Needs Assessment Process

 

Mississippi’s MCH population needs are continuously assessed by MCH programs through ongoing monitoring and surveillance to evaluate progress and trends, track implementation of work plans, and identify and address emerging issues. The MCH personnel meet monthly to discuss programmatic efforts, accomplishments, existing and emerging issues, and next steps of ongoing and upcoming projects. This ensures MCH programs can align their efforts and encourages collaboration across MCH programs to support Mississippi’s MCH population needs.

 

Needs Assessment Findings

 

Needs assessment findings revealed several recurring themes across domains highlighting the need for MSDH to align strategies and use resources for the following:

• Improving access to patient- and family-centered care
• Improving health equity for underserved populations
• Decreasing discrimination based on race, class, or gender
• Providing education on mental health issues and improving access to mental health services
• Decreasing provider shortages

 

Access to Patient- and Family-Centered Care

 

Mississippians are significantly impacted by inequitable access to care. Most health care resources are concentrated in a few areas of the state. Given the dearth of resources in some areas of the state, barriers, such as transportation, impede the quality and effectiveness of care received. Even when providers are geographically close, residents may still lack the financial resources, insurance, or time to utilize services, resulting in inadequate care. Furthermore, as health is largely driven by behaviors and experiences outside of healthcare services, healthcare providers need to acknowledge the importance of the patient in achieving positive outcomes and view themselves as partners, rather than directors, of health. New strategies are needed to ensure all Mississippians have access to quality and equitable healthcare that is responsive and respectful of them.

 

The MCH/Title V Block Grant supports Mississippi’s efforts to increase access to patient- and family-centered care. For example, the CYSHCN program partners with specialty clinics, federally qualified healthcare centers (FQHC), and private clinics within communities to provide easier access to care and coordination of services to establish mental and dental homes for under-served citizens. The ability to provide access support via tele-medicine has also improved conditions for those in under-resourced areas.

 

Improving Health Equity and Decreasing Discrimination Based on Race, Class, or Gender

 

The need to promote health equity was also evident from the needs assessment findings. Health equity will increase community capacity to shape outcomes and foster multi-sector collaboration, in turn creating the foundation for a healthy and vibrant community. The Perinatal/Infant Health program has made efforts to address this need through racial equity trainings, focusing on the structural and social dynamics working within health care institutions and communities that prevent optimal births for every woman, particularly Black and indigenous women of color. With trainings on racial equity, social determinants of health inequities, collective impact and advocacy, participants will begin to realize their role within the transformation of those systems.

 

The MCH Program hosted an implicit bias workshop training for staff. Its purpose was to help staff understand the biases in our everyday life, to discuss how to manage biases, and to understand how biases can affect the level of care for MSDH clients and staff. The workshop provided tools to begin discussions on how to adjust automatic patterns of thinking and to eliminate discriminatory behaviors. It equipped staff the necessary tools to maintain and promote an inclusive and respectful work environment. The workshop training also focused on the topic of patient-centered care and how implicit bias can lead clinicians/and service providers to use personal biases that affect the use of family planning in specific situations or populations (e.g., unmarried adolescents). Since integration of family planning into maternal and child health services is a vast area with many intersections, considering how to address bias is an important element for family planning success.

 

In addition to trainings, some programs have developed plans and policies addressing health equity within their program. The Early Hearing and Detection Intervention (EHDI) program received a grant through HRSA to establish an Inclusion and Diversity Plan. The purpose of this plan is to promote and foster a culture that values diversity, equity, and inclusion throughout the EHDI program and the diverse communities that the program serves.

