Cross-Cutting/Systems Building – Application Year

In this section, South Dakota MCH Title V reports on planned activities in the Cross-Cutting/Systems Building Domain for the period October 1, 2021 through September 30th, 2022. In the Cross-Cutting/Systems Building Domain, selected priorities and the corresponding State Performance Measure are as follows:

Priority: Data sharing and collaboration

SPM 2: The extent to which data equity principles have been implemented in SD MCH data projects

ESM: 2.1 Number of times the data dashboard is accessed

ESM: 2.2 Number of reports or data briefs used that highlight health disparities or inequities.

ESM: 2.3 % of SD maternal deaths that are reviewed by the MMRC

2021-2026 Objectives and Strategies:

Objective:

1. Increase the number of new data sharing projects accomplished from zero to seven by September 30th, 2025.

2. Increase the number of new partners that we collaborate with on data projects from zero to five by September 30th, 2025.

Proposed strategies:

 2.1: Provide access to timely, reliable data so that partners and communities can use it in their own efforts to advance equity.

• MCH Data Use Survey

The MCH data survey was sent out in the April MCH newsletter. It was also sent out to MCH domain leaders so that their workgroup members could distribute it to additional partners. Thirty-two partners responded to the survey. Overall, partners wanted more data at a county and local level, and wanted data shared through dashboards. This and other information from the survey will be used to inform work for the next year. This activity was removed from this year’s action plan since it was completed.

• Data dashboard with MCH data

The MCH epi and OCFS data analyst took a Tableau training so they would have the skills needed to create a data dashboard. They are currently working on an infant mortality data dashboard and will create a larger dashboard with overall MCH outcomes and data specific to each of the current NPMs and SPMs.

• MCH Newsletter The MCH newsletters were sent out quarterly to over 200 MCH partners. The newsletter included a “Data Bytes” section that highlighted MCH data and new reports. The MCH team will continue to use this newsletter to communicate new data reports and other projects happening in the data sharing and collaboration work group.

 2.2: Develop reports that highlight health inequities across programs and issue areas.

• Updated Infant mortality report The MCH Epidemiologist, OCFS data analyst, and infant domain leader reviewed other states’ child death review/infant mortality reports to brainstorm what a new South Dakota report could look like. They liked Louisiana’s last Child Death Review report and were able to meet with two of the staff who had worked on this report. The Louisiana staff answered questions the South Dakota staff had around data reporting and gave helpful tips about how to visualize the data and include special sections such as considerations for CYSHCN, health disparities, and data to action. The analyst for the infant death review data is looking at additional variables to model Louisiana’s analysis. The MCH Epidemiologist, data analyst, and MCH team will continue to work on creating an updated infant mortality report over the next year.

• Update MCH data briefs This activity was not started during this reporting period but will continue to be an activity for the next year. The goal is to update MCH data briefs that were first created during the needs assessment. This would give partners and the public smaller snapshots at the data for MCH population domains.

2.3: Analyze de-identified data to assess social determinants of health and other underlying factors that play a role in morbidity and mortality.

• Medicaid maternal morbidity data DOH Maternal Child Health Director and MCH Epidemiologist were part of a team with SD Department of Social Services (DSS) to analyze Medicaid data for causes leading to maternal mortality and severe maternal morbidity. The DSS data analyst presented an analysis of Medicaid claims data that showed claims corresponding to maternal morbidity. The MCH Epi and DSS data analyst will continue to review the claims data, looking at it by risk factors such as obesity, substance use, and history of mental health and think about how it could be shared to potentially impact programmatic change.

• SD Maternal Mortality Review Committee A new maternal mortality abstractor began with South Dakota in April 2021. SD DOH is in final stages of signing data sharing agreements with the three major health systems in the state so that the abstractor will have access to medical records. The new abstractor is signed up with the MMRIA platform and has started abstracting cases with data from vital records and the state’s Health Information Exchange. The maternal mortality abstractor, MCH Epi and MCH/Title V Director all participated in the MMRIA user meeting held in April. The team hopes to hold its first meeting in the fall of 2021 and review 2018 cases. During this reporting year they also hope to review 2019 cases.

