Priority: MCH populations are able to obtain, process, and understand basic health information needed to make appropriate health decisions.

SPM: Percentage of Title V grantees that develop and disseminate basic health information that is accurate and clearly understandable.

Objective 1: Beginning in the first year of the grant cycle, disseminate at least one simple and clear message about basic health information.

Health literacy is the capacity an individual has to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy impacts an individual’s ability to: navigate the healthcare system, share their heath history with providers, and engage in self-care and disease management. In order to be health literate, an individual must have basic literacy skills, have basic mathematical skills, have a knowledge of health topics that are relevant to them, and understand the nature and causes of diseases or conditions that impact their health. For individuals from different cultural backgrounds, beliefs, communication styles, and ability to comprehend and respond, these factors may impact their ability to understand health related information. Poor health literacy is a stronger predictor of a person’s health than age, income, employment status, education level, and race. Therefore, it is imperative that programs, providers, and patients work together to improve health literacy.

BFH staff completed an introductory training on health marketing in 2018 developed as part of the work of the 2017 summer graduate interns. Some basic background in concepts and the contexts for health marketing, will position BFH staff to have broader discussions with Title V grantees around the use of clear messaging and materials when promoting health behaviors and choices. Feedback through client satisfaction surveys, now becoming a requirement in all grant agreements, will allow grantees and the BFH to understand what is working and not working as well in the provision of services including how grantees and the BFH communicate. This knowledge will allow the BFH to potentially develop technical assistance for grantees around the use of language, the appropriate reading level of materials in multiple languages to ensure basic, accurate, and clear health information is being conveyed at all levels of the Title V system of care. In addition to continuing to gather feedback on clients’ satisfaction with grantee services, the BFH will also survey grantees on their satisfaction with the BFH. Information collected will be used to identify strategies to strengthen the partnership between grantees and the BFH.

Priority: Appropriate health and health related services, screenings and information are available to the MCH population.

Objective: By the end of the grant cycle, all Title V vendors will have developed a plan to identify and address health disparities in the population they serve.

The BFH is making a commitment to address and combat health disparities in all MCH populations by inserting language into all grant agreements requiring grantees, including those receiving federal Title V and state MCH funding, to do the following:

• Develop a plan to identify, address and eliminate health disparities in the populations served by Title V.
• Align their work plan with the goals and strategies of the National Stakeholder Strategy for Achieving Health Equity.

Grantees are required to submit a summary of their health disparities work plan in their reports to the BFH from which the BFH can begin building long term goals and additional strategies to address health disparities within the MCH populations of PA. As a result of participation in the 2019 Cohort of the National MCH Workforce Development Center, the BFH aims to build the skill sets of BFH staff to be able to provide technical assistance around the development, implementation and evaluation of health disparities plans created by grantees by December 2019. Work of the Health Disparities Committee in 2020 will be guided by the accomplishments and workplan developed through Cohort 2019 participation and will include the implementation of technical assistance to grantees to further operationalize the developed health disparities plans.

The BFH plans to continue to develop technical assistance documents researching and summarizing the evidence-base for intervention strategies around specific topics and target populations at increased risk of experiencing poor health outcomes for use by grantees.

Priority: Title V staff and grantees identify, collect and use relevant data to inform decision-making and evaluate population and programmatic needs.

SPM: Percent of Title V staff who analyze and use data to steer program decision-making.

Objective 1: By December 2021, develop resources and tools to increase the utilization of 17 alpha-hydroxyprogesterone caproate or 17P by eligible women.

ESM (new): Percent of eligible women receiving 17P treatment compared to baseline data.

The BFH will continue its partnership with the March of Dimes (MOD), the Children’s Hospital of Philadelphia Research Institute Policy Lab (CHOP) and the Pennsylvania Department of Human Services, funded by a combination of Title V and State Systems Development Initiative (SSDI) funds to identify and develop interventions to increase the use of 17P among eligible women. The project will be implemented in four phases. Phase 1: Understanding the scope of the problem; Phase 2: Understanding the barriers to accessing 17P therapy; Phase 3: Determining an intervention; and Phase 4: Implementing the intervention. In order to understand the scope of 17P utilization and barriers to accessing 17P therapy, the BFH will partner with MOD and CHOP to perform a retrospective longitudinal study of women who were issued a Pennsylvania birth certificate for each live birth that occurred between 2008 and 2016. CHOP will analyze preterm birth status, 17P utilization among eligible pregnant women, and determine which sociodemographic and clinical characteristics are more predictive of receiving full treatment 17P therapy among women whose pregnancy and childbirth where covered under Medical Assistance. In Phase 2, CHOP will conduct qualitative interviews with mothers of current preemie NICU admissions to determine the contextual factors and decision-making surrounding the use of 17P. CHOP will develop an outcome report detailing the results of the study for MOD. In Phase 3, MOD will convene CHOP and other key stakeholders including the obstetrical chairs from the six birthing hospitals in Philadelphia, to determine and implement an intervention to address barriers identified in the report. In Phase 4, MOD will coordinate the implementation of the intervention to reduce barriers to accessing 17P therapy. There have been delays in obtaining data for this project, which has resulted in a late start and an inability to acquire baseline data to develop goals for the program. At the time of this report all of the data had been received and the program was moving forward with Phase 1. 