 

The Office of Preventive Health and Health Equity was asked to lead the efforts in addressing the impact of COVID-19 on minority and vulnerable populations such as rural communities, African Americans, Hispanics/Latinx, Vietnamese, and immigrants through education on protective and social distancing measures, access to COVID-19 testing, access to vaccines, and access to resources. The Office of Health Equity has worked to increase access to the COVID-19 vaccine for the state’s minority and vulnerable populations through the Community Vaccination Program and by addressing vaccine misinformation and hesitancy through health promotion campaigns via multiple media platforms. The Office of Health Equity serves as a link and liaison between community-based organizations and community health centers and the community to provide timely and effective response to needs and issues surrounding the COVID-19 pandemic and distribution of vaccinations in minority and vulnerable populations in the state. The Office recruits community health centers and community partners to work together to identify sites in communities that will improve access to the vaccine for minority and vulnerable populations. To date more than 380 vaccination events have taken place across the state, and more than 8,600 vaccines have been administered through the Community Vaccination Program.

 

Mental Health Services and Education on Mental Health Issues

 

According to the Mississippi Primary Care Needs Assessment that was conducted by the Office of Rural Health, “Mental and behavioral health (MBH) comprise a range of conditions, the majority of which are responsive to treatment, and many of which are exacerbated by poverty. Of the 3 million residents of Mississippi, 4.7% (close to 150,000) of adults are reported to have a serious mental health condition, such as schizophrenia, bi-polar disorder and/or major depression, which are difficult to manage and often require hospitalizations. Other less acute mental health conditions, such as mild depression and anxiety, post-traumatic stress, etc., are preventable and respond well to treatment” (p.18).

 

To begin to build capacity to address the mental health needs in our state in MCH populations, MCH program personnel have participated in mental health first aid training. In 2021, Adolescent Health Program personnel became certified in mental health first aid. Certified personnel provided statewide training to address mental health needs. In 2022, the CYSHCN personnel also attended Mental Health First Aid training to gain skills and knowledge in recognizing and addressing mental health concerns in CYSHCN youth.

 

In addition to training, MCH programs have also coordinated workshops and mental services to families. The Maternal and Infant Health Bureau program also facilitated a partnership with MOM.Me to address the mental health needs in the state. The goal of this collaboration is to:

• Establish a Maternal Mental Health Network
• Conduct health education and outreach
• Provide training to community stakeholders to increase provider knowledge of maternal mental health disorders
• Link women and children to support services

 

During this collaboration, the Maternal and Infant Health Bureau and MOM.Me hosted a coordinated care program designed to provide the care mothers need. Participants of the program received (1) a one-hour individual session with a therapist; (2) a one-hour weekly group session led by a peer or therapist; (3) a weekly mood assessment conducted by a Care Coordinator via Zoom; and (4) post-program follow-ups for up to six months. The program also hosted a series of virtual workshops on mental health and baby safety.

 

MOM.Me also offers the same content for fathers to bring awareness to the importance of fathers on maternal mental health and the developmental milestones of their child. Fathers are also educated on postpartum in fathers, infant care, and infant first aid. 

 

More activities related to addressing the mental health needs across the MCH lifespan for MCH populations are being undertaken in the current year and are being planned for the application year. All social workers and service/care coordinators in all MCH programs, including CYSHCN, EI, HMHB assisting MCH personnel who work with infants and toddlers to earn the Infant Family Specialist Endorsement recognized by the Alliance for the Advancement of Infant Mental Health.

 

Provider Shortages

 

The impact of provider shortages is inevitably felt throughout the state. Provider shortages impact the health system by lowering the quality of care provided and increasing the number of poor health outcomes. Although Mississippi experiences provider shortages in every medical and health field, the following highlights some particularly challenging shortages.

 

Newborn Screening and Diagnostic Provider Shortages.

The United States, and Mississippi in particular, is facing a shortage of pediatric audiologists and lacks the genetic specialists to work with families of infants who are found to have conditions identified during newborn screening. This shortage will be difficult to address as training programs are costly, lengthy, and insufficient to address the need. Particularly with pediatric audiologist, reimbursement for working with pediatric populations disincentivizes providers, encouraging them to focus on older, geriatric populations.

