Cross-Cutting/Systems Building, Application Year FY 2022

The 2020 needs assessment resulted in the creation of two cross-cutting priorities for the first time in Ohio. The new FY 21-25 priorities include addressing health equity and Adverse Childhood Experiences (ACEs), and both priorities are addressed at the systems-level through the cross-cutting Action Plan and were included as priorities to address for each population workgroup throughout the development of the Action Plan. Cross-cutting priority strategies are included in this section and incorporated throughout the population domains in the Action Plan.

Emerging Issues

The COVID-19 pandemic shined a light on Ohio’s continued racial disparities in health outcomes. As reported in the COVID-19 Ohio Minority Health Strike Force Blueprint, “Black/African American Ohioans make up 13% of the state’s population but account for larger percentages of COVID-19 cases, hospitalizations, and deaths.” One of the recommendations of the Blueprint supports the direction of BMCFH’s Health Equity strategies around workforce development. Specifically, in the work around dismantling racism and the systems that support this oppression. The Blueprint also identified the gap in working in partnership with our primary stakeholders (i.e., people with lived experienced) to co-create programs within the community and strategies that will improve health outcomes.

The stress created by COVID-19 also has had a cumulative effect on Ohio’s population. Ohio’s youth suicide rates had spiked in 2019. OhioMHAS believes that the spike will have grown during COVID-19 based on their initial data. The Ohio Domestic Violence Network released their 2020 Fatality Report, which shows a 35% increase in domestic violence related fatalities between June 2019 to June 2020 in Ohio. Even with stay-at-home orders lifting during the summer 2020, stressors like financial strain and school and childcare closures supports the need building a system in Ohio that prevents, increase resiliency and heals traumatic outcomes resulting from ACEs.

Priority: Prevent and mitigate the effects of adverse childhood experiences

Measures

• SPM: Percent of children, ages 0 through 17, who have experienced two or more adverse childhood experiences (NSCH)
• ESM: None developed at this time.

The SPM aligns with the measure included in the State Health Improvement Plan. ESM development will continue to be considered as activities are planned and implemented.

Objective: By 2022, enhance data collection to inform ACEs prevention and intervention.

Strategies:

1. Apply for funding from CDC to add ACEs questions to the Youth Risk Behavior Survey (YRBS) (completed in FY 20)
2. Coordinate YRBS and OHYes data collection efforts
3. Develop and implement a plan to share YRBS data (including ACEs) to inform state and local programming (ADDED for FY 22)

ODH applied for and received funding from CDC to add the ACEs questions in the next Youth Risk Behavior Survey (YRBS). This survey is being combined with Ohio’s Youth Tobacco Survey (YTS) and coordinated with OHYes collection efforts. The 2021 YRBS/YTS includes 16 new ACEs questions. Due to COVID-19 the survey administration will be moved from Spring 2021 to Fall of 2021. Survey results are expected to be received Spring 2022. A strategy was added to ensure the newly collected ACEs data is shared broadly to inform programming.

Objective: By 2025, reduce the number of children 0-17 who experience two or more ACEs by 10%.

Cross-strategies with other priorities:

1. Explore opportunities to support/implement evidence-based models for pediatric primary care to identify and address ACEs exposure with brief screening and assessments and referral to intervention services and supports (Child).
2. Implement evidence-based adolescent resiliency projects through MP grant (Adolescent).
3. Continue MCH participation in existing prevention workgroups and coalitions, such as Ohio Anti-Harassment, Intimidation, and Bullying Initiative (Adolescent).
4. Provide resources, technical assistance, and professional development to health professionals working in the school and early childhood level to support resiliency and decrease HIB (Adolescent).
5. Support programming in local communities for professionals and community members on preventing violence and identifying and responding to victims of violence through SADVPP (Women & Adolescent).
6. Support MCH programs to further integrate ACEs and Health Equity priorities within each population Action Plan (ADDED for FY 22).

The strategies within this objective are included in the other population Action Plans and activities for the upcoming year are reported within those narratives. An additional strategy was added to continue integration of both ACEs and health equity within each population’s strategies and activities. During FY 21 the cross-cutting co-leads presented to each population on the systems-level progress for the cross-cutting priorities to increase awareness and lay the foundation for further integration in FY 22.

Objective: By 2025, develop and begin implementation of a plan to build a state system that prevents ACEs, increases resiliency, and heals traumatic health outcomes resulting from ACEs. (ADDED for FY 22).

1. Leverage and expand the state team from the ASPIRE project to continue strategic planning on ACEs.
2. Continue coordination of efforts around the three risk and protective factors identified through the ASPIRE project (Caring Adult, Economic Stress, Stigma Associated with Seeking Help).