Another valuable tool being used by one of the County Municipal Health Departments is the Perinatal Periods of Risk (PPOR) Study.  The PPOR study will determine disparities in fetal-infant mortality and identify significant risk factors by analyzing vital records data and interviewing health and social service organizations to learn about aspects that may have an impact on birth outcomes. The identified disparities and risk factors bring focus on what services and resources are needed for women to improve birth outcomes and for infants to be healthier. Once the data is obtained, reviewed and analyzed a strategic plan will be developed for strategies to address these disparities.  

SPM: Percent of Title V staff who analyze and use data to steer program decision-making.

Pennsylvania has selected a state priority to build capacity of Title V staff and programs to collect, analyze, and use data. By building this capacity, the BFH anticipates a positive impact across all of the population health domains. While the BFH has several programs that are strong in collecting and using data for program evaluation and decisions, the 2015 Needs and Capacity Assessment revealed that there are not consistent practices in place across the BFH and in the local MCH workforce. To systematically address this, the BFH has developed objectives and strategies to build capacity in an intentional manner, similar to the way objectives and strategies are created to serve population needs. By investing in this capacity, the BFH will be better equipped to understand the needs of the MCH population and make informed decisions about programmatic investments.

The State Performance Measure defined for this priority is the percent of Title V staff who analyze and use data to steer programmatic decision-making. This will be calculated by dividing the number of Title V staff who analyzed and used data at least once during the reporting year by the number of Title V staff. This SPM was chosen because improved data collection and analysis will result in better decision making by staff and lead to improved health outcomes for families in Pennsylvania.

The BFH is committed to using data to steer program decision-making. The target percent for Title V staff who actively analyze and use data in program decision-making for 2020 is 55 percent. This is an increase in the number of Title V staff who regularly analyze and use data in program decision-making by approximately 25 percentage points over the base year in 2017. The BFH plans to meet with individual programs to continue discussing data collection and how program staff can better utilize data. As part of workforce development efforts, the BFH plans to survey staff to understand exact usage of data in decision-making. Findings will be used to identify areas where training and technical assistance is needed.

The Pennsylvania Pregnancy Risk Assessment Monitoring System (PA PRAMS) is an ongoing population-based surveillance system designed to identify and monitor selected maternal experiences and behaviors that occur before and during pregnancy, and during the child’s early infancy. It is a good example of a program that collects and uses data to increase understanding of maternal behaviors and experiences. PA PRAMS data is analyzed and translated into usable information for planning and evaluation of public health programs and policies. PA PRAMS is operated as a collaborative project with funding from both the Centers for Disease Control and Prevention (CDC) and Title V. Title V funds most of the surveying work performed by a contractor, while the CDC funds are used to pay for a PA PRAMS coordinator within the BFH. The project is designed to inform services and interventions statewide, driven primarily by the findings revealed. As such, analysis priorities and plans are informed by the programs and groups impacted. It remains an aim of PA PRAMS to increase visibility and recognition as an ideal source of maternal and infant health information and data. It remains a significant contributor in ongoing efforts to build state capacity for collecting, analyzing and translating data to address MCH issues.

Staff currently conduct descriptive analyses on PA PRAMS data to improve understanding of maternal health behaviors and prevent adverse health events. In the coming year, staff will identify opportunities to disseminate PA PRAMS findings to key stakeholders and increase analytic capability in order to inform, develop, modify and evaluate public health programs and policies in Pennsylvania. By April 2019, PA PRAMS staff will have an official steering committee with members and meeting processes in place. Additionally, PA PRAMS will be adding an opioid questionnaire to the core PA PRAMS survey for the 2019 birth year and will also be participating in an opioid call-back survey when the infants of PA PRAMS survey respondents turn nine months. PA PRAMS has developed an oversample plan and the operational sample size will increase to 2,107 from the current 1,693. PA PRAMS will also be increasing the number of strata from two to three to incorporate an oversample of counties with a high opioid burden.

By July 2019, PA PRAMS plans on developing and distributing a Descriptive Analysis Report (Report) of the PRAMS Phase 7 data (2012-2015). This Report will give BFH staff and other stakeholders a reference point for not only what data PA PRAMS can provide but more importantly, this Report will detail what kind of health behaviors and risk factors are impacting the health of mothers in Pennsylvania. This Report will then function as a jumping off point for stakeholders to ask questions and request more complex, in-depth data analysis for topic areas of interest. When complete, the report will be put in a readable format for use by internal and external stakeholders. Additionally, PA PRAMS staff will begin to distribute PA PRAMS data on specific topic areas of interest.

