For 2024, the priorities for women’s health are to reduce and eliminate barriers to ensure equitable and optimal health for women and to reduce disparities in infant and maternal morbidity and mortality. The strategies described below are linked to NPM 1: Well-Women Visits and NPM 13.2 Preventive Dental Visits - Pregnancy.

In 2024, all activities under each priority will be assessed annually and categorized using Levels of Public Participation (Inform, Consult, Involve, Collaborate, Empower) to identify the appropriate level of public participation and engagement for each activity, as found in Appendix H. Levels of Public Participation. The Women/Maternal health population domain will continue implementing Health Equity and Family Engagement activities. The Health Equity activities are identified in italics throughout the report and the Family Engagement 2024 activities for each population domain are highlighted in the CYSHCN 2024 Action Plan narrative.

In 2024, $2,017,415.00 in Title V funds will be allocated across 14 (out of 15) of Arizona’s county health departments via the Maternal and Child Health (MCH) Healthy Arizona Families (HAF) Intergovernmental Agreement (IGA) to implement strategies specific to self-selected MCH National Performance Measures (NPMs). The counties will implement strategies focused on NPMs related to improving the health of women and mothers at the community level. BWCH will also promote and provide webinars on topics related to achieving health equity and selecting evidence-based strategies for the county programs.

Title V Family Planning Program: Within the MCH HAF IGA, nine (9) counties (Apache, Cochise, Gila, Graham, Greenlee, La Paz, Mohave, Navajo, and Yuma) implement family planning and reproductive health services to low-income and other higher needs women, including those living in rural and underserved areas or without a reliable form of health insurance, and their partners. The overall goal of this program is to improve the health of women of childbearing age before, during, and after birth to promote optimal health, outcomes, and wellness for all Arizonans, which is in alignment with our priority to reduce and eliminate barriers to ensure equitable and optimal health for women and NPM 1: Well-Women Visits. Services provided will include family planning and reproductive health education; counseling on birth control methods and provision of birth control; screening for pregnancy, sexually transmitted infections, and cervical cancer; and referrals to other clinical or social services. Separately, the Arizona Title V Program also provides $250,158.00 to a network of federally qualified health centers (Valleywise Health) to provide these services in Maricopa County.

BWCH will also continue to improve access to care for women by collaborating with the Healthy Arizona Workforce Program, WIC, home visitors, and community health workers to encourage and promote well-woman visits and sliding fee scale clinics; leverage partnerships to increase awareness and address barriers to accessing well-woman visits; and encourage technical assistance to safety net providers to establish patient reminder protocols.

BWCH will continue to coordinate with the STD Control and the HIV Prevention Programs within the Office of Disease Integration & Services to ensure that we are aligning program activities and leveraging funding to reduce the incidence of sexually transmitted infections before, during, and between pregnancies and eliminate vertical transmission of syphilis and HIV. Likewise, efforts will be coordinated with the Sexual and Domestic Violence Programs in the Bureau of Chronic Disease and Health Promotion to align strategies.

Arizona identified the continued need to improve the health of women before and between pregnancies as a priority. BWCH will continue to support the Preconception Health Alliance in partnership with Affirm (formerly known as Arizona Family Health Partnership) and the Arizona Chapter of the March of Dimes. The Alliance meets quarterly and will continue to increase its partnering agencies and will continue to implement strategies outlined in the strategic plan.

Arizona’s Title V Program will continue to work on reducing severe maternal morbidity (SMM) and maternal mortality (MM) through a multi-pronged approach that includes coordination between the federally funded Maternal Health Innovation Program (MHIP), Maternal Mortality Review Program (MMRP), Alliance for Innovation on Maternal Health (AIM), Maternal Infant and Early Childhood Home Visiting (MIECHV) and the state lottery–funded Health Start Program.

The Arizona Health Start Program is an evidence-informed, promising approach home visiting program for at-risk pregnant and/or postpartum women with children under the age of 2. Arizona’s Health Start Program, funded through state lottery funds (Title V state match funds) and MIECHV, uses community health workers (CHWs) to conduct home visits. In 2024, the Health Start Program will continue to provide home visiting services and provide home visitors with ongoing training. Additionally, Health Start will continue to support ESM 6.1 (number of home visitors trained to provide ASQ3 and SE2 training over the next five years). Health Start provides developmental screening for children ages 10-17 months to increase early identification and treatment of developmental delays.

