Ongoing Needs Assessment Activities and Partnership Updates
The Title V program uses a Population Domain Action Group structure to manage its MCH Priorities and implement strategies within the 5-Year Action Plan. Each Priority Domain Group include two co-leads, epidemiologist(s), and program researcher(s) to guide the work of a diverse stakeholder group. These stakeholders are made up of internal and external subject matter experts in the priority topics. The Domain Group Co-Leads are responsible for working with the stakeholder group to: update the 5-year Action Plan, assess performance measures outcomes, implement and monitor strategies to impact the performance and outcome measures, and create or identify an evaluation plan used to assess whether or not the interventions have been successful. In addition to the population Domain Groups, program managers utilize data collection, program evaluation, and surveys to solicit feedback and monitor program outcomes. External stakeholders involved in the Domain Groups include sister state agencies, medical associations, providers, insurance, parent and family groups representing CYSHCNs, universities, local health departments, and community agencies.
Over the last year, the Domain Groups have worked to operationalize the 5-year needs assessment through the development of workplans detailing implementation of the Action Plan. Each Domain Group utilized the public comments from the 2021 survey to identify additional partners and ensure alignment with stakeholder feedback during planning and implementation. The Title V epidemiologist developed a MCH BG measures tool to serve as a centralized source for all MCH BG required measures including data trends and disaggregated data to monitor disparate outcomes to inform both previous year evaluation efforts and future year planning by the Domain Groups.
The BMCFH has furthered the use of the Results Based Accountability (RBA) framework for performance management. Over 20 BMCFH staff have been trained in RBA and the Clear Impact software, and programs are developing contributing program scorecards to track program performance toward the State Health Improvement Plan (SHIP) Infant Mortality (IM) population indicator. To ensure these scorecards are useful as we specifically strive to eliminate the Black IM disparity, each program is including disaggregated measures by race and county. The bureau’s efforts align with the overall agency’s adoption of RBA and Clear Impact, and future efforts will focus on expanding to additional SHIP metrics for contributing program scorecards, as well as additional planning for RBA use by the MCH BG Domain Groups and across the BMCFH.
Following the 2020 needs assessment, the BMCFH established the bureau’s Health Equity Committee (HEC) to assess and improve both the bureau’s internal culture and capacity to address health equity through program, grant, and contract administration. After reviewing other state’s methods, the HEC developed a plan to assess staff competency through a survey, program capacity through facilitated reviews, and community engagement through a subrecipient assessment. The three-pronged assessment approach is discussed in more detail in in the III.E.2.c. Cross-Cutting Annual Report. Results from the staff competency survey and program review pilot are driving the HEC’s activities.
The following are examples of continued stakeholder involvement and feedback, data collection, monitoring, and evaluation that support and enhance the work of the five-year needs assessment and action plan strategies:
- Eliminating Racial Disparities in Infant Mortality Task Force listening sessions– Governor Mike DeWine formed the Task Force to create actionable recommendations for interventions, performance and quality improvement, data collection, and policies to reduce infant mortality rates and eliminate racial disparities by 2030. Ohio’s Black and African American communities serve as the Task Force’s greatest resource for recommendation development. Families shared their expertise and knowledge on experiencing a poor birth outcome or loss of an infant or participating in a program or receiving support that improved the health of their pregnancy or postpartum experience. The Task Force plans to share the recommendations back to the families who participated in listening sessions to gather further feedback on planning and input for tailored design and implementation.
- Breastfeeding focus groups for Black or African American and Appalachian women in Ohio– In March 2021, Professional Data Analysts, Inc. (PDA) created two reports, Breastfeeding Experiences of Black or African American Women in Ohio and Breastfeeding Experiences of Appalachian Women in Ohio, based on quantitative and qualitative data from focus groups. PDA also identified future collaborations, topics for discussion, and strategies to implement to improve breastfeeding initiation and duration, particularly focusing on African American and Appalachian women. ODH will engage partners to identify new strategies and activities as well as improve and enhance current activities.
