Population Characteristics

 

For population characteristics, see Overview of the State.

 

COVID-19 Data Collection and Analyses

 

Surveillance of Emerging Threats to Mothers and Babies

Tennessee continued to receive CDC’s Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) and partner with the MCH/Title V Program to inform data to action efforts for COVID-19. SET-NET data dashboards and infographics are published in English and Spanish to the Pregnancy and Infant Care COVID-19 Website, quarterly. Data are regularly presented to the Perinatal Advisory Committee and the Health Disparities Task Force. In 2022, Tennessee partnered with SET-NET to inform six-month outcomes of infants born to people with SARS-CoV-2 in pregnancy in a Pediatrics article, breastmilk feeding among people with SARS-CoV-2 infection in pregnancy in a American Journal of Public Health article, preterm birth among pregnant people with SARS-CoV-2 infection in a Journal of Perinatology article, neonatal SARS-CoV-2 infection in a Pediatric and Perinatal Epidemiology article, and recurrent SARS-CoV-2 infection after COVID-19 illness in pregnancy in Emerging Infectious Diseases. In addition, Tennessee partnered with SET-NET to inform Mpox cases among cisgender women and pregnant persons in a MMWR article.

 

Pediatric COVID-19, Multisystem Inflammatory Syndrome, and COVID-19 Vaccines

Pediatric COVID-19 cases as well as MIS-C cases are publicly available as data dashboards on the Special Populations Website, monthly. To support the equitable rollout of the pediatric COVID-19 vaccine, maps of pediatric vaccine (5-11) uptake rates by county were published monthly and shared with community partners. Due to changing COVID-19 burdens over the past year, community partnership meetings have transitioned to quarterly.

 

New Data Collection & Analysis Efforts

 

Neonatal Abstinence Syndrome Surveillance Data

The TDH Neonatal Abstinence Syndrome (NAS) Surveillance Program was established in 2013 when NAS first became a reportable condition. The 2013 to 2020 annual reports featured data on NAS cases reported by hospitals. Due to the COVID-19 pandemic and its effect on hospital reporting, data from new sources (hospital discharge data and birth statistical data) were analyzed and incorporated into the 2021 data report. The inclusion of additional data sources provides a more comprehensive picture of NAS in Tennessee.

• The number and rate of NAS cases reported to TDH directly increased each year from 2013 to 2017 until a decrease was observed in 2018 and again in 2019. In 2020 there were 835 reported cases (10.2 per 1,000) and 734 in 2021 (9.1 per 1,000).
• Analysis of hospital discharge data (using the ICD-10 diagnostic code most often used in NAS cases, P96.1), however, showed an increase from 793 in 2020 to 830 in 2021, translating to a rate of 10.2 per 1,000 live births in 2021.
• Geographic variability continues to be observed among reported cases, and the eastern part of the state continues to see the highest rate of reported cases.

Family Planning Telehealth Patient Satisfaction Survey

• Implemented a patient satisfaction survey for the Family Planning Telehealth Program in 2021. Data are collected on an ongoing basis and were analyzed in September 2022. Between November 1, 2021 and August 31, 2022, there were 606 Family Planning Telehealth encounters and 170 survey responses, for a response rate of 28%. Among respondents,
• The majority (85%) reported Family Planning Telehealth was their first experience with telehealth, with most (80%) reported using audio and visual through their own phone or computer.
• The most common benefits reported among respondents were not having to wait for an in-person appointment (75%) and decreased transportation time.
• Almost all respondents (99%) were given clear instruction on how to obtain their method of choice; among respondents, 61% selected birth control bills.
• The vast majority of respondents (93%) were satisfied with their Family Planning Telehealth visit and 95% would recommend Family Planning Telehealth to friends and family.

 

Pregnancy Risk Assessment Monitoring System (PRAMS)

Tennessee PRAMS conduced new analyses on stress before or during pregnancy and the impact on both preterm birth and low birth weight outcomes and created a fact sheet, highlighting common stressors included: moving to a new address (37%), a family member sick or in the hospital (26%), arguing more than usual with a partner (24%), and problems paying the bills (21%). Demographic groups experiencing more stress included: non-Hispanic Black women, unmarried women, women who reported depression prior to pregnancy, women aged less than 20 years, and those with Medicaid insurance coverage at delivery. TN did not find that overall stress to be associated with birth outcomes; however, analyses noted non-Hispanic Black women had a higher likelihood of low birthweight and preterm birth regardless of stress experiences.

