women report their baby did not usually sleep with blankets, toys, cushions, pillows, or crib bumper pads.

 

Evidence-Based Home Visiting Programs: According to PRAMS, 7% of Georgia women with a recent live birth from 2017-2021 reported receiving a home visit from a health care worker since their infant was born to learn how to care for themselves and/or their new baby.

 

Congenital Syphilis: The Centers for Disease Control and Prevention’s (CDC) 2021 Sexually Transmitted Disease (STD) Surveillance Report provided trends in STDS to describe current epidemiology of nationally notifiable STDs. In 2021, the number of reported congenital syphilis cases was 93, with a rate of 75.0 per 100,000. This rate is comparable to the national congenital syphilis rate of 77.9 cases per 100,000 live births (a 30.5% increase relative to 2020).

 

Child Health

Developmental Screenings: According to 2020/21 National Survey of Children’s Health (NSCH), approximately 33.1% of children, ages 9 through 35 months, received a developmental screening using a parent-completed screening tool.

 

Medical Home: In 2020-2021, NSCH estimated half (49.2%) of children without special health care needs (non-CSHCN), ages zero through 17, received care that met the criteria for having a medical home. Non-Hispanic Black children (41.8%) were less likely to report having care that met the criteria for having a medical home than NH White children (61.8%).

 

Childhood Immunization Rates:  The 2022 Georgia Immunization Report for Children, showed Georgia’s immunization coverage for the complete 4:3:1:3:3:1:4 series was 75.5%. The 2021 Georgia Immunization Report for Adolescents aged 13 through 17 reported Georgia’s overall immunization coverage for the complete 1:3:2:3:2:1 series was 28.3%. By individual vaccines, Hepatitis B had the highest coverage at 91.4% and Human papillomavirus (HPV) for all genders was lowest at 38.2%.

 

Physical Activity: The 2020/21 NSCH showed 42.8% of children, ages six to 11, were physically active at least 60 minutes per day for one to three days per week, 23.3% were physically active at least 60 minutes per day for four to six days per week, and 27.0% were physically active for 60 minutes every day.

 

Adolescent Health

Bullying: In the 2020/21 NSCH, 8.9% of adolescents, ages 12 to 17, were reported by a parent or guardian to have bullied others. The 2020/21 NSCH estimated approximately 26.5% of adolescents, ages 12 to 17, were reported by a parent or guardian to have bullied, picked on, or excluded by other children. According to the 2019 High School Youth Risk Behavior Survey (YRBS), 14.5% of students reported having been bullied on school property in the last 12 months before taking the survey. In the same survey, about one in ten (10.6%) of public high school students reported having been electronically bullied (i.e., through texting, Instagram, Facebook, other social media) during the 12 months before the survey.

 

Suicide: The 2019 High School YRBS reported 18.5% of Georgia high school students seriously considered attempting suicide during the 12 months before the survey. Over one in ten high school students reported that in the 12 months before the survey, they (1) planned about how they would attempt suicide, 12.4%, and (2) attempted suicide, 11.8%.

 

Transition to Adult Health Care: According to the 2020/21 NSCH, 14.2% of adolescents without special health care needs, ages 12 to 17, received services necessary to make transitions to adult health care. Parents and guardian of NH White adolescents (16.9%), ages 12 to 17, were more likely to report they received services necessary to make transitions to adult health care than NH Black adolescents (14.7%).

 

Physical Activity: The 2020/21 NSCH showed 39.4% of adolescents, ages 12 to 17, were physically active at least 60 minutes per day for one to three days per week, 26.1% were physically active at least 60 minutes per day for four to six days per week, and 16.8% were physically active for 60 minutes every day.

 

Children and Youth with Special Health Care Needs

Medical Home: In 2020-2021, NSCH estimated half (48.5%) of children special health care needs (CSHCN), ages zero through 17, received care that met the criteria for having a medical home. NH White CSHCN (50.7%) were slightly more likely to report having care that met the criteria for having a medical home than NH Black CSHCN (48.0%).

 

Transition to Adult Health Care: According to the 2020/21 NSCH, approximately 14.9% of adolescents with special health care needs, ages 12 to 17, received services necessary to make transitions to adult health care. Parents and guardians of NH White adolescents with special health care needs (18.0%) were twice as likely to report they received services necessary to make transitions to adult health care than NH Black adolescents with special health care needs (8.3%).

 

Access to Specialty Care: The 2020/21 NSCH estimated 28.2% of CSHCN and 7.1% of non-CSHCN, ages zero to 17, received care from a specialist doctor (other than a mental health professional) during the past 12 months. Approximately 4.6% of CSHCN, ages zero to 17, needed to see a specialist doctor, but did not receive care. Over a quarter of CSHCN (27.2%), ages three to 17, received treatment or counseling from a mental health professional in the past 12 months.