- OPAS for Dads– The Ohio Pregnancy Assessment Survey (OPAS) is Ohio’s PRAMS-like survey. In 2019 ODH initiated implementation of a stillbirth survey (SOARS) with methodology identical to OPAS but the target population from fetal death certificates rather than live birth certificates. In another expansion, OPAS for Dads will collect data on new and expectant fathers’ behaviors and attitudes towards pregnancy, and the health of men during their reproductive years. The data will provide insight into gaps and disparities in male health care services and use, ultimately supporting men and improving the family’s health outcomes.
- COVID-19 data modules– In response to the COVID-19 pandemic, data collection has been expanded for maternal populations through additional questions on SOARS and OPAS and linking of birth certificate data to the Ohio Disease Reporting System. This data is used to understand the impact of the pandemic on Ohio’s MCH population.
- ACES on YRBS– ODH received funding from CDC to add 16 questions on Adverse Childhood Experiences (ACEs) to the Youth Risk Behavior Survey (YRBS) for the Fall 2021 administration.
The following are key updates to existing partnerships and new partnerships to support implementation of the five-year action plan:
- Eliminating Racial Disparities in Infant Mortality Task Force– Task force members will work with local, state, and national leaders to identify needed changes to eliminate Ohio’s racial disparities in infant mortality. Jamie Carmichael, Chief Health Opportunity Advisor, ODH, and the Director of Children’s Initiatives for the Governor’s Office co-chair the task force with members from state agencies, public health agencies and organizations, health plans, advocacy organizations, and family members with lived experience. The Task Force facilitators represent the Kirwan Institute at OSU, BUILD Initiative, and AMCHP.
- OH-CAMH– The Ohio Collaborative to Advance Maternal Health was established in spring 2020 as a statewide membership organization to develop and implement a statewide strategic plan for maternal health. The Pregnancy Associated Mortality Review program convenes over 80 stakeholders representing clinical providers, local public health, community services, state agencies, advocacy organizations, and women with lived experience (i.e., near misses for maternal mortality).
- CMH PAC recruitment– The Children with Medical Handicaps Parent Advisory Committee is continuing efforts to diversify the PAC by increasing targeted recruitment, revising the PAC application to increase accessibility, and updating the PAC By-Laws to reflect a stronger emphasis on health equity and diversity.
- Birth Defects Advisory Board– The Ohio Connections for Children with Special Needs, birth defects surveillance program, is planning to re-establish a birth defects advisory committee representing both internal and external stakeholders who will bring knowledge and perspectives from parents, hospitals, physicians, genetic centers, and other vested stakeholders. The original advisory committee provided essential guidance for establishing birth defects surveillance in Ohio in 2008.
- Child Fatality Review Advisory Committee– With the goal of reducing the incidence of preventable child deaths, the CFR program oversees CFR review boards in each of Ohio’s counties who review the deaths of children under eighteen years of age. The CFR program is planning to re-establish the state advisory committee to further support the work of the county review boards by reviewing compiled state data compiled, identifying trends, providing expertise in understanding factors related to child deaths, and making recommendations for the prevention of future deaths at the state level.
Changes in Health Status, Needs, and Emerging Public Health Issues
Since the completion of the 2020 Needs Assessment, the COVID-19 pandemic has had profound impacts on Ohio. MCH populations experienced dramatic shifts in their live including the loss of jobs and income, remote schooling, limited childcare, stresses to mental and behavioral health, and reduced access to health care. As described above and throughout the application, data collection activities were expanded to better understand and address the pandemic’s impacts on Ohio’s MCH populations. MCH services were transitioned to telehealth/remote options to ensure access to MCH programs and many MCH staff have supported the response. MCH programs have provided guidance for the resumption of face-to-face services where appropriate, and continue to assess and work to address the COVID-19 pandemic’s disproportionate impact on certain communities, including racial and ethnic minorities, and individuals living with a chronic condition. Throughout the pandemic, the MCH program participated in the #WellChildWednesday campaign to promote well child visits and MCH programs are working with partners to address the lag in catch-up visits for adolescents. In addition, The COVID-19 pandemic has exacerbated previously identified needs for mental health supports for adolescents and women and underscored the MCH priorities for both populations.
