BAE receives funding from various sources (federal and state funds), apart from Title V and SSDI, to support data capacity efforts. The HRSA-funded Maternal Infant and Early Childhood Home Visiting (MIECHV) Program supports 0.50 FTE of an epidemiologist to maintain the Efforts-to-Outcome (ETO) home visitation data system. This is a statewide data source for Arizona’s MIECHV-funded home visiting programs to submit data to the Bureau of Women’s and Children's Health. The epidemiologist addresses data quality issues, serves as the chair for the statewide data coordination team, and responds to incoming home visiting data requests. The epidemiologist also performs epidemiological and research tasks that require expertise in analyzing, compiling, and coordinating data and conducting literature reviews for surveillance and reporting for the program. This position works with the MIECHV data quality analyst for ongoing monitoring of data for home visiting programs to identify data quality issues and coordinate data transfer among various partners and consultants. The MIECHV program also provides 0.20 FTE for the BAE Bureau Chief. The Bureau Chief guides in the areas of data collection, analysis, and interpretation of public health maternal child health data and provides assistance and guidance to the MIECHV Program Director in the areas of needs assessment, data collection, and analysis. The Bureau Chief collaborates with the Prevention Epidemiology and Evaluation Team Lead to provide direction and guidance to the Home Visiting Epidemiologist, supports efforts of the ETO Coordinated Data Management workgroup and BWCH ETO-related work, and reviews all MIECHV benchmark reports for the program.

Combined funding from the CDC-funded Enhancing Reviews and Surveillance to Eliminate Maternal Mortality Program (ERASE-MM) and the HRSA-funded Maternal Health Innovation Programs (MHIP) is used to support 1.0 FTE for a maternal health epidemiologist. This position serves as the data manager and evaluator for the MHIP and is responsible for the identification of maternal health outcomes and conducting linkages with existing data sources to improve the identification and availability of information on maternal health disparities. The maternal health epidemiologists conduct data quality assurance checks for data completeness and analyze data. They will also lead the data activities associated with the implementation of MHIP activities, participate in the MHIP evaluation team and any related continuous quality improvement initiatives, participate in all Maternal Health Task Force (MHTF) meetings, and produce reports on the status of maternal health in Arizona, specifically maternal mortality and morbidity. This position will also coordinate efforts with the site-level Tribal MCH Epidemiologist and the two MHIP program managers to evaluate MHIP activities. This position is also responsible for the timely identification of maternal deaths and conducts linkages with existing data sources to improve the identification and availability of information on maternal death. They will conduct data quality assurance checks for data completeness in Maternal Mortality Review Information Application (MMRIA) and analyze MMRIA data to provide information on burden, causes, and distribution of deaths by age, race, rurality, and opportunities for prevention. Additional funding has been identified in FY2024 to support an additional maternal and child health epidemiologist to support additional maternal health activities.