 

Dental Health Provider Shortages.

According to the HRSA Bureau of Health Workforce, 248 dentists are needed to eliminate the dental shortage designations. This shortage will be difficult to address and presents a strong rationale to expand the scope of practice of support dental staff, such as hygienists and other midlevel personnel, to address the unmet primary dental health needs in the short term. In addition, consideration should be given to expanding teledentistry. Longer-term solutions point towards expanding dental education to build a pipeline to increase dental providers.

 

Mississippi’s Office of Oral Health developed a Mississippi State Oral Health Plan, 2016-2021. The Plan called for surveillance and assessment of oral health status, which was subsequently addressed by the development of the Mississippi Oral Health Surveillance Plan, 2018-2022. The data collection for the surveillance plan is currently underway, and the results will establish a baseline for oral diseases and resulting health outcomes in Mississippi. The surveillance activities include dental caries, periodontal disease, cancers of the oral cavity and pharynx and access to care issues occurring over one’s lifespan. This information will assist in the placement of new dental providers and public education programs in the areas of the state with the greatest needs. Other benefits of the surveillance process will be an improvement in actionable oral health data for the state and local health providers, more accurate data to report to policy makers, and baseline data to evaluate success.

 

Mental Health Providers Shortages.

The need for mental health providers across the state is dire. The ratio of mental health providers to population as greater than 1 to 200,000 in the Delta region. It is important to note that the HRSA designation process counts psychiatrists only, and there is a nationwide shortage of psychologists and other mental health professionals. Employing a regionalized approach and counting psychologists and licensed clinical social workers would provide a better assessment of capacity. In partial response to the need for psychiatrists, the Mississippi State Hospital (MSH) added a Psychiatric Residency Program with the first residents having started in July 2021.

 

Changes in MCH/Title V Program Capacity

 

Over the past 3 years, MSDH has experienced numerous events that have had a serious impact on staff and services, many of which remain challenging: the impact of COVID-19, including critical staffing shortages; a statewide reassessment and realignment of job classifications; and a continuing drain of skilled public health professionals. These events have made it challenging to recruit and maintain knowledgeable and skilled Title V staff. The Title V Block Grant team is mostly comprised of personnel who have been in their roles for two or fewer years and have recently assumed responsibilities for preparing the Title V application and report.

 

To recruit and retain qualified MCH staff, MCH works closely with Human Resources to increase efficiencies within the hiring process. Standardized hiring procedures are now in place and additional technical assistance has been provided throughout the hiring process. Proactive strategies have also been employed to publicize vacant positions. Strategies include broadly circulating state vacant positions through established MCH listservs, using additional advertisement and targeted postings, and determining innovative and creative ways to attract and retain a diversified workforce. MCH works with colleges throughout the state to initiate critical conversations to draw student talent.

 

While MSDH has made limited progress, there is a need for improved recruitment strategies, core competency training, competitive salaries that provide a livable wage, and leadership coaching. From previous workforce development surveys, MSDH has been viewed as bureaucratic, lacking innovation, and under resourced. Job attributes should offer fulfilling, meaningful work, a position that is mission-driven and provides the opportunity to make an impact on their community. MSDH realizes a qualified and competent public health workforce is essential in addressing existing and emerging public health issues. The growing variability of these challenges emphasize the need for adequate core competency training and education of public health professionals. Competitive salaries are needed to attract potential employees, provide a livable wage, encourage low employee turnover, and increase the work environment morale. Leadership coaching provides an inclusive workplace that fosters the development of others and the ability to lead staff toward meeting MSDH’s vision, mission, and goals.

 

To build MCH Program capacity, some leadership staff have been supported to participate in coaching and leadership training programs such as the certified public manager program through the Mississippi Personnel Board and the Advanced Applied Leadership Program through the Else School of Management at Millsaps College.

