Delaware’s MCH Block Grant is complimented by other funding sources within the Family Health Systems (FHS) that increase our data capacity efforts, which support up to date Maternal and Child Health (MCH) data and information systems.  This ensures our program managers, epidemiologists, partners, and stakeholders have MCH data collection and analysis capacity.  They are then able to leverage this capacity to make data informed decisions, particularly regarding program planning.  For example, access to MCH data allows for population assessment, program development, and progress monitoring of the MCH Block Grant State Action Plan.  This in turn, facilitates the creation of effective programs, which leads to health improvements in the MCH population.

The accomplishment of our mission will facilitate the Division in realizing its vision of creating an environment in which people in Delaware can reach their full potential for a healthy life.  The Division of Public Health (DPH) Family Health Systems (FHS) section solicits services in the area of maternal, child, adolescent, children and youth with special health care needs, health epidemiology, research, and evaluation.  It is the intention of FHS to integrate data and epidemiology into research and evaluation of programs and activities.

In addition to our State Systems Development Initiative (SSDI) grant, other key components of our MCH epidemiological and data enhancement activities support our Title V program and activities.  FHS is committed to contracting consistent, high-quality support in research, epidemiology and program evaluation for our section and its associated programs.  Forward Consultants is our epidemiology, research, and evaluation (ERE) contractor and FHS is confident they have the experience and capacity to carry out all required activities with assistance and guidance from the DPH, FHS section.  Our ERE contracting services maintain and improve existing methods of information collection for FHS MCH statistical analysis.  Examples include linked infant birth and death records, poor birth outcomes registry, and birth certificate data analysis.

The contract covers developing new methods to collect key information for decision-making and research.  This can include merging existing sources of information (e.g., population-based information, surveillance systems, survey information and program/service utilization information).  Project examples include data collections methods to assess the impact of nurse home visiting, data collection methods to assess the impact of preconception care and enhanced prenatal care services, and literature review of provider cultural competence and health equity.

Our Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) Needs Assessment was also facilitated by our ERE contracting services.  MCH leveraged and aligned the activities of our MIECHV Needs Assessment as well as our Title V Five-Year Needs Assessment.  Combining efforts to gather the information and data required for both needs assessments helped leverage staff and fiscal resources across the two programs and aligned the data collected by each to better meet the needs of women, infants, and children in the state of Delaware.  Coordinating the two needs assessments, helped avoid duplication of effort and strengthened a statewide approach to addressing the needs of young children and their families.

Our ERE contracting services also aims to improve access to and use of information in addition to translating information into an easily understandable form to inform the public and key stakeholders.  Project examples include data analysis and presentation of data for the annual Delaware Healthy Mother & Infant Consortium (DHMIC) report, birth defects registry analysis, and social distal factors report.  Forward Consultants also designs and implements research studies to assess program impact.  This includes natural experiments, prospective studies, case control studies, and/or cross-sectional studies.  Research studies may rely on quantitative methods, qualitative methods, or a mix of the two.  Some project examples include one research study proposed by the Data/Science Committee of the DHMIC, and a study to assess the impact of nurse home visiting.

The FHS contracted services with Forward Consultants design and implements program evaluation to measure whether program goals are met, and activities are effective.  This may include process evaluation but should primarily focus on outcome and impact evaluation.  Some project examples may include evaluation of preconception and enhanced prenatal care programs, evaluation plan and two surveys funded through the federal Pregnancy Risk Education Prevention (PREP) grant, Healthy Women, Healthy Babies (HWHB) Program, community health program, and Children & Youth with Special Health Care Needs (CYSHCN) activities.

This past year, Forward Consultants has assisted MCH with the development of a dashboard that would capture developmental screenings and referrals from pediatricians to early intervention programs through the CHADIS platform.  In addition, our ERE has worked with Delaware’s core team to implement House Bill 202, which mandates licenses child care facilities to administer developmental screens on an annual basis.  Forward Consultants also leads the Data and Surveillance sub-committee of the Help Me Grow Advisory committee to track, analyze HMG/2-1-1 data and recommend improvement.  Lastly, our ERE participated in the HMG National Return on Investment (ROI) sessions and developed a detailed ROI for Delaware.

In addition, the ERE contracted services provide expertise with respect to all phases of statistical interpretation related to family health epidemiologic topics.  This includes interpreting infant birth certificate data, newborn screening, birth defects surveillance data, hospital discharge data, Pregnancy Risk Assessment Monitoring System (PRAMS), and other national data sets to answer MCH questions posed by consumers and/or stakeholders.

Lastly, our contracted services also require Forward Consultants to analyze and prepare reports in order to communicate research and surveillance trends to diverse audiences.  This also requires prepared ad-hoc reports and data summaries, as requested by DPH and DHMIC.

The following are examples of programs that require ERE services:

• Healthy Women, Healthy Babies 
  • This is composed of: preconception care, prenatal care, interconception care services, and infant care (home visiting)
• Adolescent health services through school-based wellness centers
• Children with special health care needs (traumatic brain injury, birth defects and newborn screening)
• Violence and injury preventions services
• Pregnancy Risk Assessment Monitoring (PRAMS) system
• Fetal Infant Mortality Review (FIMR)
• Reproductive health
• Women’s health
• Men’s health
• Community health

When it comes to women’s and maternal health, we continue to focus on increasing the number of women who have a preventive visit to optimize the health of women before, between and beyond pregnancies.  As in the past, our key priority is to find ways to reduce the infant mortality rate in Delaware and we understand the importance of preconception care and quality prenatal care for our mothers.  In order to continue making progress in providing “whole health” care to our women and mothers, we continue to bolster and nurture our community partnerships by working together focused on addressing the social determinants of health, leveraging talents and resources, and striving to find new ways to provide services.

