In addition to population domain specific activities and programs, Arizona's Title V program addresses cross-cutting issues affecting women, infants, children (including children with special health care needs) and adolescents through programs that cross the lifespan (such oral health) and programs that strengthen health systems and improve access to care in Arizona (such as the workforce development programs, site development for safety net clinics, family and youth engagement, and funding to local county health departments). 

In 2023 the ADHS Office of Oral Health (OOH), within the Bureau of Women’s and Children’s Health, will continue to work toward reducing disparities in oral health.  To help achieve this goal, 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.

Given the current COVID mitigation efforts—and to keep students, staff, and dental providers safe—OOH will implement updated infection prevention protocols, social distancing requirements, and team health assessment policies that will be incorporated into the existing School-Based Dental Sealant Program and other school-based program protocols. Protocols will be shared, and training will be implemented for all grantees.  OOH will be working closely to monitor school openings in order to resume school-based services.  OOH will be developing communication materials about the safety and need for oral health prevention services and sharing these materials widely with schools, state agencies, and oral health grantees.

HRSA awarded ADHS the Oral Health Workforce grant to implement a silver diamine fluoride (SDF) program. The program partners with existing Title V funded oral health programs, including the Dental Sealant Program and Fluoride Varnish Program. The SDF Program pilot projects began in 2019 in Cochise, Pima, Pinal, and Santa Cruz counties. In 2023, the SDF program will expand services to more counties by adding silver diamine fluoride services for those children who are also eligible for the partner programs. 

OOH will continue to collaborate with the Arizona Health Care Cost Containment System (AHCCCS; Arizona’s Medicaid agency) to identify opportunities to link Medicaid-eligible children 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 children in need.

In addition to collaborating with county health departments, OOH will continue its partnership with AT Still University, School of Dentistry and Oral Health, to implement the sealant program in underserved schools.  Through this program, dental screenings, sealants, and referral services will be provided to children at eligible schools by licensed dental faculty and dental students. Through this program, a partnership with local community dental clinics in Pinal County was established and will continue to be utilized for children needing additional dental services. In FY23 the goal is to continue to serve the 15 eligible schools that participated in the OOH school-based sealant program through this partnership.

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 dental providers and program administrators on dental public health issues.

Oral Health will continue to focus programming to identify children who are at highest risk of tooth decay and increase the number and proportion of children served. Collaborations and outreach to expand the program to new service areas will continue. OOH will continue to seek to expand preventive dental service programs in some of the most rural counties in Arizona by partnering with local partners who are embedded in rural communities throughout the state.

In addition, OOH will continue the statewide oral health survey, Healthy Smiles, Healthy Bodies, which is to be completed during the 2022-2023 school year.  The survey includes a stratified random selection of schools to provide county-level point estimates and identify disparities in oral health.  Through a partnership with First Things First, Arizona’s early childhood agency, children in kindergarten and 3rd grade will be screened. Data from the survey will be disseminated and shared with partners, stakeholders and the CDC’s National Oral Health Surveillance System to help monitor the health status of children and improve oral health programs. In addition, a partnership with the ADHS Bureau of Nutrition and Physical Activity (BNPA) allows for the collection of children’s BMI status.

The Fluoride Varnish Program will continue to provide services at Women, Infants, and Children (WIC) Program offices as well as at immunization clinics, child care centers and pediatric offices throughout Maricopa County. Families at WIC receive health and nutrition education and those at immunization clinics receive necessary immunizations and education. Parents are recruited to participate in the Fluoride Varnish Program while waiting for appointments. The goal of the Fluoride Varnish program is to provide education and referrals to 1,000 pregnant women and to screen and provide fluoride varnish and education to 25,000 children, 0 to 5 years old. New infection control guidelines and program procedures will allow providers to implement the program while adhering to COVID-19 safety recommendations.

The OOH intends to continue oral health and motivational interviewing training across the state for home visitors with a focus on reaching rural home visitors. Evaluation will continue to measure home visitor confidence in speaking to families about oral health and also measuring oral health knowledge gained from training.

The OOH will continue to partner with the BNPA to support and promote the Empower Program. Materials have been developed to assist child care facilities in implementing toothbrushing programs and oral health education activities. Materials include the ‘Arizona Tooth Brushing Manual: Fostering Healthy Smiles in the Child Care Setting for Ages 3 and Older’ and an online course, ‘Toothbrushing in Child Care Settings.’  More than 350 providers have completed this online course since its launch in September 2017.  Lastly, oral health education materials are regularly included in the monthly Empower Newsletter, reaching over 4,500 subscribers. 

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 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.

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 2023, OOH will continue to support the ongoing dental HPSA designations in Arizona in order 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.

OOH has a long history of facilitating family engagement through school and coalition partnerships. In 2023, as part of the bureau's efforts to increase family involvement, the Office of Oral Health will continue efforts to participate in the Families and Young Adult Program to establish a family advisor position to inform the work of OOH.  The OOH will convene coalition partners to help identify candidates for training on becoming Family Advisors.

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 587 federally designated HPSAs in the state, including 238 primary care HPSAs, 218 dental HPSAs, and 229 mental health HPSAs. Arizona needs an additional 653 full-time primary care physicians, 406 dentists, and 217 psychiatrists statewide to eliminate the existing HPSAs. Arizona also has 37 Medically Underserved Areas (MUAs) and 11 Medically Underserved Population (MUPs) designations. MUA/Ps are areas identified as having a need for medical services based on demographic data, including the provider-to-population ratio and infant mortality rate.  