The Pennsylvania Child Death Review (CDR) program is another public health program that relies heavily on high quality data collection. The mission of the CDR Program is to promote the safety and well-being of children and to reduce preventable child fatalities. Currently, all 67 counties in Pennsylvania are covered by one of the 63 local CDR teams and review children’s deaths in all 67 Pennsylvania counties. The child death review process involves the multidisciplinary team gathering and reviewing available information related to the child’s life and death. This includes information derived from death certificates, traffic and law enforcement reports and hospital records. Data gathered is entered in to the National Center for Fatality Review and Prevention’s Case Reporting System (CRS). Local teams analyze their data to develop effective prevention strategies to reduce the number of preventable child deaths in Pennsylvania. Teams design prevention education, trainings, and recommendations for legislation and public policy. A statewide multidisciplinary team, comprised of local professionals and representatives of state agencies, will review data submitted by local teams and develop protocols and prevention strategies for child death review at a state level.

The BFH plans to maximize the use of the CDR and SUID/SDY registry data and recommendations as it moves forward with current and future program planning to address the highest priority needs of the Maternal and Child Health population. The CDR data will specifically be used to guide the targeting of programming and services related to safe sleep practices. Additionally, data from the CRS shows that in roughly one third of 2015-2018 deaths a death scene investigation was completed, the State CDR Team is developing Death Scene Investigation training for the Local CDR Teams to address this deficiency. Other federal funds will be used to support administrative oversight of CDR at the state level and federal Title V funds will be used to implement prevention measures based upon CDR findings.

In addition to supporting PRAMS and CDR, PA Title V funds will continue to partially support the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a CDC supported, but not fully funded, telephone survey of U.S. adult residents used to gather information about health-related risk behaviors, chronic health conditions, and use of preventive services. As BRFSS is the federal data source for the NPM 1: percent of women who have an annual preventive medical visit, using Title V funds to achieve an adequate BRFSS sample maintains a vital data source not only for Title V outcome reporting, but for a broad range of Department of Health programming. BRFSS allows for the addition of modules to address state data needs and the BFH plans to continue to take advantage of this opportunity as well.

Objective 1: By 12/31 each year, the BFH will identify one strategy to improve data collection for BFH programs.

To begin the process of transforming data into programmatic strategies, BFH staff identify one strategy to improve data collection for BFH programs by 12/31 each year. This objective was updated to be more specific and measurable. While the information gathered during BFH staff interviews during 2016-2017 indicated how each program is currently collecting or using data, the BFH is going to take a closer look at what data each program is collecting, starting with an examination of what data is in annual reports submitted to the BFH by the Title V and state match grantees. This will begin the process of identifying trends, strengths and needs in the BFH’s data collection efforts.

Objective 2: By 12/31 each year, the BFH will develop at least one actionable goal for each BFH program.

ESM: The percent of BFH staff who participated in the Introduction to Data Application and Interpretation in Public Health training.

Supplementing examination of the BFH’s data collection efforts will be the identification and implementation of training to assist BFH staff in identifying potential sources of data, how to link program goals to available data, and how to conduct basic analysis of data to inform the development of program performance measures. Title V funds have been set aside to support these training activities. As program goals are reviewed and data sources determined, BFH staff will be able to define process or impact measures in the form of revised ESMs or SPMs. More refined performance measures, closely linked to program goals, will enable BFH staff to not only identify areas for improvement, but more accurately describe program impact. The use of data analysis and clearly defined impact measures creates the foundation for on-going quality improvement activities and the development of actionable goals.

There continues to be a concurrent need for data analysis and program goal development within BFH programs as well as training for BFH staff with respect to these topics. It is anticipated that by the close of 2019, the BFH will have finalized a workforce development plan with identified clear, measurable goals for staff development around identifying data sources, data use and basic analysis, and the development of process and impact measures. Further, as reviews of individual program data collection activities are performed, each program will receive technical assistance as needed to move forward in conducting analysis and defining program performance measures.

To build the capacity of staff to develop actionable goals, further training and technical assistance on various data topics will be made available to BFH staff. The Introduction of Data application and Interpretation in Public Health training, developed for the BFH by two Master of Public Health interns, will continue to be offered to new staff in the BFH. The ESM for this priority is the percent of BFH staff who participated in the Introduction to Data Application and Interpretation in Public Health training. This will be calculated by dividing the number of staff who participated in the training by the number of Title V staff.

Objective 3: By 12/31 each year, the BFH will disseminate data from at least two programs.

This objective was updated to be more specific and measurable. As each program evolves the use of actionable findings and the development of programmatic strategies, the program will plan for the release of this data through appropriate outlets. This could be through reports, publications, data briefs, fact sheets, poster presentations, and conference presentations. Those programs that have grantee involvement will include the grantee in planning how best to disseminate findings and strategy outcomes.