III.C.  Need Assessment Update

Women and Maternal Health

To conduct needs assessment for the Women and Maternal Health domain, Title V invited stakeholders to a virtual meeting on March 24, 2022. Participants included staff from ADH, UAMS, the Arkansas Minority Health Commission, Arkansas Foundation for Medical Care (AFMC), Office of Oral Health, and Arkansas Department of Human Services’ (ADHS) Division of Medical Services. Participants were asked to select the priority needs from the Title V Women’s Maternal Health Needs Assessment that they believed were still ongoing priority needs.  The respondents selected one or more of the following priority needs:

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

Current program strategies to achieve Women and Maternal Health MCH objectives were reviewed by stakeholders and agreed upon that Arkansas was achieving results.

Perinatal and Infant Health

To conduct needs assessment for the Perinatal Domain, the Title V Perinatal Domain invited stakeholders to a virtual meeting June 9, 2022. Participants included ADH Title V Staff, ADH WIC, Arkansas Home Visiting Network, Arkansas Infant and Child Death Review, Arkansas Minority Health, Baptist Hospital, Arkansas Department of Human Services, the Arkansas Chapter of the American Academy of Pediatrics and Arkansas Children’s Hospital. Participants were asked how to help the families that are served by our programs. Collected feedback included the following:

• Provide new mothers with more information about infant mortality.
• Create a statewide safe sleep education plan.
• Plan statewide activities to increase breastfeeding rates.
• Use local organizations to circulate information about programs, services, events, etc. 

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

Child and Adolescent Health

The Child and Adolescent Health domains held an annual meeting during the fall of 2022. Thirteen individuals attended the meeting representing the Arkansas’s Physician Associations, Family-Based Organizations, Department of Education, Children with Special Health Care Needs, Part C, Head Start Collaboration, Advocates for Children and Families and interagency departments within ADH (e.g., WIC and Chronic Disease). During the meeting, all priorities and evidence-based strategies were reviewed and assessed via an interactive poll. The majority of the attendees reported the current priorities were correct, measures and strategies were doable, but more time was needed to develop and see desired results.

Children with Special Health Care Needs (CSHCN) 

The Title V CSHCN Program conducts ongoing needs assessment for the CSHCN Domain in addition to the required 5-year State Needs Assessment. The program convened a virtual stakeholder meeting June 8, 2022, inviting cross agency collaboration from stakeholders from other Title V programs under the Arkansas Department of Health, pediatricians, AR Transition Services, parent information and advocacy groups such as Family 2 Family and the Center for Exceptional Families (TCFEF), Early Childhood Special Education (Arkansas Department of Education), program staff and staff from other DDS programs such as First Connections, Arkansas’ Part C early intervention program.

The June stakeholder engagement meeting reviewed key program strategies to achieve block grant objectives with the stakeholder participants. 100% (22 out of 22) of participants agreed the program’s activities were achieving the desired results. To promote engagement and to solicit input and feedback from stakeholders in attendance, this interactive domain meeting used online IdeaBoardz. Participants were asked if they felt the priority needs identified in the 2021 Title V CSHCN Needs Assessment were still an ongoing need of families of CSHCN and if any new needs had arisen as a result of the pandemic. Stakeholders in attendance responded (anonymously) on the IdeaBoardz (or not anonymously in the zoom chat) to identify that the following needs identified in 2021 are still a priority need:

1. Transportation.
2. Understanding, financing, accessing, and navigating the health care system including Medicaid.
3. Technological issues with Internet access and computer use to access teletherapy, virtual appointments, and online learning.
4. Accessing specialists and services.
5. Finding respite care.

Participants were asked to identify any new or emerging needs of CSHCN and their families or additional priority areas. Stakeholders at the meeting identified emerging and additional priority needs as:

Additional Priority Needs:

• Availability of respite services
• Trauma-informed care

Emerging Needs:

• TEFRA changes post-COVID may leave many children uninsured.
• Dental (State insurance not covering Arkansas’s children).
• Pay for conducting developmental screenings (there is a code now in Medicaid, but providers can’t bill).
• TeleMed access.
• ABA (Applied Behavioral Analysis) or other Evidence-Based Practices (EBP) for school-aged children.

An effective State Needs Assessment also looks at the strengths in the State and considers ways to use these strengths to overcome barriers to meet identified needs. To support this work, participants were asked, “how we can work together to support Access to Care?” Stakeholders shared ideas, with the most popular ideas (the ideas shared by stakeholders that earned the most votes on IdeaBoardz) involving:

• Clearly communicate timeline/expectations to families seeking services and provide more support in the application process.
• Building partnerships with other agencies and nonprofits outside of those the Title V CSHCN program usually partners with.
• Request CSHCN program information and a link to make a referral be placed on the new Part C Program (First Connections) website.

To ensure that Arkansas’s Title V CSHCN program is effectively partnering across agencies to support Access to Care and aligning key strategies with other initiatives and work in the state, the June 2022 meeting provided an opportunity for participants to share “what’s going on” to identify these State strengths which could be used to support CSHCN and their families in accessing care, supports, and services. Stakeholders in attendance who represented other programs and agencies serving the Children and Youth with Special Health Care Needs (CYSHCN) population were asked to identify initiatives or strategies their program is doing (or planning to do) that support access to care for this domain population. Stakeholders suggested extending/enhancing access to services through more effective collaboration between divisions in the lead agency and with other State departments. Stakeholders also identified current initiatives and work in the State that the Title V CSHCN program could align strategies with to improve Access to Care, including:

• The State’s work to promote the ‘Learn the Signs. Act Early.’ tools (LTSAE)
• Pritzker Initiative/Grant goal of increasing percentage of young children (0-5) who receive developmental screenings.
• National Wonders First 2100 Days Initiative
• Family 2 Family launch of Project Accelerate

In the area of Transition from Pediatric to Adult Health Care, participants had opportunities to share “what’s going on” to identify State strengths that could be used to support CSHCN and their families in preparing for and experiencing a smooth transition from pediatric care systems. All stakeholders in attendance were asked about their ideas for supporting Transition for not only this domain population but all youth. Ideas shared in the meeting included:

• Sharing resources from the Got Transition website with pediatric providers.
• Share clear state goals and partner with additional stakeholders for broader dissemination.
• Enlist the help of the Arkansas AAP to encourage all practitioners to complete the CHC Core Elements of Transition survey, for the state to have more complete data.
• Identify leaders in pediatric to adult transitions, collect stories, and share them widely.

Stakeholders participating had additional ideas to support the transition of all youth into adult health care through collaboration with education professionals (school-based nurses, regular and special education, school-based mental health, parent centers/groups), a key program strategy. Ideas for collaboration involved going beyond sharing information at school transition fairs to include:

• Hosting parent information meetings at schools on the importance of transition and how to prepare
• Share health care assessments for students/families to complete to discover goals and activities for students to accomplish while in high school
• Getting CHC Transition booklets into more youth's hands through partnership with schools to include as part of all Health classes
• High schools incorporate core elements of transition in student graduation planning from 9th-12th grade.

Thirty-four stakeholders attended the stakeholder engagement meeting in June. The program is identifying strategies to engage more of the 111 individuals invited so that stakeholders participating include more families of CSHCN and stakeholders involved are representative of the demographics of the clients served and of the State as a whole.