Extensive data shows that unplanned pregnancies have been linked to increased health problems in woman and their infant, lower education attainment, higher poverty rates, and increased health care and societal costs.  Some of the social determinants of health include income, education, housing, culture and customs, occupation, health behaviors (drinking, smoking, drug use, exercise), and stress.  DPH will strive to promote and provide training on cultural competency to improve access to health services for Delaware’s under-served populations.

Working with Forward Consultants, Newborn Screening was recently able to look into the Early Hearing Detection and Intervention (EHDI) system.  Based on the data above we can identify where the gaps are within the system.  One of the gaps that can be identified in the system is the lost to follow up, although Delaware has a great system in place to help keep the lost to follow up rate down, there is still work to be done to close the gaps.  The Diversity and Inclusion Plan will help accomplish the following:

• Engage, educate, and train health professionals and service providers in the EHDI system about the 1-3-6 recommendations;
• Emphasize the need for hearing screening up to age 3 years;
• Enhance the benefits of a family-centered medical home; and
• Strengthen the importance of communicating accurate, comprehensive, up-to-date, evidence-based information to families to facilitate the decision-making process.

Given this background, the relatively rural population in both Kent County, Delaware and Sussex County, Delaware comprises the target population chosen for the Diversity and Inclusion Plan.  Specifically, individuals and families residing in the following three regions of the state will be of focus: Smyrna/West Dover, East Dover, and Georgetown/Seaford. 

In 2019, DPH launched a data portal allowing Delawareans to assess the overall health of their communities.  The My Healthy Community data portal delivers neighborhood-focused population health, environmental and social determinant of health data to the public. The innovative technological showpiece allows users to navigate the data at the smallest geographical area available, to understand and explore data about the factors that influence health.  Just recently published on My Healthy Community is Delaware’s 2014-2018 Suicide Surveillance Study, where Delaware completed a comprehensive look at suicide.  This is a perfect example of how Delaware is making data more transparent, accessible, and easy to understand.  Sharing community-level statistics and data allows Delawareans to understand what is occurring in their neighborhoods, make informed decisions about their health, and take steps to continue improving our quality of life.

Delaware residents are able to explore a variety of data indicators in the following categories: community characteristics, the environment, chronic disease, mental health, COVID-19, and substance use.  Air quality data, asthma incidence data, public and private drinking water results, drug overdose and death data, community safety, maternal and child health, healthy lifestyles, health services utilization, infectious diseases, education, socioeconomic influencers, lead poisoning, suicide and homicide, and populations vulnerable to climate change are all currently available.  DPH believes that our health and the environment in which we live are inherently connected and the My Healthy Community portal will allow communities, governments and stakeholders to better understand the issues that impact our health, determine priorities and track progress.  Communities can use the data to initiate community-based approaches, support and facilitate discussions that describe and define population health priorities and educate residents about their community’s health and the environment in which they live.

The Division of Public Health in convinced that access to data is a key factor in making progress toward a stronger and healthier Delaware.  The ability to easily access such crucial information like substance use and overdose data by zip code enables Delawareans to compare it to larger areas and examine trends.  For the first time, Emergency Department non-fatal drug overdose data from DPH, and Prescription Monitoring Program (PMP) data will be available thanks to a partnership with the Division of Professional Regulation.  Addiction, air quality, chronic disease and drinking water quality impact every one of us and when communities become aware of the level at which these issues are occurring in their neighborhoods, it can spur action that can improve the quality of life for current and future generations.

Additional substance use disorder (SUD) data and additional health indicators were also built to highlight Delaware’s progress in meeting health care benchmarks (obesity, tobacco use, preventable Emergency Department visits, etc.) as part of DHSS’s ongoing efforts to bring transparency to health care spending and to set targets for improving the health of Delawareans.  Future funding has been secured for data on vulnerable populations and climate change, and for violent death data and internal sharing of timely SUD data.

Over the last three decades, scientific evidence has clearly demonstrated how personal behaviors affect development of diseases.  Smoking, physical inactivity, poor eating habits, obesity, alcohol abuse, and other risk factors can lead to a variety of chronic health problems-like heart disease, cancer, type 2 diabetes, or lung diseases.  Lifestyle behaviors increase the risk of communicable diseases such as AIDS, sexually transmitted diseases, and vaccine-preventable diseases.  Injuries from violence and accidents also may be caused by behavioral risks.  As a result of this evidence, public health professionals are focusing on ways to help people change their behaviors to reduce risks and prevent illness or premature death

These data are gathered through the Behavioral Risk Factor Surveillance System (BRFSS).  The Behavioral Risk Factor Survey (BRFS) is an annual survey of Delaware’s adult population about behaviors which increase the risk of disease, premature death, and disability.  BRFS is a cooperative effort of the Delaware Division of Public Health and the CDC and is primarily funded by CDC.

During the current reporting period Delaware applied for AMCHP/HRSA GSEP fellowship but was unsuccessful in matching a candidate.  Delaware has been collecting behavioral risk factor data continuously since 1990.  Interviewing is conducted every month of every year, and data are analyzed on a calendar-year basis.  The BRFS made methodological improvements in 2011 to address social and technical changes in telephone usage.  The annual sample in Delaware is about 4,000 adults aged 18 and older.  The random-sample telephone survey is conducted for the Division of Public Health by Abt Associates, Inc.  Data from the survey are used by both public and private health providers to plan health programs and to track progress toward the state’s health goals.