Epidemiology has a central role to play in public health, education, and research and is arguably the only discipline unique to public health. Nationally, there is a shortage of epidemiologists and epidemiological capacity within the health workforce and health research. In KY, there are approximately 115 epidemiologists in the DPH, who commonly have MPH degree(s) and enter the public health workforce as practicing epidemiologists straight out of graduate school.

Within MCH, the Program Support Branch, led by Tracey Jewell, currently oversees and directs four epidemiologists and one budget specialist who are responsible for managing/analyzing data, fulfilling data requests both internally and externally, preparing reports, presenting data, evaluating programs, conducting needs assessments, and writing grants. This branch is in the process of hiring a full-time Epidemiologist I and anticipates the posting of an additional Epidemiologist I position within the year, which will increase the total number of full-time epidemiologists within MCH to six. Within this program year, this branch has hired a budget specialist that is responsible for monitoring and maintaining budgetary needs for the Division. Additional staff appointments along with recent promotions and modest increase in compensation, this branch, has made great strides in program support and analysis to MCH as a whole. This branch will continue to provide on-going epidemiological support to MCH and OCSHCN programs, conducting surveys, needs assessments and producing data reports and publications, and having those documents more readily accessible to stakeholders.

Oftentimes with additional capacity comes with expanded workload. The need for more rigorous data and enhancements to existing surveillance systems has demanded a wider range of skillsets among epidemiologists, program support staff, and managers. Staff are more frequently being asked to evaluate existing data collection systems and make recommendations for modifications that will best meet the needs of the program and collect data in a meaningful way with the least amount of burden possible. To do this, staff must have a basic understanding of various software platforms available for data collection and storage and have a working knowledge of the most appropriate software to use for data analysis. Staff within the Program Support Branch continue to build upon their existing skills by participating in trainings related to various software options available.

The funding structure for the Program Support Branch is divided among state general funds and various sources of federal funds. Those federal funds include cooperative agreements with the CDC for conducting the following programs: Birth Surveillance Registry, Childhood Lead Poisoning Prevention and Surveillance, Pregnancy Risk Assessment Monitoring System (PRAMS), and the Sudden Unexpected Infant Death (SUID) Registry. Federal funds are also received through HRSA to conduct the following programs: Title V, State System Development Initiative (SSDI), and Maternal Infant Early Childhood Home Visiting (MIECHV). In addition, federal money through USDA for Women, Infants, and Children (WIC) are also utilized. All staff within the Program Support Branch have their salary and fringe benefits paid for by one or a combination of the state general funds or federal funds discussed above.

Project Support

There are wide range of disciplines and projects epidemiologists support both in public health and outside of DPH. While these projects may vary in terms of topic, they all have the same over-arching goal of improving the lives of the families they serve.

The Program Support Branch routinely gathers data and conducts a thorough analysis of the data to support programs and projects. In addition to data analysis and surveillance, staff also support programs by conducting needs assessments and evaluating programs. These processes help determine priority areas of focus and whether existing programs are meeting the needs of the population or if they need to be altered in any way. Conducting both a needs assessment and a program evaluation helps to ensure fiscal responsibility as well, which lends to the creditability of the agency. Other ways support for projects is achieved is through participation in steering committees, stakeholder groups, advisory committees, and grant writing.

MCH epidemiologists continue to support Title V by carrying out or assisting with data collection, analysis, and interpretation. The epidemiologist prepares data presentations for use in conducting the needs assessment, assists in the needs assessment process, and provides overall recommendations to the program based on data analysis results. Certain areas of the Title V block grant application are written by the epidemiologists and data for performance measures are collected and reviewed for accuracy by senior epidemiologists.

MCH continues to participate in a workforce project led by the Division of Epidemiology and Health Planning called Building Epidemiology Capacity in KY (BECKY). State and university partners train current public health students so they can help on state projects. This project has allowed students to work with epidemiologists on many projects and some have even participated in outbreak investigations.

Data Collection

MCH Epidemiologists currently utilize a variety of data systems and methods to collect and analyze data. Routine surveillance and analysis are dependent upon different types of data collected and the feasibility of linking multiple databases. Types of databases include, but are not limited to: vital statistics data such as birth and death data; clinical data such as childhood lead poisoning, birth defects, NAS registry, newborn screening; billing data such as hospital discharge data and Medicaid claims; service data such as WIC, HANDS (home visiting), First Steps early intervention data; survey data such as PRAMS; and other surveillance systems that include a case review component such as SUID, Child Fatality Review, and Maternal Mortality Review. Whether managed directly by MCH or direct access is obtained from the owner, these are the primary sources of data utilized for monitoring MCH programs and for Title V reporting.

Just as there are several different types of data collection systems and data itself, there are also different and numerous software systems available for data analysis. The MCH epidemiologists all have varying skill sets and preferences for software platforms, but they all work together and aid one another on a regular basis. Many of the epidemiologists utilize SAS software for analysis as well as SPSS, REDCap, ArcGIS, and MS Excel. Staff also participate in trainings to enhance current skill sets or to learn a new software system on an on-going basis.

Emerging Technology and Continued Development

MCH Program Support Branch continues to evolve with rapidly changing technology. Staff continue to enhance and learn new skills for analysis and software platforms to meet arising needs and newer technology. These skills will be built over time allowing the infrastructure to be in place to support the programs as technology changes. This will ensure that data collection and analysis will be at the forefront of support provided.

MCH Program Support Branch furthered and developed several projects in 2022. These include enhancing a few of the data collection systems to meet the changing needs of the program and allow for more flexibility with Telehealth options. Some of the data systems that are being restructured include: HANDS home visiting, Newborn Screening, and Childhood Lead Poisoning. MCH is working closely with IT developers to ensure all program requirements related to data reporting are not compromised with the re-design and all needs are met.

Another principal project in FY22 was the completion of a rewrite for the database that supports and will incorporate the capabilities of both the Healthy Homes and Lead Poisoning Surveillance System (HHLPSS) and the Childhood Lead Poisoning Prevention Program (CLPPP), or CLPPPNET systems. Both systems have been utilized in conjunction to meet the lead surveillance requirements for KY.

Work continues on the project of linking of two separate data systems into a single linked cohort. The linked cohort consists of NAS registry data and the Kentucky All Schedule Prescription Electronic Reporting (KASPER) data system. KASPER is the prescription drug monitoring program for KY and contains data on all scheduled/controlled substances prescribed. Data from the NAS registry has been linked with the KASPER data on common identifiers collected in each system. This linked cohort is being analyzed in collaboration with the Epidemiologist from the KASPER program to help determine which mothers of NAS infants were utilizing MAT and the outcomes of those infants.  Findings from this analysis have been submitted for consideration in a peer reviewed journal and currently await comments.