Arizona continues to experience a rise in opioid-related overdoses and deaths, particularly those related to fentanyl use, and exacerbated by the stress due to the COVID-19 pandemic. As part of the ongoing response to the opioid epidemic, particularly as it impacts Title V populations, the Chief of the Office of Women’s Health will serve on the ADHS Opioid Action Plan team collaborating with other areas of ADHS to identify strategies around 1) increasing access to treatment; 2) improving quality of treatment; 3) reducing stigma; 4) prevention and early intervention; 5) guidelines for prescribing/dispensing; and 6) data quality dissemination.

Arizona is one of nine states that was awarded HRSA’s Maternal Health Innovation Program (MHIP) grant in 2019. With the continuation of the MHIP grant, Arizona will continue to support and address the five main goals listed in the Governor’s Goal Council: 1) Increase awareness of maternal health issues; 2) Improve access to care; 3) Support Workforce and Workforce Capacity; 4) Improve surveillance of maternal mortality and severe maternal morbidity; and 5) Support Systems of Care. MHIP funding will be leveraged to meet the needs of the Governor’s Goal Council through a work plan developed by the multidisciplinary Maternal Health Task Force that engages stakeholders from across the state to identify pressing issues and potential opportunities related to maternal health. The Maternal Health task force and its sub-task force groups: Maternal Health Steering Committee, Maternal Mental Health, Tribal Maternal Health, and AIM Steering Committee will continue to meet and provide guidance on the maternal health efforts being implemented by MHIP.

Perinatal Mental Health will continue to be an area of focus for MHIP. The Arizona Maternal Mortality Review Committee report, Maternal Mental Health and Substance Use Related Death in Arizona found that almost half of all Pregnancy-Associated deaths were related to mental health conditions or substance use disorders, and 98% were determined to be preventable. The greatest disparities are experienced by communities of color in Arizona’s rural areas, with American Indian and Alaska Native (AI/AN) Arizonans experiencing the highest rates. To increase access to care and build workforce capacity, the MHIP will provide scholarship opportunities for the first-ever BIPOC Postpartum Support International Perinatal Mental Health Certification Training. Increasing the number of perinatal mental health-trained BIPOC providers throughout Arizona will better meet the needs of the populations that experience the greatest disparities. The MHIP developed and will continue to promote the perinatal mental health awareness campaign, Know The Signs. The campaign aims to increase awareness and connect individuals and their support systems to perinatal mental health professionals through resources such as the HRSA-funded National Maternal Mental Health Hotline, 1-833-TLC-MAMA. The joint efforts of the Maternal Mental Health Task Force, MHIP, AHCCCS (Medicaid), and the University of Arizona Medical Center, made it possible to create the Arizona Perinatal Psychiatric Access Line (APAL). APAL is modeled after MCPAP for Moms in Massachusetts. This line will increase access to appropriate care and improve the capacity of maternal health providers in rural, urban, and tribal areas of the state.

Addressing Maternal Health Disparities: Data from the Maternal Mortalities and Severe Maternal Morbidity in Arizona (Dec 2020) report shows that indigenous (American Indian/Alaska Native) communities and Black communities experience higher rates of maternal mortality and morbidity compared to other racial and ethnic groups in Arizona.

To address these disparities, the Tribal Maternal Task Force will continue to convene to develop and implement a culturally relevant tribal maternal health strategic plan to improve maternal health outcomes and promote and execute innovation in tribal maternal health care delivery. The Tribal Maternal Task Force is staffed by the MHIP Tribal Maternal Health Innovation Program Manager, who has over 10 years of direct service work experience and is a member of the Navajo Nation.

MHIP will maintain and fund contracts with Diné College and with the Inter Tribal Council of Arizona to address the needs and improve health outcomes of indigenous women throughout Arizona. Through these two contracts, all 22 of Arizona’s Federally Recognized Tribal Nations are represented. Efforts include conducting training about Maternal Health and Family Wellness from an Indigenous Perspective, which are culturally centered and community-driven and are provided by elders, Indigenous knowledge holders, and birth workers. An evaluator experienced in the native culture is collaborating with partners to enhance their programming efforts.

MHIP will also continue to fund the Maricopa County Department of Public Health Healthy Start Program to extend its services to high-risk Black/African American mothers.

