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 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 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 Title V Block Grant Maintenance of Effort, Title V Block Grant, or the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) grant.

MCHE Leadership & Support Staff

The MCHE Director has led the MCHE Unit since 2019. She has her doctorate degree in epidemiology and her master’s in public health epidemiology. Her expertise is in survey research and evaluation and has been in management for nine years. She directly oversees the Technical Team, the Surveillance and Data Analytics Manager, and the unit’s Administrative Assistant. The Surveillance Data Analytics Manager oversees the Healthy Texas Mothers & Babies Epidemiology (HTMB Epi) work and the Child and Adolescent Health & Oral Health Epidemiology (CAH&OH Epi) Team. Both the director and manager staff have the training and skillsets they need to perform at the highest level possible.

Healthy Texas Mothers & Babies Epidemiology Team

The HTMB Epi team focuses their work on the health of women of childbearing age, maternal health, and infant health. This team consists of 7 full time equivalents (FTEs) and 4 temporary workers which support the Texas Maternal Mortality and Morbidity Review Committee (MMMRC) work, TexasAIM (a quality improvement project to address maternal safety), the 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. The team consists of:

• Two Epidemiologist IIIs - 1 is the team lead and the other is a MMMRC data analyst and data linking specialist;
• One Epidemiologist II - This staff person works on TexasAIM and assists with the MMMRC analyses and workload;
• Three Research Specialist  - 1 person is focused on PPD and breastfeeding trends. Another is focused on MMMRC data analytics, PPD, and PRAMS. The third is the PRAMS Coordinator. Lastly, 2 temporary Research Specialist V positions, funded through the ERASE MM grant, will focus on reviewing potential cases for the pregnancy-associated cohorts;
• One Records Analyst - This person focuses on MMMRC record requesting and record retention and is funded by the ERASE MM grant;
• Two temporary Clerks - These staff focus on record requesting and funded through the ERASE MM grant; and
• One Research Specialist IV - This person is funded through the ERASE MM grant but reports to the DSHS Center for Health Statistics (CHS) management and participates on the Data Linking Team in that unit. This research specialist focuses on all required data linking per the 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.

PRAMS Working Group: MCHE created this group so the PRAMS Coordinator could have a working team to assist with monthly PRAMS grant requirements. The team consists of the PRAMS Coordinator, 1 HTMB Epi Team Research Specialist, 1 Technical Team Research Specialist, and the Technical Team Information Specialist. The team created a new interactive PRAMS dashboard which launched in 2021 and is preparing for the Phase 9 questionnaire.

Child and Adolescent Health & Oral Health (CAH&OH Epidemiology Team

The CAH&OH Epi Team focuses their work on child health, adolescent health, the health of Children with Special Health Care Needs (CSHCN), and oral health, in particular, children and pregnant women dental screenings data. The CAH&OH Epi Team consists of 4 FTEs which support the programmatic work of the CAH Branch in the MCH Unit and the Oral Health Improvement Program. The team consists of 2 Research Specialist - 1 is the team lead and the other is the Needs Assessment Coordinator; and 2 Epidemiologist - 1 staff focused on CSHCN and the other focused on oral health.

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 where she concentrated in International Social and Economic Development. Before that, she attended Baylor University where she majored in social work. Her professional interests include utilizing research and policy development to better the health and wellbeing of maternal and infant populations.

MCHE Technical Team

The MCHE Technical Team provides technical expertise and advanced skillsets that the other 2 teams  utilize if they need project assistance. This team focuses on many data management technical aspects including: 1) the unit’s birth, death, and 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 server which will enhance Texas’ ability to streamline MCHE mapping, and 5) focusing on MCHE’s public health research agenda. This team consists of one Epidemiologist who is also doctorally prepared, a Research Specialist  who has a master’s degree, and an Information Specialist  who focuses on graphic design and data dissemination.

Title V Needs Assessment Working Group

MCHE works together on the comprehensive 5-year needs assessment, which is a critical and mandatory Title V Block Grant application/report piece. MCHE established this internal working group so  each unit domain specialist  could discuss progress and issues as the 2025 Title V Needs Assessment process begins. The Needs Assessment Coordinator leads the group and the team consists of 2 HTMB Epi Team members, 2 CAH&OH Epi Team members, 1 Technical Team member, the MCHE Director, and the Surveillance and Data Analytics Manager.