 

Care Coordination Services: In 2020/21, NSCH reported CSHCN (50.2%) ages zero to 17, were more likely to receive needed health care coordination during the past 12 months compared to non-CSHCN (31.5%). The reported percentage of CSHCN (23.5%) who needed but did not receive care coordination was also higher when compared to non-CSHCN (10%).

 

Cross-Cutting

Dental Visits During Pregnancy: PRAMS showed approximately 34% of women with a recent live birth from 2017-2021 had their teeth cleaned by a dentist or dental hygienist in the 12 months before pregnancy. Thirty-six percent of women reported having their teeth cleaned during their pregnancy. About nine in ten women reported they knew it was important to care for their teeth and gums during pregnancy, while 75% reported having insurance to cover dental care during their pregnancy.

 

Childhood Dental Visits: According to the 2020/21 NSCH, 72.8% of non-CSHCN children ages one to 17, received a preventive dental visit in the past year and 80.4% of CSHCN children ages one to 17, received a preventive dental visit in the past year.

 

Smoking During Pregnancy: The 2017-2021 PRAMS indicated 4.5% of women reported smoking cigarettes and 1.5% reported using electronic nicotine delivery systems (ENDS) during the last three months of pregnancy. Among women who reported smoking during the three months before pregnancy, the most common reasons that make quitting difficult were cravings for a cigarette (60%), loss of a way to handle stress (53%), others smoking around them (53%), and worsening anxiety (38%). During pregnancy, women who smoked in the past two year were more likely to report allowing smoking inside their home than non-smokers.

 

Tobacco, or Nicotine, Use Among Children and Adolescents: The Youth Tobacco Survey (YTS) showed one in four Georgia high school students reported ever trying cigarette smoking. In 2017, 8% of high school students reported current tobacco use, 13% reported current electronic cigarette use, 8% reported use of smokeless tobacco products, and 14% reported cigar use.

 

Title V Program Capacity

 

Organizational Structure

DPH is the lead agency in preventing disease, injury and disability; promoting health and wellbeing; and preparing for and responding to disasters from a public health perspective. The DPH Commissioner and State Health Officer reports directly to the Governor. The Director of the Division of Women, Children, and Nursing Services reports to the Commissioner and State Health Officer and is the Title V Director. The Division of Women, Children, and Nursing Services has primarily responsibility for the administration of the Title V Block Grant and includes the Office of Child Health, the Office of Women’s Health, the Office of Nursing, Oral Health, Telemedicine, and the Title V Block Grant. The Office of Child Health contains Child Health Home Visiting, Babies Can’t Wait, Child Health Referral and Screening Programs, and Children’s Medical Services, the state’s CYSHCN program. The Office of Women’s Health includes the Maternal Mortality Review Committee, Maternal Mental Health, Levels of Maternal and Neonatal Care, Regional Perinatal System, Georgia Perinatal Quality Collaborative, Breastfeeding, Breast and Cervical Cancer Prevention, and Perinatal Case Management. The Title V program sets program policy and monitors compliance with state and federal laws and rules and offers technical assistance to staff in district public health departments regarding Title V programs. The Division of Women, Children, and Nursing Services partners with other DPH programs that have responsibilities for addressing Title V priorities, including Epidemiology, Injury Prevention Program, Chronic Disease, Immunization, Infectious Disease, Public Health Pharmacy, the Public Health Laboratory, and Refugee Health.

 

DPH began a review of its programs and services during FY 2023 to realign the department structure with agency priorities following several years when the focus of the agency had been largely on the COVID-19 pandemic. DPH Leadership implemented a plan to restructure the division for maternal and child health services to elevate those programs as priorities for the agency. The reorganization began in January 2023 and was completed at the end of March 2023 and resulted in the new Division of Women, Children, and Nursing Services. Child Health and Women’s Health services were combined into one division to increase collaboration and partnerships between these programs. Child Health was realigned to equally support priority programs including CYSHCN, home visiting, infant and child screening and referral programs, and early intervention.

 

Agency Capacity

 

Maternal/ Women’s Health

The Office of Women’s Health implements a robust system of services for women of reproductive age. Women’s Health staff oversee the implementation of family planning services, cancer screenings, and HPV vaccines that occur in local public health districts and counties. Women’s Health staff also lead maternal mortality prevention programs, including the MMRC, Georgia Perinatal Quality Collaborative (GaPQC), Maternal Mental Health, Maternal Health ECHO, Levels of Maternal Care, and the Regional Perinatal System. Women’s Health Epidemiology supports data analysis for these programs. Data sources used are the MMRC, GaPQC data, PRAMS, Vital Records, BRFSS, and Family Planning program data. MCH and Women’s Health have active partnerships with hospitals, private practice physicians, academic institutes, cancer and HIV screening agencies, the Chronic Disease Prevention Section, Healthy Mothers Healthy Babies Coalition of Georgia (HMHBGA), Postpartum Support International (PSI), Georgia Obstetrical and Gynecological Society (GOGS), March of Dimes (MoD), the Alliance for Innovation on Maternal Health (AIM) Community Care Initiative, and the Maternal Health Innovation program to ensure a comprehensive system of services for women of reproductive age in Georgia.