Title V Program Capacity
Organizational Structure
ODH is a cabinet-level agency that reports to the Governor's Office. As a cabinet-level agency, the ODH Director Bruce Vanderhoff, MD, MBA, reports to the Governor's Office. ODH is organized by Offices/Bureaus as depicted in the organizational chart (see ODH TO in section V. Supporting Documents; note the organizational chart updates were in process at time of submission and do not reflect the recent appointment of the new director). ODH is organized according to our core public health responsibilities:
- Eliminate health disparities, improve birth outcomes, and improve the health status of women, infants, children, youth, and families in Ohio – Bureau of Maternal, Child, and Family Health
- Prevent and control the spread of infectious diseases – Bureau of Infectious Diseases
- Provide direction, support and coordination in preventing, preparing for and responding to events that threaten the public’s health – Bureau of Health Preparedness
- Build strong communities to enable Ohioans of all ages and abilities live disease and injury-free – Bureau of Health Improvement and Wellness
- Address health inequities and disparities, and support access to comprehensive, integrated healthcare for all to achieve the best possible outcomes – Office of Public Health Practice
- Assess and monitor environmental factors that potentially impact public health including air, water, soil, food, and physical and social features of our surroundings – Bureau of Environmental Health and Radiation Protection
- Assure quality in health care facilities, health care services, and environmental health through smart regulation to protect the health and safety of Ohioans – Bureau of Survey and Certification and Bureau of Regulatory Operations
Additionally, there are several Offices and Bureaus within the agency that assist with internal and external operations, including the Bureau of Vital Statistics, Bureau of Public Health Laboratory, Office of the Medical Director, Office of Management Information Systems, Office of Human Resources, Office of Financial Affairs, Office of Government Relations, Office of Communications, and the Office of General Counsel.
The Ohio Department of Health employs a total of 1,273 employees. The majority of ODH employees work in the ODH central office located in Columbus, Ohio, and approximately 240 employees work in the field at district or remote locations across Ohio. ODH is the designated state agency for implementation of the Title V Maternal and Child Health Block Grant (MCH BG) in Ohio. The Bureau of Maternal, Child, and Family Health (BMCFH) is responsible for MCH programs at the state/local level. The BMCFH is designed to improve the health status of women, infants, children, adolescents, and CYSHCN in Ohio by identifying needs and implementing programs and services to address those identified needs. The BMCFH capacity to address the five population health domain needs is accomplished by engaging in a multidisciplinary, collaborative approach to health improvement in coordination with internal and external stakeholders.
Programs administered and housed within the BMCFH supported by Title V funding include: Children with Medical Handicaps (CMH) Program, Title X Reproductive Health and Wellness, Perinatal Quality Improvement programs, Infant Mortality, Ohio Equity in Birth Outcomes Institute (OEI), Group Prenatal Care Initiatives, Fetal Alcohol Spectrum Disorders Program, MCH smoking cessation, Infant Safe Sleep, MP Subsidy program (Adolescent Resiliency, Pregnancy and Postpartum Peer Behavioral Health, and Pre/Inter-conception care), Breastfeeding, Genetics Services and Sickle Cell Services related to newborn bloodspot screening for 36 metabolic, endocrine, and genetic conditions, Newborn Screening for Critical Congenital Heart Disease, Ohio’s Birth Defects Surveillance System, the Universal Newborn Hearing Screening (UNHS), the Infant Hearing Program, Children’s Hearing and Vision, Early Childhood Comprehensive Systems (ECCS) program, School Nursing, Adolescent Health, Oral Health, Help Me Grow (HMG) Home Visiting Moms and Babies First (MB) Ohio’s Black Infant Vitality Program, and MCH data and surveillance including Child Fatality Review (CFR), Fetal Infant Mortality Review (FIMR), Ohio Study of Associated Risks of Stillbirth (SOARS), Ohio Pregnancy Assessment Survey (OPAS), Pregnancy Associated Youth Risk Behavior Surveillance System (YRBS).