 

Partnerships and Collaborations

 

The Title V/MCH program acknowledges the power of prevention in improving the health and well-being of across the life course. Health Services initiated a collaboration with the Office of Preventive Health and Health Equity to address the social determinants of health that affect not only Title V/MCH programs but also the health of all Mississippians. Programs in Preventive Health and Health Equity will assist MCH-related strategies around issues such as maternal and infant mortality, developmental screenings, well visits among adolescents, and cross-cutting issues such as mental health, health equity, and disparities. Mississippi’s Title V MCH Program continues to partner with numerous entities at the federal, state, and local level to expand its capacity and reach for its MCH population.

 

The Title V/MCH program also supports the Maternal & Infant Health Bureau (MIHB). Through this support, the MIHB partnered with a local community-based organization, Mom.ME (https://www.momme.rocks/), to establish a community-based collaboration and support to expand community knowledge of available services. Mom.ME works to promote maternal mental health literacy to improve the health of women across the life course and create a continuum of care and integrated system of community-based services in women’s health.

 

The Child and Adolescent Health Office partners with Teen Health Mississippi to develop and implement training and technical assistance for youth and youth-serving organizations in Mississippi, guiding providers on how to best support expectant and parenting youth, educate adolescents on sexual and mental health practices, and best practices for implementing youth friendly healthcare, particularly focused on teen populations with health disparities, such as teens of color, teens with English as a second language, teens with disabilities, LGBTQ youth, etc.

 

Organizational Structure and Leadership Changes

 

Thomas Dobbs, MD, MPH, served in various capacities since 2007 in Public Health as State Epidemiologist, Deputy State Health Officer, and State Health Officer until July 29, 2022. Dr. Dobbs led the state through one of its most challenging times, the COVID-19 pandemic. In 2022, Dr. Dobbs announced his departure and successor Daniel Edney, MD, FACP, FASAM. Dr. Edney brought years of experience in private practice when he joined MSDH in 2021 as the Deputy State Health Officer and Chief Medical Officer. Dr. Edney was officially announced as the State Health Officer in August 2022. Dr. Edney is a former president of the Mississippi State Medical Association and currently serves as a board member on the Mississippi State Board of Medical Licensure. He has also served as a fellow and laureate for the Mississippi Chapter of the American College of Physicians and a fellow of the American Society of Addiction Medicine.

 

Dr. Beryl Polk serves as Director of Health Services/Title V under the leadership of the State Health Officer, Dr. Edney. She brings decades of experience in program development, management, and evaluation. Dr. Polk is a Certified Case Manager (CCM), Certified Public Manager (CPM), Licensed Social Worker (LSW), has a MS in Counseling and a PhD in Leadership and Management with an emphasis in program development and evaluation. She has served for 23 years in various roles with MSDH. Dr. Polk provides leadership to more than 300 employees, both directly and indirectly, and across the state through the various offices listed below.

 

The Division of Health Services houses several programs: Women’s Health, Child & Adolescent Health, including Children and Youth with Special Healthcare Needs (CYSHCN), Women Infant and Children (WIC), Oral Health, and MCH Workforce Development.