 

Perinatal Health

Staff from multiple DPH sections support programs that aim to improve infant health and prevent infant mortality. Women’s Health staff lead Levels of Neonatal Care, the Regional Perinatal System, GaPQC initiatives related to infant health, and breastfeeding initiatives. Child Health staff lead the Newborn Screening program. Title V also funds staff in the Injury Prevention Program that work on safe sleep initiatives and epidemiology staff to collect and analyze data on perinatal health. The primary data source used are PRAMS and Vital Records. Women’s Health, Child Health, and the Injury Prevention Program have active partnerships with RPCs, birthing facilities, private practice physicians, academic centers, Association of State and Territorial Health Officials (ASTHO), GOGS, HMHBGA, MoD, and WIC.

 

Child Health

The Title V program has established a coordinated system of services for children in Georgia. The Office of Child Health leads a system for developmental screenings and referrals that is implemented at the state, district, and local level. The Oral Health program promotes oral health among children. The Injury Prevention Program leads the Child Occupant Safety Project that aims to prevent motor vehicle crash deaths among children. Child Health utilizes the State Electronic Notifiable Disease Surveillance System (SendSS) and the Babies Information and Billing System (BIBS) to assess developmental screening data. To ensure comprehensive system of services among children, Child Health, Oral Health, and the Injury Prevention Program have active partnerships with the Chronic Disease Prevention Section, Department of Early Care and Learning (DECAL), Department of Education (DOE), academic institutions, Georgia Chapter of the American Academy of Pediatrics (GA-AAP), Georgia Academy of Family Physicians (GAFP), Marcus Autism, and Emory Autism Centers.

 

Adolescent Health

Title V funds the Injury Prevention Program to identify the prevalence, existing prevention programs, and legislation on bullying and facilitate improvements in bullying prevention efforts to schools that serve the target population. Data resources include the Georgia Student Health Survey and Preventing Adverse Childhood Experiences data map. Partners include the DPH Office of Whole Child Supports, Prevent Child Abuse Georgia, Essentials for Childhood, and Preventing Adverse Childhood Experiences Data to Action.

 

Children and Youth with Special Health Care Needs

Title V and other federal and state funds support several programs to provide services to Georgia’s CYSHCN. Children 1st acts as the access point for children with an identified special need. BCW provides services for children from birth to three. CMS is established and continues to provide on-going, comprehensive medical care for CYSHCN. CMS promotes access to specialty care, care coordination, transition to adulthood, and medical homes for CYSHCN. Epidemiologists support data collection for CMS and the primary data sources used are CMS quarterly reports, NSCH, and contractor monthly reports. The CYSHCN programs partner with academic centers, Parent to Parent of Georgia, GAFP, GA-AAP, health care providers, payers, and multiple community-based organizations.

 

Oral Health

Title V, CDC, state, and private-donated funds support Oral Health staff and oral health initiatives. The data sources used are PRAMS, NSCH, CMS, and the Third Grade and Head Start Basic Screening Surveys. MCH Epidemiology supports data analysis for Oral Health. To ensure a comprehensive oral health system of services, Oral Health has active partnerships with WIC, private practices, dental hygiene programs, academic institutes, schools, the Oral Health Coalition, and CDC.

 

Workforce Capacity

Title V has a robust workforce across all population domains. There are 35 FTE positions that are funded by Title V at the state-level. Other positions work in the Division of Women, Children, and Nursing Services and are funded by state or other federal funds.

 

Title V leadership is comprised of the following individuals:

 

Diane Durrence, APRN, MSN, MPH – Women, Children, and Nursing Services Division Director: The Division Director provides oversight for all programs in the Division of Women, Children and Nursing Services. In this role, the Division Director provides leadership and guidance to support DPH priorities across the Offices of Women’s Health, Child Health and Nursing including grant deliverables, budget actions, and reports.

 

Laura Layne, MSN, MPH, RN - Women’s Health Director: The Women’s Health Director is responsible for providing operational and programmatic support for Women’s Health programs and initiatives.

 

Kimberly Ross, MA - Child Health Director: The Child Health Director is responsible for providing operational and programmatic support for Child Health programs and initiatives for children, including CYSHCN.