The MHIP will continue to support workforce capacity and support systems of care through the implementation of the Alliance for Innovation in Maternal Health (AIM). Currently, Arizona has enrolled 35 of the 42 birthing hospitals in the state to participate, accounting for almost 92% of all births in Arizona, per preliminary 2022 birth data. The program will explore expanding these efforts to free-standing birthing centers. A new patient bundle, Obstetric Hemorrhage, will be introduced in the fall of 2023 and continue implementation into 2024. Working towards implementation of the Perinatal Mental Health Conditions bundle, the AIM steering committee in collaboration with MHIP’s Maternal Mental Health Task Force will be working with participating hospitals to identify resources and training needed to successfully implement the bundle. The Arizona Hospital and Healthcare Association will continue to provide technical assistance and ongoing support to the participating birthing hospitals through monthly calls, webinars/training, and interpersonal education to share lessons learned and challenges experienced to improve implementation efforts and health outcomes. MHIP will also be working with community partners to develop a Continuing Medical Education (CME) course for emergency department staff to better equip them in providing care and identifying early warning signs for pregnant and postpartum people.

March of Dimes recently released an updated report on maternity care deserts and areas of low access to care across the United States for 2020 births. Within Arizona, they identified La Paz and Greenlee counties as maternity care deserts (areas without a hospital or birth center offering obstetric care and without any obstetric providers), and Graham and Cochise counties as areas of low access to care. Because Arizona’s counties are so large, birthing individuals may have to drive hundreds of miles to reach the nearest hospital or birthing center. Access to prenatal care is no different. The MHIP contract with Chiricahua Community Health Center (CCHC), a rural health center in Cochise County, will continue to be supported through MHIP funding. The CCHC partners with the Tucson Medical Center to provide prenatal telemedicine services in the community. This collaboration allows families to be seen locally with providers they know and trust. Their services are coordinated with specialists at Tucson Medical Center via telemedicine. Bloodwork, ultrasounds, etc. can be monitored locally, reducing the time and distance for visits, thus increasing the likelihood of attendance to all prenatal visits.

In 2024, BWCH w ADHS Office will continue to partner with the Office of STI Control, Bureau of Infectious Disease and Services regarding the statewide outbreak of syphilis in women and newborns. BWCH will continue to monitor data, build awareness, and educate the MCH workforce and partners using the resources and tools created by the ADHS Office of STI Control which includes a dashboard to monitor and track real-time data as well as a Find a Clinic web page with testing sites by county.

BWCH will enter into year three (3) of the Count the Kicks campaign and training in Arizona. Continuing the partnership with Count the Kicks builds awareness among women in their third trimester of the importance of counting their baby’s movements with the aim of decreasing stillbirths in Arizona. Webinars targeted to specialized groups such as OBGYNs, home visitors, etc. will be provided to continue to create awareness and promote the materials available for ordering. Additionally, targeted email campaigns and social media ads will be used to further create awareness of Arizona’s campaign. According to Count the Kicks’ Arizona profile, Arizona loses, on average, 489 babies a year due to stillbirth, and, on average, 158 babies could be saved every year. Participating states have shown a significant decrease in stillbirth rates after a five-year investment.

The Maternal Mortality Review Program (MMRP) is also aiming to address health disparities in Arizona through several data-related activities. The MMRP continued the partnership with Diné College and the University of Arizona to conduct an extension of the 2020 Title V Needs Assessment focused on access to prenatal, postpartum, mental, and oral healthcare in Arizona. The original assessment was completed in 2020, and the report was published in July 2021. The assessment revealed racial and residential disparities that impact maternal health outcomes in Arizona. Since then, a supplementary study was conducted to explore the findings and better understand the maternity care experiences of women residing in rural areas and African American women. In September 2022, a slide deck was published describing the supplementary analysis and results. Findings will be used to inform future programming for MMRP, MHIP, and Title V programming.

The MMRP is also focused on the development and dissemination of new data regarding maternal deaths. A topical report on 2018-2019 deaths related to mental health conditions and substance use disorder was completed in March 2022. Data from this report has been shared with multidisciplinary partners across the state. The report included eight (8) recommendations developed with the Maternal Mental Health Task Force that aim to reduce maternal mortality related to mental health conditions and substance use disorder. To date, two recommendations have been implemented: Arizona expanded medicaid coverage to one year postpartum, effective April 1, 2023, and Arizona established the Arizona Perinatal Access Line (APAL) for providers to access real-time perinatal psychiatric consultation, effective June 1, 2023. The MMRP is currently developing a data brief on all 2018-2019 maternal deaths while wrapping up the review of 2020 maternal deaths.