This new objective and associated strategies are informed by Ohio’s participation in the ASPIRE (ACEs and Suicide Prevention in Remote Environments) collaborative learning institute which began in November 2020. The ASPIRE project included multiple state agencies and the Health Policy Institute of Ohio working as a team to identify shared risk and protective factors across programs. The resulting crosswalk identified two risk factors and one protective factor to focus on: economic stress, stigma associated with seeking help, and association with a caring adult. Another outcome from the ASPIRE project included the need to emphasize primary prevention, resiliency, and trauma informed care. NOTE: Ohio was the only state level collaborative at the institute and the other teams were from local communities.

An agency wide workgroup made up of ODH staff, primary and secondary stakeholders, and key/influencer stakeholders will be built to develop a strategic plan the further the work of the ASPIRE project. In addition, based on the results of the ASPIRE crosswalk, in FY 21 the cross-cutting co-lead reviewed each population’s portion of the Action Plan and shared the results with each group that many are already preventing ACEs, increasing resiliency, and providing healing through trauma informed care. However, not all are using the shared ACEs language, and in addition to highlighting where current efforts exist the mapping project identified areas for improvement in FY 22. Potential areas for improvement include identifying new and lower resource partners in addition to the usual partners to better reach communities; advancing efforts in co-create with primary stakeholders; and exploring shared marketing campaign(s) focused on “caring adults.”

Priority: Improve health equity by addressing community and social conditions and reduce environmental hazards that impact infant and child health outcomes

Measures

• SOM: (Women/Maternal) Non-Hispanic Black rate of severe maternal morbidity per 10,000 delivery hospitalizations
• SOM: (Perinatal/Infant) Black infant mortality rate per 1,000 live births
• SOM: (Child) Percent of children, ages 0-5, with elevated blood lead levels (BLL ≥5 ug/dl)

• SPM: Percent of Performance Measures that include at least one strategy focused on social determinants of health, at-risk populations, or health disparities.
• ESM: none developed at this time.

SOMs from the Women and Infant populations are relevant to this health equity priority. In addition, the lead poisoning SOM from the Child population is also relevant to reducing environmental hazards. The SPM reflects the commitment to incorporating the priority into each population. During the first year BMCFH established the Health Equity Committee, which developed a plan to advance health equity within BMCFH and through our policies and programs. ESM development will continue to be considered during activity planning and implementation.

Objective: By 2025, implement plan developed by the bureau health equity committee to build system to advance health equity in MCH staff and programs.

Strategies:

1. Select and implement health equity-increasing strategies in all state priority areas
2. Build bureau equity workgroup
3. Develop plan for improving internal MCH organization equity and staff capacity through bureau equity workgroup
4. Develop plan to institutionalize health equity in policy, program, grant, and contract administration through bureau equity workgroup
5. Build diversity in CMH Parent Advisory Committee (PAC)

During FY 20 and FY 21 the BMCFH Health Equity Committed (HEC) was established and the group developed a plan after reviewing literature and other state’s health equity efforts. The objective was updated to focus on implementation of the plan to advance health equity as developed by the HEC. During FY 22 the HEC will continue implementation of the three-pronged assessment approach (staff survey, program review, and community engagement subgrantee assessment) as well as use the results of the assessments to inform efforts of the working groups (Data, Onboarding and Participation, Training, and RFP).

The SPM provides an indicator of the integration of the equity priority within each of the priority population Action Plans. The Action Plan submitted in FY 20 had four performance measures with specific strategies focused on social determinants of health, at-risk populations, or health equity. These performance measures with equity strategies were in the Women and CYSHCN populations. Activities planned for FY 22 will focus on working with the population action teams for the populations without specific equity strategies associated with their performance measures, that is Infant, Child, and Adolescent. In addition to providing support for the population groups in reviewing approaches and evidence for equity increasing strategies, activities will also include further integration of equity within the existing strategies. During FY 21 the cross-cutting co-leads presented to each population action team on the cross-cutting priorities to set the stage for further integration during FY 22. The population teams expressed interested in the equity in all strategies approach in addition to adopting specific equity increasing strategies for each of the performance measures.

In FY 22 the CMH Parent Consultants will continue their efforts to maintain and increase diversity in the CMH PAC.

Other Efforts Supported by Title V MCH

BMCFH Parent Consultants

Parent consultants were hired in FY 20 and are tasked with improving parent perspective in BMCFH. In FY 21 they will be developing plans to assess family and/or community engagement for BMCFH programs. We anticipate this work will help to function as an assessment to inform future efforts and to be compared with results of parent consultant efforts.