 

Ankit Sutaria, MBBS, MPH - Epidemiologist III: The Epidemiologist III oversees Child Health Epidemiology and is the Newborn Screening Team (NBST) lead within MCH EPI. This role performs surveillance and analytic activities for several programs related to child health and newborn screening.

 

Kristina Lam, MD, MPH – Women’s Health Medical Epidemiologist: The Women's Health Medical Epidemiologist oversees WH Epi and provides scientific oversight, strategic planning, and coordination of women’s health epidemiology activities.

 

The Family Support Coordinator, a CYSHCN parent, provides support and guidance to state and local district BCW and CMS staff by developing and promoting opportunities to engage families, establishing partnerships with community stakeholders, and facilitating resolutions to family concerns.

 

Prior to the reorganization that occurred in 2023, there were several vacancies in Child Health. Salary structure and position descriptions were revised to align with the responsibilities and skill sets needed for the positions. The Child Health organizational chart was revised to reflect a new support and reporting structure. As a result of the revision, responsibilities for all positions were streamlined resulting in fewer positions required to implement Title V funded programs and state-led initiatives. At the end of SFY 2023, there is only one vacancy still under recruitment in the Office of Child Health.

 

The Office of Women’s Health had previously been organized to include positions posted at higher levels for both salary and responsibility and has been successful for several years in recruiting highly qualified staff. Fortunately, due to increased focus on maternal health and outcomes, recruitment has primarily been a result of new positions being posted when increased funding was added for program growth and expansion rather than a result of turnover. Women’s Health has only had one resignation in the past two years and currently only has one vacancy. The current vacancy occurred because of an internal staff promotion during the creation of the new Women, Children, and Nursing Services Division. 

 

Partnerships and Collaborations

Title V continues to focus on collaborative partnerships to expand the capacity of the Title V program to meet the needs of MCH populations.

MCHB Investments: Title V works collaboratively with other MCHB investments, including but not limited to: State System Development Initiative, Maternal, Infant, and Early Childhood Home Visiting, Healthy Start, the Alliance for Innovation on Maternal Health Community Care Initiative, and the Maternal Health Innovation program.

Other Federal Investments: Title V receives other federal investments through CDC funding which includes PRAMS, Oral Health, perinatal quality improvement, ERASE MM, and EHDI. The United States Department of Agriculture funds WIC and works closely with Individuals with Disabilities Education Act Services Part C.

Other Health Resources and Services Administration Programs: District coordinators partner with Federally Qualified Health Centers, Head Start, and Early Head Start.

State and Local MCH Programs: The Title V program coordinates regularly with the state’s 18 public health districts and 159 local health departments to implement activities. The Title V program also partners with various local community-based organizations, including but not limited to HMHBGA, Postpartum Support International, Georgia Chapter, March of Dimes, and the Center for Black Women’s Wellness.

Other programs within DPH: The Division of Women, Children, and Nursing Services partners with the Adolescent Health, Chronic Disease Prevention, Immunizations, Injury Prevention, STD, Refugee Health, Environmental Health, and Vital Records.

Other governmental agencies: Title V has strong relationships with the Georgia Department of Community Health, the Department of Behavioral Health and Developmental Disabilities, the Division of Family and Children Services, DOE, and DECAL.

Public health and health professional educational programs and universities: Title V frequently partners with Emory University, Georgia State, University of Georgia, Morehouse School of Medicine, Mercer University, Valdosta State University, and Augusta University.

MCH Advisory Council: The MCH Advisory Council serves in an advisory capacity to the Title V Program, monitors progress, and addresses specific MCH population needs. The Council is comprised of a multidisciplinary team of professionals with expertise in MCH and people with lived experience.

Operationalization of Five-Year Needs Assessment Process and Findings

Title V operationalized the Five-Year Needs Assessment process and findings by developing practices to better assess and monitor the status of process measures intended to advance the national and state performance measures. Quarterly ESM meetings with Title V program staff provide the opportunity to regularly assess the impact of developed strategies and activities contained in the State Action Plan. The Title V team held monthly meetings with Title V programs outside of the Division to review program activities and provide technical assistance. The budget representative is included in monthly meetings to ensure that the Title V budget is aligned with programming needs and activities. Through regular and continued assessment of strategies and practices, improvements in performance and improved outcomes are expected.

Emerging Public Health Issues

Creating health equity is a guiding priority and public health issue. DPH seeks to improve the health of all Georgians by integrating the promotion of health equity into all statewide public health programs and services and into the organizational culture of the department. Efforts to improve health equity, including those to reduce health disparities and improve minority health, is embedded across all divisions, sections, and programs. DPH continues to reduce the burden and impact of COVID-19 among vulnerable populations using the following approaches for ensuring health equity: Identify Vulnerable Populations, Community Engagement and Outreach, Utilize Data and Technology, and Identify and Engage Stakeholders.