BWCH and BAE will continue to partner in the coordination and planning of the Maternal and Infant Mortality Summit to share data, increase awareness about strategies, and build capacity among internal and external stakeholders to improve maternal and infant health outcomes.

ADHS will continue to implement the Pregnancy Risk Assessment Monitoring System (PRAMS), a joint research project between the Arizona Department of Health Services and the Centers for Disease Control (CDC). AZ PRAMS aims to obtain data of high scientific quality on maternal attitude and experience before, during, and shortly after pregnancy that can be used to monitor health status as well as allow ADHS to more effectively tailor preconception, pregnancy, and postpartum services and programs to Arizona’s diverse population. AZ PRAMS provides longitudinal data on factors such as low birth weight, preterm birth, ante/postpartum obesity, mental health, social determinants of health, and breastfeeding during and after pregnancy, across Arizona’s diverse maternal population. This knowledge across the state population of new mothers is necessary to monitor the progress of state and non-governmental program efforts to improve the quality of maternal and infant health services. AZ PRAMS is predominantly funded through the CDC but receives supplemental funding through the Justice Reinvestment Fund (state) and Title V to enhance program reach. Over the past year, AZ PRAMS saw an increase in response rates from June 2022 at 37.30% to June 2023 at 52.33%. AZ PRAMS surpassed the nationwide all-site average response rate by 4.27%. This notable improvement can be attributed to the creation of new positions and the hiring of three PRAMS staff members in 2023, resulting in response rates through phone interviews rising from 5.43% (June 2022) to 13.90% (June 2023). In 2024, AZ PRAMS will implement new methods of communication with participants, such as texting and emailing, to increase contact rates and response rates. AZ PRAMS will also implement a new “Phase 9” survey in 2024. The Phase 9 survey will include questions aimed at assessing health equity, such as discrimination and sexual orientation, and will be available in three modes: web (new), paper, and interview. Two Phase 9 site-specific questions were submitted and approved by the CDC. Following the launch of the PRAMS data dashboard, ongoing efforts will revolve around disseminating data and enhancing the turnaround time for data sharing and reporting. PRAMS will be increasing partnerships with Maricopa County and, potentially, with the Arizona Health Care Cost Containment System (for more accurate participant contact information). AZ PRAMS will continue to collaborate with the Navajo Nation, the Inter Tribal Council of Arizona, and the Preconception Health Alliance to distribute and translate data into actionable changes.

In 2024, the Office of Women’s Health will continue efforts to fulfill the goals as outlined in the Engaging Families and Young Adult Program to place family advisors in the developed family advisor roles within the women’s health domain. Meetings began in 2022 and the Office of Women’s Health is working on developing drafts of scopes of work. CYSHCN Program Director, Janet Viloria and Family Advisor, Dawn Bailey have been providing technical assistance and the Office of Women’s Health will continue to support bureau efforts to establish a family advisor position.

The MHIP and the MMRP have also focused on engaging patients and families in our work and will continue to do so in 2024. The MMRP has onboarded three patient and family advisors to the Maternal Mortality Review Committee. These advisors not only serve as full MMRC members with voice and vote but will also be engaged to inform how we disseminate MMRC findings to communities.

Alongside the Women/Maternal Health activities and work that will be led by the Office of Women’s Health team and collaborators, the Office of Oral Health (OOH) and Primary Care Office (PCO), housed within BWCH, will continue their cross-cutting activities that impact Women/Maternal Health.

OOH will continue to implement strategies to address NPM 13.1, the percentage of women with a preventive dental visit during pregnancy. In 2020, only 32.4% of Arizona women had their teeth cleaned during their most recent pregnancy. Strategies to increase dental visits will include anticipatory guidance and motivational interviewing training for medical and dental providers who treat and refer pregnant women; increasing the number of socioeconomically disadvantaged pregnant people receiving oral health care services; and exploring alternative models of care for service delivery. OOH will continue its partnerships with the Arizona Alliance for Community Health Centers, the Inter Tribal Council of Arizona, and the Greater Valley Area Health Education Center to provide professional development opportunities for medical and dental providers on oral health anticipatory guidance for pregnant women.