 

Tennessee PRAMS also conducted new analyses on postpartum depressive symptoms, creating a fact sheet. In Tennessee, one in six women reported postpartum depressive symptoms during 2016-2019. The strongest factors associated with postpartum depressive symptoms included: depression prior to pregnancy, intimate partner violence, smoking prior to pregnancy, and preterm birth.

 

National Survey of Children’s Health Oversample

Through collaboration with the Division of Health Disparities Elimination, FHW applied for an oversample of Black and Hispanic respondents for the National Survey of Children’s Health starting in 2022 for an initial period of two years. The initial results of the oversample should be available in October 2023.

 

Severe Maternal Morbidity Analyses

TDH received the HRSA Maternal Health Innovation grant award in 2022. One key proposal in the grant was to analyze severe maternal morbidity data. In 2021 – 2022, FHW, in partnership with the TDH Office of Informatics and Analytics, successfully added and linked birth certificate data into the Integrated Data System (IDS), through support of the HRSA Emerging Issues in MCH grant. In 2023, two FHW epidemiologists supporting the Maternal Health Innovation grant were approved for access to the IDS to complete analysis for severe maternal morbidity using linked birth certificate and hospital discharge data.

 

Tennessee Department of Health Roadshows

The roadshow is an annual event that takes place between January-March of each year. Several Central Office based offices/divisions met with metro health department health promotion staff, as well as select local and regional staff. In 2023, a key component of the road show included local and regional staff to participate in a root cause analysis of various issues in their communities The following were the most common topics to analyze:

• Mental health
• Substance use disorder
• Immunization rates
• Obesity
• Affordable housing
• Public health employee retention

 

TN Department of Human Resources State Enterprise Exit Survey: Health

Tennessee State Enterprise Exit Survey results for the Tennessee Department of Health was conducted from March 2022 through February 2023. This survey identified workforce-related opportunities to address turnover and improve retention. For Health, there were 427 eligible separations and 80 respondents, with 12 identified as working within Family Health and Wellness. The top reasons for leaving included low pay, lack of supervisory trust, and no room for professional advancement. Survey respondents indicated inadequate onboarding and training, ineffective supervisory and leadership support, and feeling unappreciated and a lack of recognition.

 

Advisory Councils

 

There are specific advisory councils required by state law:

• Traumatic Brain Injury Advisory Council continues to meet quarterly and has nine members.
• Genetic Advisory Committee meets three times a year and has 18 members. Membership includes the directors of the genetics and hemoglobinopathies centers, subspecialists, and a consumer representative.
• Perinatal Advisory Committee meets three times a year and has 21 members. Membership includes co-directors of the five regional perinatal centers, other neonatal and obstetric providers, and a consumer representative.

 

Other work groups or task forces also support MCH/Title V work to engage with a multidisciplinary team of partners. Examples of these groups include:

• Maternal Health Task Force
• Lead Advisory Committee
• Birth Defects
• Hearing Advisory Committee
• Suicide Task Force
• Injury Prevention Coalition
• Health Disparities Task Force

 

Changes in Health Status and Needs of the State’s MCH Population

 

National Outcome and Performance Measures

There are 9 Outcome and Performance Measures with significant improvement in Tennessee since baseline from data reported in the 2023 Federally Available Document:

• Neonatal abstinence syndrome decreased from 16.9 per 1,000 birth hospitalizations in 2015 Q1-3 to 9.6 in 2020 (NOM-11)
• HPV vaccination increased from 48.7% among adolescents 13-17 in 2015 to 75.3% in 2021 (NOM 22.3)
• Tdap vaccination increased from 79.7% among adolescents 13-17 in 2015 to 92% in 2021 (NOM 22.4)
• Meningitis vaccination increased from 76.7% among adolescents 13-17 in 2015 to 88% in 2021 (NOM-22.5)
• Teen births decreased from 30.6 per 1,000 among 5–19-year-olds in 2015 to 21.5 per 1,000 in 2021 (NOM-23)
• Low-risk cesarean delivery decreased from 27.6% in 2015 to 26.6% in 2021 (NPM-2)
• Developmental screening among children, ages 9 through 35 months increased from 26% in 2016 to 44% in 2020-2021 (NPM-6)
• Transition among non-CYSHCN aged 12-17 increased from 12.1% in 2016 to 19.8% in 2020-2021 (NPM-12)
• Smoking in pregnancy decreased from 14.3% in 2015 to 9.1% in 2021 (NPM-14.1)

