It is critical to also maintain consistent direct access to electronic maternal and child health (MCH) health data such as birth files, death files, hospital discharge files, and Behavioral Risk Factor Surveillance System (BRFSS), and the Youth Risk Behavior Surveillance System (YRBSS) surveys to inform Texas MCH program planning, evaluation, and improvement and Title V MCH Block Grant reporting.

MCH (both the MCH policy unit and MCHE) develop logic models that speak to current national and state performance measures. Logic model development requires cross-unit teams to review the 5-Year Needs Assessment data sources, assess applicable data sources, and identify and discuss MCH-offered programming evaluation plan data gaps. If data gaps are identified, MCH teams strategize how, where, and what data may need analysis or evaluation plan collection. MCH is developing data management and dissemination plans for all domains.

 The MCHE Maternal and Morbidity Epidemiology Branch provides data and analytical support for maternal mortality and morbidity surveillance and reporting.  Support includes linking provisional and finalized death data with birth and fetal death data for pregnancy-associated death identification and requesting needed medical/delivery records for pregnancy-associated death identification and MMMRC case review.

In July 2020, as part of the Centers for Disease Control and Prevention (CDC) Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) grant, the team started entering Texas 2019 case cohort data into the Maternal Mortality Review Information Application (MMRIA), a standardized data system available to support essential MMMRC review functions.  In addition, the team expanded MMMRC supplemental documentation available during their review processes including a socio-spatial context dashboard that reviews community and environmental indicators the woman had lived in prior to her death and, if the woman was on Medicaid, a Medicaid coversheet outlining key events, prescription medication claims, and service utilization claims. Having these data points standardized allows for accurate data analysis and clear findings through the MMMRC review process. MCHE also started a vital record quality improvement project by coordinating with theTexas Department of State and Health Services (DSHS) Vital Statistics State Registrar to provide maternal death information identified during the MCHE records review process.

The Texas MMMRC has a maternal health disparities subcommittee. One of the subcommittee’s goals was to create a Discrimination Assessment and Social Determinants of Health (DASH) Facilitated Discussion Tool to enhance the review process and discussions about potential discrimination noted in medical records. MCH developed an evaluation plan and recruited other state’s MMMRCs to evaluate this new tool with data collection occurred between Fall 2021 and Spring 2022.

The MCHE Epidemiology Branch provides data and analytical support for child and adolescent health, children, and youth with special health care needs (CYSHCN), and oral health surveillance and reporting.  Support includes validating and running reports, collecting, and analyzing statewide dental screenings’ oral health data, working on the Help Me Grow program assessment and evaluation, and designing and analyzing the biennial CSHCN survey data. Additional data sources are used to drive program decisions including specific modules added to the Texas BRFSS (i.e., adverse childhood experiences) and the Texas YRBSS (i.e., adverse childhood experiences, positive youth development, and preventive health care).

MCH also provides partial funding for the Texas School Physical Activity and Nutrition (SPAN) survey. Texas SPAN is a state-wide surveillance system which monitors the body mass index (BMI) and related variables in Texas children and adolescents in grades 2, 4, 8, and 11 for the 2015-2016 and 2019-2020 school year. The survey focuses on several BMI factors and outcomes including nutrition knowledge, nutrition attitude, physical activity, and dietary behaviors. The state performance measure on obesity prevention utilizes this data source. Texas SPAN continued data collection resumed in December 2021 after pausing due to the COVID-19 pandemic.

The Texas Oral Health Improvement Program (OHIP) Basic Screening Survey (BSS) occurs every 3-5 years to collect information about the observed oral health of children, their demographics, and self-reported access to care information. Texas BSS paused data collection due to the COVID-19 pandemic, but Texas BSS data collection will resume for the 2022-2023 school term.

MCHE provides technical assistance to the Texas Early Hearing Detection and Intervention (TEHDI)program to support a CDC grant-funded data quality improvement project. On an annual basis, MCHE links vital event data and program data for public health surveillance and inform decision making. The State System Development Initiative (SSDI) Project Director (PD) attended technical assistance meetings and provided statistical programming assistance in support of the TEHDI grant.

Challenges

MCHE expanded data capacity through use of national surveys, DUAs, and MOUs. However, data capacity challenges continue to exist for various MCH subpopulations. Access to Texas data on children aged 1-5 is challenging as school administrative data are not available and there are few national surveys that reach this population. Neighborhood-level data, important for allocating program resources, are difficult to obtain as most surveys are limited to large regions or state-level analyses. Many data sources use administrative data and cannot provide individual stories, a crucial component to understanding the data’s context. Some data systems such as PRAMS, BRFSS, and YRBSS are available in Texas, but these surveys do not reach all MCH populations. This was exacerbated during COVID-19 which created challenges for school-based data collection systems. Additionally, Texas data quality has been a challenge, but efforts are underway to improve maternal mortality, PRAMS, and TEHDI data.