OOH will continue to collaborate with the AHCCCS to identify opportunities to link Medicaid-eligible pregnant women to dental homes. As a result, referral connections will continue to be made with AHCCCS-contracted health plans to help establish follow-up care for pregnant women in need.

The OOH will also continue to partner with the Arizona Dental Society to help fund and staff the annual Arizona Mission of Mercy Event. This event provides free urgent and needed dental care and education to uninsured Arizonans and pregnant women helping to reduce health risks, divert individuals from hospital emergency rooms, and improve the quality of life for those who suffer from dental disease. The four-day event was originally hosted each December in Phoenix and has now branched off to also include an event each June in Flagstaff, Arizona. OOH will continue to support the Mission of Mercy for the annual event by providing technical assistance, resources, coordination, and supplies.

To help achieve the overarching goal of reducing health disparities across all population domains including pregnant women, OOH will continue to educate communities and individuals on the benefits of Community Water Fluoridation. OOH will provide technical assistance to communities, water systems, and other organizations that are sustaining existing fluoridation efforts or are looking to implement new water systems. OOH will continue to partner with tribal and minority grassroots organizations and the statewide oral health coalition to increase outreach, identify resources, and implement programs aimed at reducing oral health disparities through community water fluoridation efforts.

OOH will continue to partner with the Primary Care Office (PCO) within BWCH to help statewide efforts to improve access to dental care in Arizona’s rural and underserved communities. For FY 2024, OOH will continue to support the ongoing dental HPSA designations in Arizona to leverage state and federal resources. OOH will partner with the dental provider associations and the Arizona Board of Dental Examiners to explore a statewide system for collecting dental provider information and completing dental HPSA designations in a more sustainable mechanism. OOH will also continue to partner with the PCO and workforce programs to help identify dental providers in the State Loan Repayment Program to help partner with existing prevention programs and serve in rural communities and counties where recruitment of dental providers has been historically challenging.

The Primary Care Office (PCO) leads statewide efforts to improve access to care in Arizona’s rural and underserved communities. The PCO’s core functions include:

1. The identification of areas that need improved provision of primary care, dental, or mental health services through state and federal Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P) designations;
2. Recruitment and retention of providers in areas with limited or no access to services through Workforce Incentive Programs;
3. Support for the development and expansion of health centers and safety net providers, including sliding fee scale clinics for low-income and uninsured people;
4. Technical assistance to statewide partners to facilitate the expansion of health services; and
5. Increase knowledge and opportunities for continuing education, internships, and clinical rotations in rural and underserved communities and populations to create a diverse workforce in Arizona.

Arizona is faced with ongoing, significant workforce shortages. As of March 2022, there were 695 federally designated HPSAs in the state, including 248 primary care HPSAs, 249 dental HPSAs, and 236 mental health HPSAs. Arizona needs an additional 667 full-time primary care physicians, 485 dentists, and 227 psychiatrists statewide to eliminate the existing HPSAs. Arizona also has 37 Medically Underserved Areas (MUAs) and 10 Medically Underserved Population (MUPs) designations. MUA/Ps are areas identified as needing medical services based on demographic data, including the provider-to-population ratio and infant mortality rate.  

In 2024, Title V funds will continue to support the assessment and evaluation work required to identify and designate HPSAs and MUAs, which are used to continually assess health care needs in Arizona and leverage state and federal resources to address those needs. The Title V Program will provide financial and technical support to the PCO to complete the statewide assessment of areas for HPSA designation, including completing the provider surveys of primary care, dental, and behavioral health clinics to accurately assess the number of providers working in the service area. The PCO plans to continually update the HPSA maps for primary care, dental, and behavioral health. The PCO will continue to support the data collection for the newly established Maternity Care Target Area (MCTA) criteria.

The Arizona Medically Underserved Area (AzMUA) report data collection and evaluation were streamlined and improved in 2021 and has been added to the PCO Portal. The AzMUA report is generated biennially and made available to the public through the PCO website. The next report will be generated and published in the fall of 2024. This report is used by communities applying for state and federal grants and by providers applying for the State Loan Repayment Program.  Another future enhancement of the AzMUA project will be to connect report results to the PCO Portal and to automatically update the Primary Care Profiles in the database.