BMCFH also houses the Asthma, Save Our Sight (SOS) children’s vision programs, non-Title V Home Visiting including Maternal Infant and Early Childhood Home Visiting (MIECHV), Infant Vitality Community Intensive, Sexual Risk Avoidance Education, Choose Life, and the Supplemental Nutrition Program for Women, Infants, and Children (WIC) and WIC Farmers’ Market Nutrition (WIC FMNP) programs.
Programs with close working relationships and Title V funding outside of the BMCFH include Ohio Healthy Homes and Lead Poisoning Prevention Program, Primary Care Office, State Office of Rural Health, Violence and Injury Prevention, and Sexual Assault and Domestic Violence Prevention. The Title V program also has plans to strengthen programmatic relationships with the Tobacco Use Prevention and Cessation Program and Immunization Program.
Agency capacity
The BMCFH maintains a map of all programs within the bureau that specifies program characteristics including MCH population(s) served, service level, service area, funding sources, types of partner organizations, inclusion of health equity activities, and if the program is required by Ohio statute. Key partner programs receiving Title V funds outside of the bureau are also included in this program map to represent the full scope of the MCH BG funds. The program map details the number of programs serving each of the populations and the breadth of partnerships with external organizations. Additional information on partnerships was reported in the Five-Year Needs Assessment Summary section b.iii. Title V Program Partnerships, Collaboration, and Coordination. Updates to partnerships were provided in the preceding section and are included throughout the application. The Program Map is available in section V. Supporting Documents.
The Children with Medical Handicaps (CMH) program serves CYSHCN and administers a diagnostic, treatment, and hospital-based service coordination program, supporting team-based service coordination for conditions such as spina bifida and hemophilia; and community-based service coordination, supporting public health nurses in local health departments who assist families in linking to local resources and helping families navigate the health care system. CMH utilizes vital committee/council structures to foster open dialogue, receive input and feedback regarding CYSHCN needs across the state. One of these committees is the Medical Advisory Council (MAC), whose members are appointed by the Director of Health, and represents various geographic areas of Ohio, medical disciplines, and treatment facilities involved in the treatment of children with medically handicapping conditions. CMH also convenes the Parent Advisory Committee (PAC) composed of parents from around the state who meet regularly to advise CMH. The mission of the PAC is to assure that family-centered care is an essential component in the development and delivery of programs and services for CYSHCN. The 2022-2023 biennial budget extended the age of eligibility for the CMH program from 21 years of age to 22 in 2022, and 23 in 2023, with the ultimate aim to extend the age to 26.
BMCFH also utilizes the medical expertise of highly skilled physicians and a dentist who serve as subject matter experts in addressing issues directly impacting MCH populations. Bruce Vanderhoff, MD, serves as Director of ODH and previously served as Chief Medical Officer for ODH. Dr. Vanderhoff previously served for more than a decade as senior vice president and chief medical officer at OhioHealth. He has years of experience leading large teams in successfully dealing with important healthcare issues in Ohio and prepared OhioHealth to deal with the threat of Ebola and the H1N1 flu pandemic. Dr. Vanderhoff oversees the agency and its response to medical issues with the goal of developing and implementing public health policies to improve the health of all Ohioans.
James Duffee, MD, MPH, FAAP, has spent his life advocating for the needs of Ohio’s most disadvantaged children and has served as the chair of the CMH MAC. During COVID-19, BMCFH secured a contract with Dr. Duffee to act an as advisor for response activities. BMCFH renewed Dr. Duffee’s contract to leverage his clinical expertise on BMCFH initiatives to improve access and care for children and adolescents.
Cynthia Shellhaas, MD, MPH provides medical consultation to BMCFH programs serving reproductive age and pregnant women, children, and families and guides ODH’s work in fetal, child, and pregnancy fatality and mortality reviews. Dr. Shellhaas is a licensed OB/GYN specializing in maternal-fetal medicine (high risk obstetrics) and holds a full-time faculty position in the Ohio State University's department of OB/GYN.
Dr. Homa Amini, DDS, MPH, MS provides general supervision, training, and technical assistance to the ODH Oral Health Program staff. This includes advising and training on program planning, clinical oral health practices, and program implementation. Dr. Amini also provides training to local School-based Dental Sealant Program staff.