 

There are 8 Title V Outcome and Performance Measures with significant worsening since baseline:

• Early term birth increased from 26.6% in 2015 to 29.7% in 2021 (NOM-6)
• Tooth decay/cavities among children 1-17 years increased from 8.9% in 2016 to 12.8% in 2020-2021.
• Adolescent mortality among 10–19-year-olds increased from 39.8 per 100,000 in 2015 to 54.9 per 100,000 in 2021 (NOM-16.1)
• Adolescent motor vehicle death among 15–19-year-olds increased from 15.1 per 100,000 in 2014-2016 to 20.6 in 2019-202 (NOM 16.2)
• Flu vaccination among children 6 months to 17 years decreased from 61.8% in 2015-16 to 54.2% in 2021-2022 (NOM-22.2)
• Child injury hospitalization among children 0 through 9 years increased from 109.3 per 100,000 in 2015 Q1-3 to 130.3 in 2020 (NPM-7.1)
• Adolescent injury hospitalization among children 10 through 19 years increased from 191.2 per 100,000 in 2015 Q1-3 to 233.1 in 2020 (NPM-7.2)
• Adolescent physical activity among children 12 through 17 years decreased from 22.4% in 2016 to 13.8% in 2020-2021 (NPM-8.2)

 

Overall

The 2023 Vanderbilt Child Health poll aimed to gather insights from Tennessee parents regarding their children. A representative sample of 1,034 parents in the state was surveyed in Fall 2022. The top five concerns parents had for kids were: 1) education and school quality, 2) child mental health & suicide, 3) bullying & cyber bullying, 4) school gun violence, and 5) drug and alcohol use. Parents’ report of their child’s overall wellbeing has declined from 87.1% in 2019 to 81.6% in 2022.

 

Emerging Issues

 

Food Insecurity

Over 40% of Tennessee families reported low or very low food security in 2022, an almost 10% increase from 2021, according to the Vanderbilt Child Health Poll. Over 70% of families have changed their spending habits due to an increase in food prices, with almost 30% of those parents skipping meals.

 

Child Homicide Deaths

In 2020, 67 Tennessee children died of homicide, a rate of 4.4 deaths per 100,000 children; the highest number and rate over the past five years. Tennessee consistently is above the national rate of 2.2 per 100,000 from 2019. Firearms were used in 75% of homicide deaths among children. Additionally, child homicide deaths persist in disproportionately impacting Black children.

 

Mental Health

Since the COVID-19 pandemic, mental health continues to be critical issue in Tennessee. According to the Vanderbilt Child Health poll, ~1 in 3 parents reported a diagnosis of attention deficit hyperactivity disorder, anxiety or depression in 2022, a 7% increase since 2019. The Tennessee Youth Risk Behavior Survey 2021 results support this, as they found 42.5% of high school students felt sad or helpless almost every day for greater or equal to 2 weeks in a row so that they stopped doing some usual activities; this represents a significant increase from 2015 (28.0%). Additionally in 2021, 22.8% of high school students seriously considered suicide, which represents an increasing trend since 2011, when the percentage was 14.7%.

 

Pregnancy-Associated Mortality

In 2020, 98 women in Tennessee died during pregnancy or within the year after pregnancy. There were 46 pregnancy-related deaths, which translates to a pregnancy-related mortality ratio of 58.5 deaths per 100,000 live births, a 51% increase from 2017 – 2019. In 2020, more than 3 out of 4 deaths were deemed to be preventable, and discrimination contributed to 1 in 3 pregnancy-related deaths.

 

Drug Overdoses and Opioid Prescriptions

From the Tennessee Hospital Discharge Data System, in 2021, there were 7,110 nonfatal overdoses in the state among women aged 15-44 years (defined through the International Classification of Diseases, Version 10, Clinical Modification Codes T36-50), an increase of 3.6% from 2020. The burden of opioid prescriptions for pain is also high: in 2021, 240,418 women aged 15-44 filled at least one prescription for opioids for pain. The overall number of prescriptions for pain filled by women of reproductive age in 2021 was 517,2286.

 

Home Births

In 2022 provisional birth data, 1.5% of all births were intended home births (N=1285), a significant increase from 2017, when intended home births comprised 0.9% of all births. There were 543 more intended home births in 2022 compared to 2017. Looking across the state, public health regions varied from 0.7% to 4.3% in births that were intended home births. To ensure timely access to newborn screening for these home births, TDH added functionality to the Tennessee Newborn Screening Performance Indicators Dashboard to track screening for home births.