• Ms. Krista Guynes, MSW, LCSW, is the Director of the Office of Women’s Health, which includes the Breast and Cervical Cancer Program, Maternal and Infant Health Bureau, Healthy Moms/Healthy Babies Perinatal Case Management Program, and the Family Planning/Comprehensive Reproductive Health Program. She began serving in this role in 2022.
• Ms. Stacy Callender, SCSP, is the Director of the Office of Child and Adolescent Health, which includes Newborn Screening, the Birth Defects Registry, Early Hearing Detection and Intervention, Early Intervention (Part C), Lead Prevention and Healthy Homes (LPPHH), Maternal Infant and Early Childhood Home Visiting (MIECHV), Adolescent Health, and Children and Youth with Special Healthcare Needs (CYSHCN) Programs. She began serving in this role in 2021.
• Ms. Valecia Davis, MS, is the Director of the Children with Special Healthcare Needs Program and interim Adolescent Health Director. She has been serving in this role since summer 2022.
• Dr. Jameshyia Ballard was appointed Director of WIC in July 2022, when the previous WIC Director retired after more than 30 years of service. Dr. Ballard previously served as State Breastfeeding Coordinator and State Vendor Management Director with the WIC program.
• Dr. Angela Filzen, DDS, is State Dental Director and oversees the Oral Health Office. She has been serving in this capacity since 2017 and works with community-based organizations to increase dental and medical homes for women and children across the state.
• Ms. Danielle Seale, MSW, LCSW, was tasked to lead the MCH Workforce Development Office in 2021, bringing her experiences from more than a decade in public health. In 2022 she was assigned a cadre of Health Services Social Workers to supervise in their social service support of Health Service programs.

 

New Brand, New Program

Beginning in August 2021, the Perinatal High-Risk Management/Infant Support Services (PHRM/ISS) program that has been in existence at the health department for over 30 years changed to the Healthy Moms/Healthy Babies (HM/HB) of MS program, a nurse case management and home visiting program. To complete the transformation, the program began by developing provider-specific training and orientation for new and existing staff and revamping protocols to implement evidence-based strategies. The HM/HB program developed a recruitment strategy to address the shortage of nurses within the program. The overall goal of the program is to increase capacity, training, and accountability to better serve pregnant women and infants in the state of Mississippi.

 

Emerging Issues and MCH Program Response

 

Dobbs Decision

On June 24, 2022, the U.S. Supreme Court officially issued a ruling in the Thomas E. Dobbs, State Health Officer of the Mississippi State Department of Health, et al. v. Jackson Women’s Health Organization. In doing so, the Court overturned its 1973 decision of Roe v. Wade. Given the existing challenges Mississippi already experiences with high maternal and infant mortality and morbidity, these rates are predicted to increase as a result of this recent Supreme Court decision and subsequent enforcement of state laws making abortions illegal. As a result, the state’s only abortion clinic has closed and restrictions for medication abortions are in effect. Additional pregnancies and births, which would have previously been terminated during pregnancy, are most likely to occur for younger women, single women, women of color, women in under-resourced areas without local family planning services, and women with economic hardships who lack the resources to receive reproductive services out of state.

 

The MSDH currently estimates the elimination of elective abortions will result in as many as an additional 5,000 births annually, many of which will be unplanned, and for which many women will receive little or no prenatal care. Research has shown repeatedly the negative consequences of inadequate prenatal care for mothers, including three to four times the risk of dying from pregnancy-related complications than those who do receive care, and for infants, including increased rates of prematurity, low birthweight, and infections after birth. As these conditions place infants at increased risk of requiring more advanced neonatal care after delivery, Mississippi expects an increased need for NICU admissions in the coming years.

 

COVID-19

The COVID-19 pandemic has again laid bare the influence of poverty, race, and ethnicity on the vulnerability to disease and the resulting health disparities. Death rates among Blacks are being disproportionately experienced by younger Blacks and death rates are higher among Native Americans. Since the pandemic began, death rates among Blacks aged 55-64 years are higher than for Blacks aged 65-74, and for whites aged 75-84. Mortality rates per 100,000 among Blacks in Mississippi was 253.8 (2,050 deaths), twice the rate of white Mississippians (126.4). The mortality rate from COVID-19 among Native Americans in Mississippi was 1,235 / 100,000 (94 deaths), almost 10 times the rate of white mortality. Despite the low number of deaths, the mortality rate from COVID-19 among Native American Mississippians was the highest among the indigenous residents nationwide.