In 2023, 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.  In May 2022, HRSA established the Maternity Care Target Area (MCTA) criteria. The PCO will be collecting the required data to ensure that the required data is collected and updated to ensure accurate MCTA scores for Arizona Primary Care Areas.

The Arizona Medically Underserved Area (AzMUA) report data collection and evaluation was 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 2022. 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 AzMUA project will be to connect report results to the PCO Portal and to automatically update the Primary Care Profiles in the database. In order to complete this PCO Portal enhancement, we will require additional support and funding.    

The PCO administers a number of 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 and National Interest Waiver Programs.  It is important to continually promote these programs in order 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 to 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 also work to formalize our partnership with the Arizona Area Health Education Center (AzAHEC) Program Office, at the University of Arizona, and the six 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.

Building off the existing partnership with AACHC and CYSHCN partners, the PCO will work to create opportunities for new providers or medical students who are interested in becoming Developmental Pediatricians; for example, a rotation at a Federally Qualified Health Center could be established via an MOU with the AzAHEC and AACHC.  

One of the short-term strategies to assist with COVID-19 was the implementation and maintenance of the Telemedicine Sliding Fee Scale (SFS) clinic mapper to assist patients in identifying the nearest SFS clinic that provides telemedicine services based on their zip code.  This strategy was implemented based on feedback from stakeholders that patients generally have a lack of awareness on where to go for telemedicine services during the pandemic.  The mapper is available on the PCO website.  

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 2023, 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. 

To measure this, the PCO will add a question to their State Loan Repayment Program Site Registration Application to assess whether or not patients get assistance with insurance applications at their site. Arizona’s Title V has also added NPM 15: Adequate Insurance to our selected NPMs to measure our work in this area.

In 2023, as part of the bureau's efforts to increase family involvement, the Office of Primary Care Office will focus on recruiting Family and Youth Advisors to help identify improvements and the best approach for outreach and training activities. The target Family and Youth Advisors from will be high school or college students and families from rural or underserved areas who are interested in health professions. We will work on gathering feedback on training materials and the best time in a student’s journey to hear about scholarships, loan repayment and other opportunities. We will also seek feedback on who would be the ideal audience for these outreach activities. We will gather feedback and ideas on how to best increase outreach and support to interested underserved youth and families to build a pipeline of health professionals from these areas.

The Engaging Families and Young Adults Program’s aim is to ensure Family and Young Adult Advisors are key partners in health care decision-making at all levels in the system of services, especially those who are vulnerable and medically underserved. In 2022, the grantee was identified to implement and fulfill the scope of work.  In 2023, there will be continued integration and expansion of young adult and family engagement strategies through the identified contractor Diverse Ability Incorporated (DA) in partnership with Raising Special Kids (RSK).

Within the program, Family Advisors must be family members (i.e., parent, grandparent, foster parent, aunt, uncle, adult sibling or adult cousin, or other adult considered family by a child) who have first-hand, lived experience with systems of care in order to have direct and meaningful input into the systems, policies, programs, and/or practices that affect care, health, well-being and the lives of children, youth and families. Young Adult Advisors recruited must be individuals ages eighteen to twenty-six (18-26), including youth with special health care needs and a variety of disabilities.

By early 2023, the implementation throughout BWCH will have been fulfilled by placing a family/young adult advisor in each identified Office (Primary Care, Oral Health, Children’s Health, Assessment and Evaluation, and Women’s Health). The goal in 2023 is to expand the engagement, support, and placement of young adult/family advisors by establishing memorandum of understandings (MOUs) with Placement Agencies, MCH-serving organizations across the state that work to improve systems of care, health, well-being, and/or lives of children, youth, and families. An overarching description of BWCH’s approach to family and youth engagement can be found in the Family Partnership section and domain-specific activities can be found with each population’s 2023 Action Plan narrative.

On July 1, 2020, ADHS entered into a new five-year intergovernmental agreement with local county health departments to leverage the partnerships between state and local health departments in Arizona by providing Title V funding to counties to promote and implement evidence-based or evidence-informed strategies that will improve the health and wellbeing of Title V populations in their communities. Through the MCH Healthy Arizona Families IGA (MCH HAF IGA), counties are encouraged to address needs identified through the 2020 Title V Needs Assessment and the 2019 State Health Assessment (SHA) (and subsequent annual updates) and to align their efforts with the 2021-2025 MCH health priorities and Arizona Health Improvement Plan (AzHIP) strategies; however, they are provided with the flexibility to design their strategies and activities in a way that meets the needs of their local context. Fourteen out of Arizona’s fifteen counties have elected to participate in the MCH HAF IGA; only Santa Cruz County does not because its health department is too small to conduct prevention and health promotion work. Through this mechanism, $2,017,545.00 is invested each fiscal year to serve Title V populations across Arizona. Local health departments (LHDs) develop Action Plans for each state fiscal year, which runs July to June. On August 15, 2022, they will submit their Action Plan strategies and activities for SFY2023. The ADHS Block Grants Program Manager, who also manages the MCH HAF IGA, will review the Action Plans to assure that all proposed strategies and activities will work towards improving health status and outcomes of Title V populations and will provide technical assistance and coordinate statewide collaboration on strategies to ensure funds are used in an impactful, efficient way.