 

Electronic Vapor Products

In 2021 Tennessee Youth Risk Behavior Survey, 39.5% of high school students reported ever using an electronic vapor product, including e-cigarettes, vapes, vape pens, e-cigars, e-hookahs, hookah pens and mods (such as JUUL, SMOKE, Suorin, Vuse, and blu). While there is no change in trend after controlling for sex, race/ethnicity, and grade since 2015 (41.6%), the outcomes associated with electronic vapor products in adolescents remains a high concern.

 

Changes in Title V Program Capacity or MCH Systems of Care

 

FindHelpNowTN

TDH led the development of a real-time treatment locator to help those with substance use disorders, www.findhelpnowtn.org. A formal launch occurred in March 2023. This site allows people to search for treatment providers based on location and insurance payor. Additionally, an option to select pregnancy/postpartum specific treatment resources was built into the platform. As of May 2023, FindHelpNowTN has 263 facilities onboarded to its referral website of treatment facilities, both inpatient and outpatient. Of those, 189 have indicated they serve pregnant/postpartum populations. Of those, 110 serve both Adolescents and Adults, 2 serve Adolescents only, and 77 serve Adults only. Out of the 189 facilities that served pregnant individuals, only 27 (14%) were located in rural areas. There was at least one facility in 65 out of 95 counties in Tennessee. Of the thirty counties without any facility, nine are considered rural, according to the HRSA Federal Office of Rural Health Policy.

 

Family Medicine Student Loan Repayment

New legislation passed in 2023 creates a family medicine student loan repayment program that will incentivize resident doctors to provide medical health services in Tennessee health resource shortage areas following completion of their training. The legislation authorizes the Department of Health to award family medicine student loan repayment grants to qualifying physicians of up to $40,000 per year for a maximum of five years. The Department of Health is authorized to use private donations, grants, federal and state funds to maintain the loan program.

 

Women’s Reproductive Health Services

In March of 2023, the Office of Population Affairs made the decision to no longer grant Title X funds to Tennessee. This removed over $7 million of federal funds from Tennessee’s Family Planning annual budget. With Governor approval and support, an additional $7.5 million dollars of state funds were allocated for family planning services to fill the gap. The Tennessee Family Planning Program plans to continue to expand access to contraception, reproductive health screenings and preventive care for individuals and families in Tennessee.  

 

New Grants to Promote MCH in Tennessee

 

Tennessee Strong Families

The Governor’s FY 2024 budget contained significant maternal and child health investments as part of a multi-pronged approach to health counteract factors contributing to infant and maternal mortality. The budget contains $2.3 million for perinatal telehealth infrastructure, $2 million in investments in regional perinatal centers and EMS training, $1.3 million for expansion of Community Health Access and Navigation in Tennessee to allow for expanded work with care coordinators and increased outreach using community health workers, and $1 million for a doula pilot program (non-recurring).

 

Maternal Health Innovation

In 2022, Tennessee received the HRSA Maternal Health Innovation grant, a 5-year $5 million award, to fund community and clinical programs to improve maternal health outcomes in the state. Over the grant cycle, Tennessee will

• Enhance the maternal health task force in Tennessee and develop a maternal health strategic plan
• Strengthen capacities for data collection and analysis to implement maternal health clinical quality improvement projects
• Launch new maternal health service delivery activities (e.g., improving access to services during pregnancy and the postpartum period; equipping the maternal and child health workforce with new training and resources).

Evidence-Based Home Visiting

Tennessee received an additional $25 million in recurring state funding to continue evidence-based home visiting expansion in 2023. Tennessee now offers home visiting programming in each of the 95 counties in the state and will continue expansion efforts to reach eligible families. Additionally, TN EBHV programs received an additional $2.2 million in American Rescue Plan Act (ARPA) funding in 2022. In FY2022, Tennessee was awarded $2 million as a Maternal, Infant, and Early Childhood Innovation Award to develop TN Early Connect (TEC), a collaborative referral mechanism between the Tennessee Department of Human Services, TennCare, and TDH for earlier identification and enrollment of pregnant women into evidence-based home visiting.

 

Tennessee Pediatric Mental Health Care Access Program

Children's behavioral health needs continue to grow, further exacerbated by COVID-19, and the number of mental health providers is insufficient to meet the needs. In 2021, Tennessee received this grant to promote behavioral health integration into pediatric primary care by supporting pediatric mental health care telehealth access programs. In 2023, Tennessee received $300,00 in additional expansion funds to support this work.