 

In early 2021, MSDH and health systems partners statewide prioritized vaccine distribution. In October and November 2021, during this reporting period, Mississippi saw its highest rates of COVID and COVID-variant transmissions, infections, hospitalizations, and deaths. In response, the MSDH engaged in targeted campaigns with specific communities, such as engaging with the Hispanic Community to address COVID in October 2021, and began issuing vaccines for children in County Health Departments in November 2021. To improve access to records, Mississippi began participation in MyIR providing online access to immunization records.

 

As the COVID-19 pandemic began winding down in 2022, MSDH and other health systems stabilized and returned to routine operations. For example, BCCP focused on engaging providers and partners in efforts to return women to breast and cervical cancer screening. This was done by maximizing carryover CDC funding for subgrants with health settings that employed community health workers (CHWs) and patient navigators to provide rapid patient navigation.

 

Jackson Water Crisis and Lead Lawsuits

As reported under MCH success stories, in mid-August 2022, the capitol city of Jackson experienced heavy rains and flooding which damaged the O.B. Curtis water treatment plant located near the Ross Barnett Reservoir in the Pearl River basin. With the crippling of this major water treatment plant and malfunction of pumps at the J.H. Fewell water treatment plant, the city was unable to produce sufficient water pressure to serve its residents. For weeks, many residents were unable to access clean, safe water for drinking, cleaning, and bathing in their homes. Even as the pressure was slowly being restored across the system, residents remained under a boil water notice for several more weeks and continued to experience waves of rolling boil water notices until the end of the emergency in November 2022.

 

This presented challenges for MCH program participants in the Jackson area as well as MCH program personnel. The MSDH Offices housing the leadership for its MCH programs, located in Jackson less than 2 miles from the malfunctioning J.H. Fewell water treatment plant, was significantly impacted by the water crisis. Not only was the water unsafe for drinking but the pressure was insufficient for functioning facilities, resulting in the temporary closure of the building and the use of portable restrooms after the buildings reopened. Nonetheless, MCH personnel, working remotely as needed, focused on addressing the needs of the women, children, youth, and extended families impacted by this crisis through helping them access bottled water at distribution points, purchasing water faucet filters, and providing information on updates and education on installing and using filters and protecting young children from lead in water.

 

Though this event was a specific crisis, the Jackson water system presents an ongoing challenge as years of deferred maintenance and lack of investments in upgrades combined with unique soil conditions that increase the likelihood of breaks in underground water pipes. The MCH programs periodically are called to respond to boil water notices, water outages, and occasional facility shutdowns.

 

Health Disparities

Health disparities threaten the health and quality of life of the overall population. According to the CDC, “A growing body of research shows that centuries of racism in this country has had a profound and negative impact on communities of color. The impact is pervasive and deeply embedded in our society—affecting where one lives, learns, works, worships, and plays and creating inequities in access to a range of social and economic benefits—such as housing, education, wealth, and employment. These conditions—often referred to as social determinants of health—are key drivers of health inequities within communities of color, placing those within these populations at greater risk for poor health outcomes.”

 

The impact of centuries of racism have led to significant inequities in health and wellbeing both directly and through negative impacts on social determinants of health. To improve the health of Mississippi communities overall and for a greater quality of life, the public health system must address generational injustices that contribute to these health inequities in our state and nation.

 

Maternal Mortality

Maternal mortality has continually plagued the black community in our state. According to the CDC, Black women are three times more likely to die from a pregnancy-related cause than white women. This profound difference is appalling and must be addressed, as 87.5% of pregnancy-related deaths are preventable. Addressing the variation in quality healthcare, underlying chronic conditions, structural racism, and implicit bias will help reduce the black maternal mortality rate.

 

Undocumented Residents

Immigrant mothers and children are a vulnerable group that faces dangers to their physical and mental health. This stems from immigration policies that include the right to asylum, detention and deportation protocols, regulation of health coverage, and access to both physical and mental health care. These factors can be seen as social determinants for immigrants. As such, the MSDH MCH Program must consider these determinants in ensuring every mother and child has access to quality care despite their citizenship status.