COVID-19 Response

Two MCHE staff provided expertise in state COVID-19 response efforts through August 2021. These staff members analyzed COVID-19 case trends, created and maintained dynamic dashboard systems for internal and external stakeholder use.

State System Development Initiative (SSDI)

The purpose of the Texas State Systems Development Initiative Grant (SSDI) is to complement the Title V Maternal and Child Health (MCH) Block Grant through objectives and activities supporting 3 specific goals. The first goal is to build and expand state MCH data capacity to support Title V MCH Block Grant program activities and contribute to data-driven decision making in MCH programs including assessment, planning, implementation, and evaluation. The second goal is to advance development and utilization of linked information systems between key Texas MCH datasets. The third goal is to support surveillance systems development to address emerging Texas MCH data needs.

The Texas SSDI grant expanded state MCH data capacity to support Title V MCH Block Grant program efforts which include support for the PRAMS survey, extensive analytical support for content for the annual Block Grant application and annual reports, educational training for MCH Epi staff, and data analysis software licensing. The SSDI project also supports the Children and Youth with Special Health Care Needs (CYSHCN) program through the development of the biennial Texas CYSHCN survey, the Oral Health Surveillance program through work disseminating the Basic Screening Survey, and PRAMS survey sampling and analysis.

The SSDI Project Director (PD) and a Technical Team member provide statistical expertise in the R statistical language for daily reports creation to track COVID-19 cases and ArcGIS mapping training for agency staff for 10 hours a week. The SSDI PD also provided data analytic guidance on the Texas Collaborative for Healthy Mothers and Babies’ (TCHMB) Data Subcommittee, the state’s perinatal quality collaborative. The PD also serves as a DSHS Institutional Review Board primary member where he provides expert comment on research to DSHS, is the SSDI Maternal Health Supplement grant PD, and is the CDC Early Hearing Detection and Intervention (EHDI) grant to improve data quality lead Medical Research Specialist.

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:

• Submitted and received the SSDI Alliance for Innovation on Maternal Health (AIM) Maternal Health Supplement grant to improve maternal health data;
• Recruited 7 Other states’ MMRCs for an evaluation of the Texas MMMRC-created Discrimination Assessment and Social Determinants of Health (DASH) Facilitated Discussion Tool. Participants are engaged in learning sessions using mock cases and describing their experiences with the tool;
• Provided data linking expertise to the Texas EHDI program to improve linking vital events and EHDI data as part of the CDC EHDI grant. The Texas team was able to improve the matched records number 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 and PRAMS data to address questions on maternal pregnancy experiences;
• Provided 2020 Title V MCH Block Grant report/2022 application data content;
• Developed an interactive dashboard for release of 2012-2019 PRAMS data that consolidated previous reports making data more accessible while providing more information;
• Provided MMMRC legislative report analyses MMMRC, and TexasAIM data analysis to improve hospital hemorrhage and hypertension outcomes;
• Presented data at: the Texas Medical Association, Council of State and Territorial Epidemiologists’ (CSTE) MCH Symposium, City Match, the DSHS Epidemiology and Laboratory Capacity (ELC) Workshop, the Texas Public Health Association Annual Education Conference, and the TCHMB Summit;
• Presented a poster at the 2021 CSTE annual conference on Perinatal Periods of Risk (PPOR) analysis;
• Assisted COVID-19 response efforts including statistical expertise to creation measures to track changes in COVID-19 cases. Statistical modeling experiences were presented at the DSHS ELC Workshop and submitted in peer-reviewed journals;
• 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 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 placenta accreta spectrum disorder to the DSHS Perinatal Advisory Committee for use in developing statewide hospital rules to manage the disorder;
• Attended workforce development conferences including the Healthier Texas Summit, the Association of Maternal and Child Health Programs (AMCHP), DSHS Grand Rounds sessions, United Way: Early Childhood Data Community, Fatherhood Summit, Leadership and Strategic Planning for Public Health, Maternal Mortality Review Information Application (MMRIA) user meetings, and the Esri Health and Human Services geographic information system (GIS) Conference;
• Published the 2020 HTMB Databook and 2019 PRAMS Databook;
• Attended classes in Tableau dashboard creation, SAS data analysis, and Esri’s GIS analysis; and
• Attended and participated in DSHS Grand Rounds seminars, the ADJUST Health Equity & Social Justice Workshop, the Prioritizing Equity in Public Health Leadership Summit, and the CDC-Harvard Virtual Program Evaluation Practicum.