 

Improving State-level Preparedness through Measuring Improvements to the System of Care

In 2022, TDH’s partner, Tennessee Chapter of Family Voices, received this small project grant to improve the state system of care for preparedness by centering the needs of families, including youth, on emergency preparedness communication, education, and resource needs, with specific focus on those with technological dependence. Additional funds ($17,000) to continue this work were awarded through July 2023.

 

Workforce Development

CDC provided Tennessee funds through the Cooperative Agreement for Emergency Response:  Public Health Crisis Response to establish, expand, and sustain a public health workforce.  Part of the funds have been used to provide software training (SAS, ArcPro, and Tableau).  FHW epidemiologists have participated in these trainings.

 

State Title V Partnerships and Collaborations

 

Tennessee’s MCH/Title V program continues to partner with numerous entities at the federal, state, and local level to serve the legislatively defined MCH populations and to expand the capacity and reach of the state MCH/Title V and CYSHCN programs. Existing partnerships are highlighted within the annual report.

 

One highlight of collaboration this past year has been our Presumptive Eligibility Program collaborating with Federally Qualified Health Centers to meet pregnant women at the place of their prenatal care to ensure they receive timely insurance coverage. The PE Program has been working with both East Tennessee State University's Johnson City Community Clinic and Memphis Health Center to establish contracts for Presumptive Eligibility to be located within these Federally Qualified Health Centers. 

 

Another collaboration has been the American Academy of Pediatrics “Improving State-level Preparedness through Measuring Improvements to the System of Care” project,  which features collaboration between TN Chapter of Family Voices, parents of children with technological dependence, TDH’s Emergency Preparedness and Response Office and Division of Family Health and Wellness, Children’s Emergency Care Alliance of Tennessee (CECATN), and Le Bonheur and Vanderbilt University Medical Center’s Children’s hospitals. The goal of the project is to improve parent satisfaction and knowledge of emergency preparedness at discharge from children’s hospitals, specifically for families navigating technology-dependent medical devices, such as ventilators or oxygen concentrators. Two pilot sites are working to test devices and tools, including DC power adaptors, electronic medical id cards, and a discharge checklist and conversation guide to improve parent satisfaction and emergency preparedness and readiness.

 

The MCH/Title V CYSHSN program has a staff member responsible for Family/Youth Engagement and Involvement whose primary responsibility is to work with Family Voices to ensure opportunities for family and youth training on patient centered medical homes, transition, and policy/advocacy. In addition, several programs continue to expand their own advisory and family groups to better inform programs and services, including recruitment of regular parent participants in the Perinatal Advisory Committee and Genetics Advisory Committee. Likewise, the Community Health Access and Navigation in Tennessee (CHANT) program has incorporated family engagement to assure that the needs of children and families are being met appropriately.

 

Efforts to Operationalize Needs Assessment Process and Findings

 

Organizational Structure for Title V Priorities

Each priority has a priority lead and an epidemiology lead. The priority lead is a Section Chief within FHW with subject matter expertise in the designated priority. The epidemiology lead is an epidemiologist within FHW who works closely with programmatic data to inform the activities around the priority. There are also supporting internal staff with expertise in each subject area. Each team continued to work closely with the new FHW Physician Liaison for Health Equity to advance health equity specific strategies in the action plan to decrease disparities identified in each priority area.

 

Partner Meetings

External partner meetings were held for each priority in October 2022 and April 2023 led by the priority and epidemiology leads. The focus of the presentations was to engage partners to reflect on the current progress and offer input to proposed action plans for Year 4, including ways in which partner organizations may support the strategies and activities planned for the upcoming block grant year. Meetings were held virtually by priority area to increase participation and engagement statewide.

 

FHW Staff Capacity Building for Programmatic Alignment and Management

Overall, 2022 – 2023 FHW Program Managers meetings prioritized management topics as well as aligning programmatic work to de-silo efforts across the Division. For management topics, staff had further opportunities on how to work as an intergenerational team, how to be great manager, and best practices for writing and reviewing a job plan. The two main programmatic areas focused on this past year were adolescent and child health initiatives. Program and epidemiology staff presented on their programmatic areas and then were paired with different programs within the Division with the goal of finding alignment and opportunities for program amplification. Additionally, staff met to discuss ways to better incorporate those with lived experience as well as men/fathers/parenting partners in FHW programs.