The PCO administers several workforce programs that aim to recruit and retain health care professionals in rural and underserved communities. These programs include the State Loan Repayment Program, National Health Service Corps, Nurse Corps, J1 Visa Waiver, and National Interest Waiver Programs. It is important to continually promote these programs to help attract qualified health care professionals to serve in places where recruitment is particularly challenging, such as rural, border, and tribal areas. The PCO will continue to identify opportunities to interface with students in primary care, dental, and behavioral health to promote the programs. We will partner with academic programs to seek opportunities to present information to students through orientation week, career fairs, exhibits, opportunities day, residents’ grand rounds, etc.  

To enhance providers’ experiences in applying for the State Loan Repayment Program (SLRP) or the J1 Visa Waiver Program, the PCO will continue to enhance its existing application portal to improve the electronic submission, management, and review of SLRP and J1 applications. The PCO also plans to build additional functionalities into the portal to be able to better track SLRP and J1 participants’ service and overall compliance with program requirements. 

The PCO will leverage and formalize existing partnerships with entities that can help advance our efforts in improving access to care in Arizona. In particular, the PCO will continue to partner with the Arizona Alliance for Community Health Centers (AACHC) to implement activities that educate and provide technical assistance to communities about programs and resources that can help with recruitment and retention efforts. These activities will continue to target federally qualified health centers, academic training programs, employers, local and state partners, tribal entities, and providers to collectively address workforce shortages in Arizona. For example, the PCO, in partnership with the AACHC, will conduct recruitment and retention training and technical assistance sessions that aim to increase awareness of the workforce programs, HPSA designations, and other resources available through the PCO.

The PCO will continue our partnership with the Arizona Area Health Education Center (AzAHEC) Program Office, at the University of Arizona, and the seven Arizona Regional AHECs to increase opportunities for students to gain experience by offering internship placement for students and Community Health Workers that are from underrepresented, rural, and minority communities. In 2022, the AzAHEC created a Tribal AHEC focused on American Indian Health, which will focus on Arizona’s American Indian health system and its workforce.

Given that the PCO serves as the state liaison for federally funded programs and the main point of contact for communities in efforts related to access to care in the state, the PCO plans to engage in professional development activities to keep abreast of state and federal initiatives, efforts, and requirements related to access to care. This will include attending access to care or workforce-related conferences and training sessions that will support staff in effectively providing technical assistance to statewide partners and stakeholders. 

The PCO will coordinate continuing education opportunities for workforce program participants and be a liaison for the participants via a robust mailing list. PCO will work to increase communication with providers throughout the state to provide resources and opportunities for continuing education units (CEUs), racial equity training, etc.

In 2024, the PCO will continue to work on our partnerships to create and deploy training opportunities for internal and external Title V MCH and other health professionals in the state of Arizona to increase the knowledge of health insurance types and eligibility requirements for state and federal programs. These learning opportunities will ensure that staff making programmatic decisions and those working with the community can link participants to the resources to obtain health insurance and increase access and continuity of care.

The PCO will continue to work on gathering information from State Loan Repayment Program Sites on whether or not patients get assistance with insurance applications at their site.

In 2024, the Primary Care Office will continue to implement the workforce initiatives that have been recently created in Arizona to increase health care providers throughout Arizona. These include:

1. The Accelerated Nursing Program provides scholarships for tuition and fees for students in programs that take 18 months or less to complete. After graduation, scholarship recipients are required to serve four years of full-time work in Arizona as a nurse.
2. The Nurse Education Investment Pilot Program is targeted to support universities and community colleges with nursing programs to increase the number of faculty available and infrastructure to expand program capacity, thus, increasing the number of spots available for students to seek nursing careers.
3. The Preceptorship Grant Program provides stipends to healthcare providers who precept a student within the same field for at least four (4) weeks. Eligible providers include Osteopathic and Allopathic Physicians, Advanced Practice Registered Nurses, Physician Assistants, and Dentists. The annual stipend is to increase the availability of preceptors in the state, prioritizing primary care and rural area providers.
4. The Behavioral Health Care Provider Loan Repayment Program provides funding to pay off portions of educational loans for behavioral health care providers and nurses, including Behavioral Health Technicians, Behavioral Health Nurse Practitioners, Psychiatric Nurse Practitioners and Licensed Practical Nurses, Physicians, Psychiatrists, and Psychologists who serve in behavioral health facilities, including the Arizona State Hospital, behavioral health residential facilities, and secure behavioral health residential facilities.