In 2021 Proposition 207, the Safe and Smart Act, passed into law in November 2020 and legalized marijuana for adult personal use. The statutory provision Prop 207 is found in Arizona Revised Statutes (A.R.S.) Title 36, Chapter 28.2. This voter initiative allows adults over the age of 21 to possess, purchase, transport, or process 1 ounce or less of marijuana or 5 grams or less of marijuana concentrate. The agency is responsible for licensing and regulating marijuana, marijuana retail sales, marijuana growth, and testing facilities in Arizona. The Arizona Department of Revenue (ADOR) is tasked in A.R.S. Title 42, Chapter 5, Article 10 with collecting the excise tax (imposed only by the state) and transaction privilege tax (state, counties, and cities) imposed on adult-use marijuana sales. A portion of these revenues were earmarked to support MCH data efforts in child fatality reviews, adverse childhood experience surveillance, violence/injury epidemiologist, the Youth Risk Behavior Survey (YRBS), and the Pregnancy Risk Assessment Monitoring System (PRAMS). Funds earmarked for the Child Fatality Review program were allocated to modernizing the review process with 10 local review teams with the state, support 0.50 FTE for the infant/child health epidemiologist, increased reimbursement amounts to local review teams to support reviews of over 800 deaths a year and provide training opportunities to first responders to complete the Sudden Infant Death Investigation Form. The CFR Program was also a recipient of funds from the National Center for Fatality Review and Prevention, the Network for Public Health Institutes, and the CDC for a pilot process to support enhanced surveillance of child drownings in Arizona. Funds earmarked to support surveillance of Adverse Childhood Experiences (ACEs) funds for a 1.0 FTE epidemiology program manager. These funds have been used to support equipment and supplies for the epidemiology program manager to establish Arizona’s first surveillance program on ACEs, support the agency’s action plan on ACEs, develop a campaign for providers on the importance of ACE screening, develop a tableau dashboard on ACEs, and conduct a policy evaluation with ASU Morrison School of Public Policy for ACE-informed or trauma-informed policies in the state and surrounding southwestern states. In 2024 funds will support an oversampling of the National Survey for Children’s Health in Arizona to collect geographical estimates and fund the ACE modules in the Behavioral Risk Factor Surveillance System (BRFSS) and the Youth Risk Behavior Survey (YRBS). Funds earmarked to support PRAMS have been used to support data collection personnel and procure participation rewards for PRAMS participants. Currently funding from the CDC PRAMS project supports 1.0 FTE for a Program Coordinator and Epidemiology Program Manager, and 0.25 FTE for the PRAMS Analyst which also functions as the Population Survey Epidemiologist. Over $267,000 per year from Title V is earmarked to support PRAMS staffing and operations.

BAE receives funding from the CDC to conduct the Behavioral Risk Factor Surveillance System (BRFSS) which collects critical surveillance data on the adult MCH population and their partners. The Bureau will receive funds from CDC to conduct the Youth Risk Behavior Survey to conduct routine surveillance on health risk behaviors for young adults in Arizona’s high schools. These fund sources support a combination of 3.0 FTEs to conduct program management, data quality assurance, and analysis activities. The maintenance and upkeep of these population surveys are critical to MCH data systems since they form the foundation of various performance metrics and benchmarks set by HRSA and at the state level. BAE collaborates with other Bureaus to support funding of other epidemiologists that are not directly connected with MCH but still contribute to Title V’s understanding of community health status such as fatal and non-fatal overdoses, suicides, and chronic diseases. Funding for these positions (3.0 FTE) is from the Bureau of Chronic Disease and Health Promotion which in turn receives funding from federal (e.g. CDC OD2A Grant) and state sources (e.g. Tobacco Tax Revenue).

BAE is highly involved and supportive of the Title V Programs in multiple initiatives. All epidemiologists are embedded into program activities to ensure that the needs of the programs are met. Epidemiologists are critical members of any program team and are often referred to for their expertise. The Bureau Chief and the Team Lead for Epidemiologists conduct routine meetings with other bureau chiefs, office chiefs, and program staff to discuss any challenges in MCH data or epidemiology, identify future opportunities for collaboration, and problem-solve any delays. BAE also manages three population surveys and two fatality review programs which generate data that inform Title V program practice. Often these data sources are used to set benchmarks for program activities. Each year BAE conducts an assessment of the current Title V benchmarks and facilitates an ESM and visioning meeting with the Title V program to innovate or enhance activities based on the metrics. Epidemiologists provide updates on emerging issues about population domains to spark conversations and innovative thinking. In addition, as part of our continuous improvement and measurement process, the team conducts an annual review of its selected NPMs, State Performance Measures (SPMs), and associated Evidence-based or -informed Strategy Measures (ESMs), using Arizona-specific information from the Strengthen the Evidence Base for MCH Programs initiative. Program managers, office chiefs, and agency stakeholders participated in the annual review along with the Title V MCH Director. BAE provides an annual dashboard to monitor and track the state’s performance measures. (Appendix F) This dashboard is used with internal and external partners during strategic planning processes to ensure that any program or project is linked to an NPM or SPM. BAE and the Title V Program worked collaboratively on emerging MCH issues. It's typical for a representative from both bureaus to attend an MCH issue meeting to ensure that data and programming are in synchronization. PRAMS recently published its first public dashboard with 2020 data. This dashboard has been shared with stakeholders and is being widely used to better understand the status of pregnant people in Arizona. Efforts are currently underway to publish the public use dataset and update the dashboard with data from the 2021 PRAMS survey. BAE also has a mechanism for county health departments and other partners to request MCH data via the ADHS webpage. This platform has been extremely helpful for the Title V program to provide data to partners while also understanding the need of our communities. The form is easy to use and is often reviewed by the BAE bureau chief and epidemiology program managers before it is assigned to an epidemiologist. The project is tracked and monitored in weekly huddles. Since its inception in 2018, the form has received 103 requests from county health departments, academic institutions, students, and other programs. Future Title V and BAE collaborations in 2024 will include the kick-off of the Fetal Infant Mortality Action Plan, situational analysis to onboard a fetal infant mortality review program, the Maternal Infant Mortality Summit, public Title V NPM/ESM dashboard, and the Family Engagement initiative referenced later in this application.