 

Strategic Plan Development

The Division of Family Health and Wellness initiated a strategic planning process in 2023 with guidance from the TDH Office of Strategic Initiatives. During the May 2023 Division meeting, input on mission and vision was collected. The next stages of the process will involve input on values and strategic areas of focus during the summer of 2023, identifying key goals for each focus area in Fall 2023, and finalizing a plan by December 2023.

 

Tennessee Health Disparities Task Force

The Health Disparities Task Force was formed in April 2020 to engage leaders from non-profit and faith-based organizations, academia, health care and local and state government agencies. Members meet weekly and collaboratively generate responsive solutions and policies to reduce disparities and to ensure equitable access to health care, resources and services. Staff from FHW Programs often present and seek community feedback during these meetings. This year, presentations have focused on: MPX updates, sickle cell disease, Ryan White Program, TN Vitality Toolkit, TN State Parks, Lead, radon awareness, lead, Alzheimer's disease.

 

Changes in Organizational Structure and Leadership

 

Division and Programmatic Transitions

Opioid Response Coordination Office

In January 2023, the Opioid Response Coordination Office was moved to the Division of Family Health and Wellness. The Office has twelve staff, including two Public Health Administrator 2 positions, 2 epidemiologists, 2 nurse practitioners, and six program and support staff and oversees approximately $6.4 million.

 

Key Staff Transitions

FHW transitions over the past year have filled key roles as well as presented new gaps to fill to address key emerging issues:

 

FHW

• Title V Program: Dr. Tobi Amosun, Title V Director, was promoted to Deputy Commissioner of Population Health in May 2023 and Title V Director position is vacant. Ashley Moore, MPH, has been in block grant coordinator role since May 2022 and was promoted in April 2023. The coordinator role was filled by Elizabeth King, MS in May 2023.
• Health Equity: Dr. Hector Carrasco started as the Family Health and Wellness Health Equity Director in Fall 2022.
• Reproductive and Women’s Health: Dr. Hannah Dudney, MD, FACOG, started as the Women’s Health Physician Consultant, a new position within FHW in Fall 2022.
• Deputy Director of Child Health and Injury Prevention: Carla Snodgrass retired as Deputy Director in December 2022 and was filled by Rachel Heitmann in January 2023. Rachel Heitmann resigned in June 2023 and the position is currently vacant.
• Section Chief of Injury Prevention: When Rachel Heitmann was promoted to Deputy Director in January 2023, the Section Chief of Injury Prevention was vacant. Ashley Moore, MPH was promoted to Section Chief of Injury Prevention in April 2023.
• MCH Emergency Preparedness: Yolanda Vaughn started in March 2022 and is responsible for efforts aimed at prioritizing systems of care gaps for emergency preparedness, a new position. Ms. Vaughn stepped down in March 2023 and the position is vacant.
• SSDI: Hanna Santuro started in September 2021 and transitioned to coordinate the SSDI grant and other data modernization initiatives in Fall 2022. Ms. Santuro stepped down in March 2023 and the position is vacant.

• CDC/CSTE Applied Epidemiology Fellowship: Emily Lumley, MPH, concluded their CSTE Fellowship in April 2023. Carissa Rodriguez, MPH, matched with the Tennessee Department of Health FHW and starts her Fellowship in August 2023.
• Technical Training: Amira Wooten provides coordination for SAS, Tableau, and ArcPro courses available to TDH employees.
• Fellows and Interns: FHW seeks to strengthen the MCH pipeline through connecting with interns and fellows early in their careers.
  • TDH Public Health Executive Fellows: FHW matched with two fellows starting in June 2022 to increase communications capacity and support MCH/Title V implementation efforts. Tiara Kemp, concluded her Fellowship in June 2023. Octavia Forrest will continue her Fellowship for an additional year.
  • Title V Interns: TDH matched with 2 Title V interns to support family planning and reproductive health efforts in Title V priorities and emerging issues in Summer 2023.Tennessee Department of Health

• Commissioner: Lisa Piercey stepped down as Commissioner in May 2022. Governor Lee appointed Morgan McDonald, former Tennessee MCH/Title V Director, to the interim position starting in June 2022. Governor Lee appointed Dr. Ralph Alvarado as Commissioner, starting in January 2023.
• Deputy Commissioner of Population Health: Dr. Tobi Amosun was promoted to Deputy Commissioner of Population Health in May 2023, leaving the Assistant Commissioner of Family Health and Wellness vacant.