The Maternal and Child Health Epidemiology (MCHE) Unit provides centralized epidemiologic, data, research, and reporting support to all Maternal and Child Health (MCH) programs. MCHE provides Title V program areas with various support including expert statistical analysis, data management, performance measure reporting, geographical and spatial analyses, research studies and consultation, and program evaluation and monitoring. All staff are highly skilled in multiple and complex computer programming languages and software (e.g., Access, ArcGIS, Python, R, SAS, STATA, Tableau) and all received MCH research, epidemiology, and program evaluation specialized training.

MCHE directs the State Systems Development Initiative (SSDI) and the Texas Pregnancy Risk Assessment Monitoring System (PRAMS) both items are used to inform MCH policy and practice. Please refer to the supporting documents for key MCHE publications and presentations and the grant application’s workforce development section. MCHE leadership encourages staff to work across teams to understand and track life course indicators, family engagement projects, and research in these areas. All MCHE positions are funded by Texas’ Title V Block Grant Maintenance of Effort or Title V Block Grant. In October 2022, the MCHE unit was restructured into three branches: Advance Analytic Branch (AAB), Epidemiology Branch (EB), and Maternal Mortality and Morbidity Epidemiology Branch (MMMEB) each managed by an Epidemiologist IV/Manager position. These three Epidemiology IV positions were the first ever created at the Department of State Health Services (DSHS). The restructure forms a career ladder for staff, facilitates cross branch collaboration, and improves the staff-to-manager ratio.

MCHE Leadership & Support Staff

Dyanne Herrera-Vasquez, PhD was promoted to MCHE Director from within the unit in May 2023. She has been with the MCHE unit since 2020 - first as an Epidemiologist III and then as the Epidemiologist IV/Advance Analytics Branch Manager - and is familiar with many of the unit’s programs and efforts. She has her doctorate degree in Interdisciplinary Health Sciences and her Master’s degree in Public Health Epidemiology. She was also a former Council of State and Territorial Epidemiologist (CSTE) Applied Epidemiology Fellow. Her expertise is in survey research, infant mortality, and border health, and she also has other state Title V and management experience. She directly oversees the EB Manager, the MMMEB Manager, the AAD Manager, and the unit’s Administrative Assistant. The MCHE director and branch manager epidemiologists all have the training and skillsets needed to perform at the highest level possible.

Advance Analytics Branch (AAB)

The ABB provides technical expertise and advanced skillsets the other two branches utilize if they need project assistance. This team focuses on many data management technical aspects including: 1) the unit’s birth, death, and fetal death file processing, 2) the unit’s DUAs and memorandums of understanding (MOUs) maintenance, 3) reviewing other staff outputs, 4) providing agency-wide technical guidance on data sharing and the implementation of an ArcGIS and Tableau server  to enhance Texas’ ability to streamline MCHE mapping and dashboarding, and 5) focusing on MCHE’s public health research agenda and innovative analyses. This team consists of one Epidemiologist IV/Branch Manager, an Epidemiologist III, a Research Specialist IV, and a Creative Media Designer III who focuses on graphic design and data dissemination.

Epidemiology Branch (EB)

The EB focuses on the health of women of childbearing age, infant health, child health, adolescent health, Children and Youth with Special Health Care Needs (CYSHCN) health, and oral health, children and pregnant women dental screening data. The staff supports the Healthy Texas Mothers & Babies (HTMB) Data Book, legislatively mandated postpartum depression (PPD) report data collection, the Infant Feeding Practices Survey (IFPS), PRAMS, and the newborn screening Texas Early Hearing Detection and Intervention (TEHDI) program data.  This branch also supports programmatic work of the MCH Unit, Child and Adolescent Health (CAH) Branch and the Oral Health Improvement Program.

The EB consists of 7 full time employees (FTEs):

• One Epidemiology IV/Branch Manager – who oversees EB activities and is the SSDI coordinator;
• Two Epidemiologist IIIs – one position focuses on oral health and one position focuses on Title V analytics, infant health, and is the SSDI analyst; and
• Four Research Specialist Vs – one position each is:  the Needs Assessment Coordinator, the PRAMS Coordinator, focused on PRAMS analytics, women’s health, and supports THMB development, focused on children and adolescent health and CYSHCN.

Amanda Garrison, the Title V Needs Assessment Coordinator, joined the team in December 2021. Amanda received her a master’s degree in public health and a master’s degree in social work from Washington University in St, Louis, Missouri where she concentrated in International Social and Economic Development. Before her master’s degree work she attended Baylor University where she majored in Social Work.

Savannah Larimore, Ph.D., is an epidemiologist in the MCHE Unit at the Texas Department of State Health Services. In this role, Dr. Larimore manages the Maternal Mortality & Morbidity Epidemiology Branch, where she and her team collect and analyze data related to maternal mortality and morbidity in Texas, including gathering data for the Texas Maternal Mortality and Morbidity Review Committee as well as Texas AIM. She received her Ph.D. in Sociology, with concentrations in Demographic Methods and Social Statistics, from the University of Washington in 2019.

PRAMS Working Group: MCHE created this group for the PRAMS Coordinator to have a working team to assist with monthly PRAMS grant requirements. The team consists of the PRAMS Coordinator, the PRAMS Analyst Research Specialist V, the EB Manager, AAB Manager, and the Creative Media Designer III. The team created a new interactive PRAMS dashboard launched in 2021 and is preparing for the Phase 9 questionnaire in Summer 2023.