New Efforts:

• AMCHP MCH Epi Intern: The MCH epi applied to host an MCH epi intern for the summer of 2021 and was matched with a Masters of Epidemiology student from Emory. This project will focus on creating a plan for officewide data reporting and visualization that includes overarching MCH outcomes and program specific data. The intern will research the outcomes (e.g. reduce obesity, reduce youth suicide, and increase breastfeeding rates) to find the best data sources and indicators for each outcome. The intern will also decide how to report that data (e.g. at state or county level, by race/ethnicity, by other demographic characteristics, etc.) and give recommendations for data visualizations for both an internal facing (DOH) and public facing dashboard. If time allows, the MCH epi would also like the intern to research South Dakota’s data on social determinants of health and how that might factor into a data dashboard to give context to the disparities.
• Maternal and Child Health Policy Innovations 

South Dakota was selected to participate in the National Academy for State Health Policy Maternal and Child Health Policy Innovations Program. A group of 8 states will work over the next two years to build state capacity to address maternal mortality for Medicaid-eligible pregnant and parenting women. The MCH Epi will be a member of the South Dakota team to provide data support. The SD team will be researching and working on possible policy changes around value-based payments and pregnancy as a qualifying condition for the home health program.

• Office of Child and Family Services Assessment of Services

The Office of Child and Family Services underwent a multi-year services assessment with Health Management Associates to understand how to make services more accessible to clients, sustainable, and equitable for South Dakotans. Workgroups were formed around organizational structure, external partnerships, program data, financial data, CQI and evaluation, digital services delivery, and communications. The MCH epi lead the program data work group and participated in CQI and evaluation. HMA will be providing their recommendations for implementation and the MCH epi will lead tasks for the program data workgroup over the next few years. Many of these recommendations align with existing strategies and activities on the SPM2 action plan, such as displaying data on dashboards and developing new reports.

• Nutrition Education Marketing Plan for WIC

Each year the SD WIC program drafts and follows a Nutrition Education Marketing Plan (NEMP) that is utilized in the community health offices across the state. It consists of a needs assessment, goal setting, and evaluation for those providing WIC services. As recommendations from the OCFS services assessment are finalized, the MCH epi is going to be revising this plan so that it is an office wide plan for implementing WIC goals and MCH goals through the community health offices. For example, the plan will contain staff goals and evaluation around safe sleep (the infant domain priority) and sexual health education (state performance measure for adolescents). It will be changed from a yearly plan to a 3-year plan, allowing for more time to carry out activities and evaluate the plans. Another goal is that OCFS priorities will continue to align across programs and staff will see how their work contributes to outcomes across the office, including within the MCH program.

• South Dakota Preventable Death Committee

SD DOH formed a multi-disciplinary group with both state government partners and other statewide agencies to look at preventable deaths across the lifespan. This group looks at infant, child, and maternal deaths, along with those deaths identified through SD National Violent Death Reporting System. The goal is to identify common causes or risks for death across age groups to inform prevention efforts with partners. The MCH Epidemiologist reports on maternal deaths and the infant and women’s MCH domain leader represents the infant and child deaths. During the next reporting year, they will continue to hold meetings and find prevention efforts that can be supported across the state in coordination with partners.

• Equity in SD MCH data

This year the MCH data sharing and collaboration workgroup talked about ways to measure their work. Out of this conversation came the idea that their focus is around equity in data sharing and collaboration. During the next reporting year, this workgroup will begin to measure its work to the extent to which data equity principles have been implemented in SD MCH data projects. The workgroup has decided on a set of 6 guiding principles for equity in data and will use these guidelines as the framework and evaluation for data activities. The workgroup members will also use a scoring tool created by the MCH Epidemiologist to measure and track implementation over time.

Ongoing Efforts Supported by MCH for Cross-Cutting/Systems Building Domain

• PRAMS: MCH continues to conduct CDC Pregnancy Risk Assessment Monitoring System (PRAMS) through a contract with South Dakota State University. PRAMS data is a vital piece to understanding the attitudes and behaviors of the maternal and child health population. 2019 PRAMS data will be available and strategies for data sharing and dissemination will follow the strategies highlighted in the SPM 2 action plan.