BAE has started the process for the 2025 Title V MCH Needs Assessment in partnership with the Title V Director and the Title V MCH Needs Steering Committee. The first kick-off steering committee happened on April 7, 2023, virtually. Twenty-four external partners attended the meeting representing twenty-four different organizations and roles in state maternal and child health. The objectives of the meeting were to:

1. Provide a brief overview of the Title V MCH Block Grant program and Arizona’s 2020-2025 MCH priorities
2. Discuss the Federal legislative mandate and requirements for the Title V MCH Needs Assessment
3. Review the previous MCH Needs Assessment activities and key findings
4. Review the goal, purpose, guiding principles, and values of the Title V MCH Needs Assessment
5. Introduce the needs assessment Steering Committee and Assessment team
6. Present the mixed-methodology approach and timeline to assessing the MCH needs in Arizona and determine the 2025-2030 priorities for Arizona’s Title V Program
7. Gather feedback from stakeholders on approaches, methods, and assessment timelines

The steering committee will convene once more in 2023, 4 times in 2024, and 3 times in 2025. BAE is partnering with the Family and Young Adult Engagement program to recruit 3 family/youth advisors to participate regularly in the needs assessment steering committee and process. Other activities that support the Title V MCH Program are listed in the Needs Assessment Update Summary section titled, Ongoing Needs Assessment Activities.

A key challenge to improving MCH data capacity is recruiting and supporting epidemiologists to conduct routine MCH surveillance. While the increased attention on supporting maternal and child health initiatives is very much welcomed, this has increased the workload on staff that were already at capacity. Recruiting and onboarding new epidemiologists delays processes and often can create challenges in utilizing and disseminating data. Access to data systems remains a unique challenge, as the Title V Program does not have access to and faces obstacles when requesting enrollment and encounter data from the state’s Medicaid agency including data from the Early and Periodic Screening, Diagnostic, and Treatment program. There have been multiple efforts to improve data availability of Medicaid claims data for improved MCH surveillance, but legal obstacles have prevented the work from continuing. Currently, BAE is limited to providing up-to-date information on maternal deaths. The maternal mortality review program currently reports starting the review of 2021 deaths. The program’s latest reporting only includes deaths from 2016-2018. Maternal death reviews are delayed since Arizona reviews all maternal deaths whether they are pregnancy related or not. This increases the workload on the program and the maternal mortality review committee. Currently, the program is working on strategies to reduce the amount of time it takes to review maternal deaths but also to produce more up-to-date preliminary reporting on maternal deaths. Lastly, the 2021 YRBS reported an all-time low in response rate (15% overall). This can be attributed ARS 15-117 which mandates that Arizona school districts and charter schools obtain written informed consent from students’ parents or legal guardians at least seven days before administering a survey regarding any information on risky health behaviors, mental health history, etc. This has had a direct effect on other programs such as the Healthy Smiles and Healthy Bodies surveillance as well. Despite these unique challenges, BAE works across various programs and Bureaus within ADHS to further understand obstacles and identify ways to share limited datasets.