Title V Needs Assessment Working Group: MCHE works between branches on the comprehensive 5-year needs assessment which is a critical and mandatory Title V Block Grant application/report component.  MCHE established this internal working group for each unit domain specialist to discuss progress and issues as Texas begins the 2025 Title V Needs Assessment process.  The Needs Assessment Coordinator leads this group and the team consists of one Research Specialist V (HTMB analyst), 1 Epidemiologist III (SSDI analyst), the MCHE Director, the AAB Manager, and the EB Manager.

Maternal Mortality and Morbidity Epidemiology Branch (MMMEB)

The MMMEB focuses their work on maternal mortality and morbidity programs and epidemiology, surveillance, evaluations methods to support the Texas Maternal Mortality and Morbidity Review Committee (MMMRC) work and TexasAIM (a statewide quality improvement program to address maternal safety). This branch consists of 7 agency FTEs and 4 temporary workers:

• One Epidemiologist IV/ Branch manager – who oversees the branch and serves as the subject matter expert for maternal mortality and morbidity;

• One Epidemiologist III - this position is the MMMRC data analyst and data linking specialist;

• Two Epidemiologist IIs - one position works on TexasAIM data assistance and severe maternal morbidity (SMM) and one position oversees work related to maternal deaths due to violence;
• Three Research Specialist Vs - one permanent research position focuses on MMMRC data analytics and assists with MMMRC workload, and two temporary positions that focus on reviewing potential pregnancy-associated case cohorts;
• One Records Analyst - this position focuses on MMMRC record requesting and record retention;
• Two temporary Clerks - these staff focus on MMMRC record requesting and
• One Research Specialist IV - This person reports to DSHS Center for Health Statistics (CHS) management and participates in all required MMMRC data linking per the MCH data use agreement (DUA) with CHS.

All epidemiologists and research specialists must have at least a master’s degree with a preference for experience working on MCH issues and knowledge in the SAS statistical programming language.

The MCHE unit is hosting a Council of State and Territorial Epidemiologist (CSTE) Applied Epidemiology Fellow from Fall 2022 to Fall 2024 and a DSHS Texas Public Health Fellow from Summer 2022 to Summer 2023. These fellows assist with the various MCHE activities and research. Current projects relate to PRAMs, oral health research, and developing a study about Adverse Childhood Experiences.

State System Development Initiative (SSDI)

The MCHE Director serves as the SSDI Project Director (PD) and provides data analytic guidance across the unit. In support of SSDI project goals, MCHE provided scientific and analytical assistance and expertise for a variety of Title V MCH Block Grant activities including the 5-year needs assessment, data analysis help, interview transcription, data entry, and the Title V MCH Block Grant application/annual report writing.

Major SSDI program activities completed during this budget period include:

• Completed the Texas MMMRC-created Discrimination Assessment and Social Determinants of Health (DASH) Facilitated Discussion Tool evaluation.
• Provided data linking expertise to the Texas TEHDI program to improve linking vital events and EHDI data as part of the CDC EHDI grant. The Texas team improved matched records  counts from 3% to 51.5% of all EHDI records;
• Participated as 1 of 4 state health agencies in the Association of State and Territorial Health Officials (ASTHO) Linking PRAMS and Clinical Outcomes Data Multi-Jurisdiction Learning Community to link vital events to address maternal pregnancy experience questions;
• Provided 2024 Title V MCH Block Grant reportand 2022 application data content;
• Updating the 2019 PRAMS interactive dashboard by consolidating previous reports to make data more accessible while providing more information;
• Provided MMMRC legislative report analyses including SMM and TexasAIM data analysis to improve hospital hemorrhage and hypertension outcomes;
• Presented data at: the Texas Medical Association, the Texas Public Health Association Annual Education Conference, and the Texas Collaborative for Healthy Mothers and Babies (TCHMB) Summit;
• Presented a poster at the 2022 CSTE annual conference on regional differences on Perinatal Periods of Risk (PPOR) analysis;
• Submitted the 5-year Pregnancy Risk Assessment Monitoring System (PRAMS) grant application to CDC and completed the annual Texas A&M University (TAMU) Public Policy Research Institute (PPRI) contract renewal for Phase 9 data collection including survey materials and survey booklet printing, postage, completed survey data entry, telephone survey interviews, interviewer training, and participation incentives;
• Presented novel analysis on Severe Maternal Morbidity (SMM) to the DSHS Disparity Advisory Committee;
• Attended workforce development conferences including the Healthier Texas Summit, the Association of Maternal and Child Health Programs (AMCHP), DSHS Grand Rounds sessions, Leadership and Strategic Planning for Public Health, Maternal Mortality Review Information Application (MMRIA) user meetings, and ASTHO Health Equity Summit: Action With Intention Conference and CSTE virtual annual Conference virtually;
• Published the 2022 HTMB Databook;
• Attended classes in Tableau dashboard creation, SAS data analysis, and Esri’s GIS analysis; and
• Attended and participated in DSHS Grand Rounds seminars, Data Visualization and Health Equity Training Series, AMCHP Leadership Lab, and From Data to Action for Healthy Texas Mothers and Babies presentation.