MCH Workforce Capacity
The BMCFH has 223 positions in the ODH organizational chart and as of August 2021 employs 179 individuals. Many BMCFH staff are supported by multiple funding sources. Across all bureaus, 139 staff receive Title V funding for a total of 86 FTEs funded by the MCH BG. Across ODH, 400 staff are eligible for retirement within the next five years. Among the 179 BMCFH staff, 39 are eligible for retirement within the next five years.
Starting in March 2020, the state of Ohio quickly adapted to address COVID-19 and remains committed to addressing inequities in these areas and across all health-related topics. MCH services were transitioned to telehealth/remote options to ensure access to MCH programs and many MCH staff have supported the response. During the COVID-19 outbreak, nearly 50 BMCFH staff have contributed to the state’s response. Specifically, BMCFH staff have been assigned full-time or volunteered part-time for Ohio’s COVID-19 call centers, participated on state workgroups to develop guidance for sectors operating safely, participated in the Minority Health Strike Force, led the data team responsible for creating the Ohio Public Health Advisory System, and provided support for the state’s population study of coronavirus infection. Staff not involved in the COVID-19 response have assumed additional duties to continue non-COVID-19 operations. As of July 2021, most MCH staff have returned from COVID-19 response duty and MCH programs have provided guidance for the resumption of face-to-face services where appropriate.
ODH and BMCFH maintain resources for recruiting, training, and retaining a qualified workforce. Plans for addressing workforce capacity are in section III.E.2.b.i MCH Workforce Development.
Bruce Vanderhoff, MD, serves as director of the agency. Director Vanderhoff’s previous experience includes serving as Chief Medical Officer for ODH and more than a decade as senior vice president and chief medical officer at OhioHealth.
Jamie Carmichael serves as the Chief Health Opportunity Officer leading initiatives to advance equity at ODH and across state agencies. Jamie previously served as deputy director of public affairs for the Ohio Department of Mental Health and Addiction Services.
Dr. John M. Weigand, a central Ohio physician who has served as a leader in the state’s COVID-19 pandemic response, has been appointed Medical Director at the Ohio Department of Health and the Ohio Department of Aging.
Dr. Tabitha Jones-McKnight, a pediatrician with a master’s degree in public health, joined the department as assistant medical director, after serving with Nationwide Children’s Hospital and Ohio University.
Jennifer Voit serves as Chief of Health Programs, which in addition to the BMCFH, includes the Bureaus of Environmental Health and Radiation Protection, Health Preparedness, and Health Improvement and Wellness. Jennifer previously served as Director of Complex Care, Healthy Weight and Nutrition, for Nationwide Children’s Hospital, and Vice President of Programs for Big Brothers Big Sisters of Central Ohio.
Dyane Gogan Turner, MPH, RD/LD, IBLCLC, serves as the Title V Director and Chief of the Bureau of Maternal, Child, and Family Health. She has more than 25 years of public health experience working with the Supplemental Nutrition Program for Women, Infants, and Children (WIC), Child and Adult Food Care Program, and Title V Maternal and Child Health programs.
Anna Starr serves as the Assistant Chief for the Bureau of Maternal, Child, and Family Health and has previously served as Interim Chief as well as section administrator for Child and Specialty Health. Anna has over 35 years of experience in maternal and child health.
Patrick Londergan and is the Director of Children and Youth with Special Health Care Needs. Patrick has over 20 years of experience in the Children with Medical Handicaps Program, serving as the administrator of the program for 15 years.
Rhonda Huckaby serves as the Title V Maternal Child Health Block Grant Coordinator and previously served as a Domain Group leader within the BMCFH.
Reena Oza-Frank has extensive training and expertise as a Maternal and Child Health epidemiologist. She manages the Data and Surveillance section for the Bureau. Dr. Oza-Frank leads the State System Development Initiative (SSDI) and Ohio Pregnancy Assessment Survey (OPAS).
Maurice Heriot was hired as the BMCFH Financial Program Manager in March 2018. Prior to this position, Maurice served as fiscal liaison for MCH within the Office of Financial Affairs.
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