Delaware’s Division of Public Health (DPH) is the largest division within the Department of Health & Social Services (DHSS). The Title V Team is part of the Bureau of Maternal & Child Health (MCH), which is situated within the Family Health Systems (FHS) unit. Title V is responsible for the planning, programming, development, administration, and evaluation of maternal and child health programs statewide. Within DPH, the Family Health Systems & Management section has direct oversight of Title V, as well as a number of other MCH programs including Children and Youth with Special Health Care Needs (CYSHCN), the Early Childhood Comprehensive Systems (ECCS) initiative, Newborn Screening (Metabolic and Hearing), Birth Defects Registry, State Systems Development Initiative (SSDI), Adolescent Health and School Based Health Centers, Infant Mortality Elimination program, Center for Family Health and Epidemiology, Title X/Family Planning, and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, as well as others that require partnerships, coalition building and leadership.
The Life Course Perspective continues to be the lens through which we view our MCH work. Delaware’s Title V MCH work focuses on ways to increase these protective factors and decrease risk factors. The Life Course Perspective suggests that a complex interaction of protective factors and risk factors contributes to health outcomes across the span of a person’s life, or developmental trajectory.[1] These protective factors and risk factors include disease status, health care status, nutrition, race and racism, socioeconomic status, and stress. Protective factors increase the developmental trajectory of a person while risk factors decrease the developmental trajectory of a person. Some key examples of protective factors:
• Data driven decision making
• Access to care
• Education and prevention
• Supporting coordinated, comprehensive and family-centered systems of care
• Title V as a leader and convener
Developing and utilizing innovative and evidence-based or -informed approaches to address cross-cutting issues
Within DPH, a performance improvement initiative led by the Division Director is re-focusing the organizations priorities to focus on core public health functions and address specific health priorities. The aim is to have DPH working at the “bottom of the public health pyramid on population based and infrastructure building services.
Title V MCH plays a very important role in the State Health Assessment (SHA) and State Health Improvement Plan (SHIP) process. It requires that our MCH partners across the state be engaged in the process, in order to access data, provide various perspectives in the analysis of data, and make a determination of contributing factors that impact health outcomes, particularly as it relates to women, infants and children. Assets and resources must also be identified and addressed as well learning directly from the community about attitudes about health behavior, socioeconomic and environmental factors, and the social determinants of health. The Title V priorities and State Action Plan build off the priorities identified through the SHA and SHIP process, as well as the DPH Strategic Planning priorities.
Mentioned throughout the application, the Healthy Women, Healthy Babies program promotes access to care, by providing an evidence-based framework to improve women’s health, mental health, and nutrition before, during & after pregnancy. The framework uses a Life Course perspective model that conceptualizes birth outcomes as the end product of the entire life course of the mother leading up to the pregnancy – not simply only the nine months of pregnancy. The goal is to provide assistive services to encourage the woman to maintain a healthy weight, nutritious diet, receive appropriate amounts of folic acid, manage chronic disease, address environmental risk factors such as smoking, substance abuse or other stress-inducing circumstances, as well as the development of a personalized reproductive life plan (for all women and men). The model is a value/performance-based approach focused on meeting or exceeding 6 benchmark indicators, with an emphasis on addressing the social determinants of health and incorporates the role of community health workers to further support outcomes.
Looking ahead, content for our Well Woman Initiative is robust on our DEThrives site to inform women of childbearing age (15-44 years old) the issues around maternal health in Delaware. This content focuses more on the consumer than the provider providing evidence-based education about annual well woman visits for example and will provide call to action messaging to help encourage women to play an active role in their maternal health.
HerStoryDE landing page recently went live on DEThrives. The HerStoryDE landing page was posted live on DEThrives in mid-March 2022. HerStoryDE is meant to educate, empower, and encourage women to use their voices when it comes to addressing their own health. It is a platform where it is has a consumer-focused voice and the woman can share their health experiences before, during, and after pregnancy. The HerStoryDE platform is a place where the consumer feels safe knowing someone is listening to them and advocating for them.
It is a powerful thing when someone decides to educate and advocate for themselves. And, hearing stories of other women stepping out of their comfort zone and sharing their story first usually helps encourage others to speak up as well. This action could empower the person to start advocating for themselves when it comes to their own health. That affect could turn into someone helping others in their community and the pattern grows outwards. If a consumer does actions such as this, they will be informed as to why it is vital to work alongside their physician by attending their well woman visits and asking questions so that they may address their health early on. These qualities are what the HerStoryDE platform aims to accomplish for the women in Delaware.
Six short form videos were created to tell the stories of different women, at different ages and stages in their life regarding their health. The videos compromised of women (consumers, a health care provider, and a DE State Representative) who shared their health journey before, during, and after pregnancy. In, addition, two long form videos were showcased during the 2021 DHMIC Summit which showcased the provider’s voice and consumer’s voice. A black maternal health infographic was also created that contains eye opening statistics about the deadly health issues women, particularly women of color, go through before, during, and after pregnancy.
To bring more attention to the Community Health Workers and to showcase how a woman can learn ways to live a healthier lifestyle, MCH ran a newsfeed video ad to increase awareness of the Community Health Workers campaign. One of the goals of this month long ad was to inform the public that the MCH CHW’s services were reaching out to new areas in the Kent and Sussex counties in addition to their services they already serve in NCC/Wilmington. Flyers were provided, which were placed on the DEThrives as well. The ad targeted females aged 15-44 years old living in specific zip codes.
MCH and community partners will again come together in observance for Black Breastfeeding Week to provide information on the benefits of breastfeeding a black or brown baby to improve black infant mortality rates and improve black maternal health. MCH ran a newsfeed ad that featured information on celebrating Black Breastfeeding Week and shared news that there was a week of community events to help black and brown mothers. The Black Breastfeeding Week blog post was written sharing the community breastfeeding related events that occurred in Delaware. In addition, HerStoryDE aired a live interactive webinar. The title for the event was “Elevating Women’s Voices: An Intimate Conversation About Black Maternal Health”. In-person panel discussions, with a live audience, were led by Tiffany Chalk and DE State Representative Melissa Minor-Brown, both DHMIC Leads. Panelists included one consumer, a physician, and a licensed professional counselor for mental health. The panel discussed topics around the health disparities women, particularly for black and brown women face before, during, and after pregnancy. The hour-long webinar was aired on DETv Broadcast and was also shown live on the DEThrives’ FB page. A flyer was created, a press release and op-ed were done, and organic social media posts were done to increase awareness of the event.
“Delaware Thrives” (DEThrives) is the branding theme and umbrella for all maternal and child health social marketing programming, developed in partnership with the Delaware Healthy Mother and Infant Consortium (DHMIC), which the state funds along with other federal funding sources, such as Title V, and DPH Family Health System staff support. DEThrives has purposefully become more robust with social media posts, messaging, programs, and partnerships. DEThrives utilizes Facebook, Twitter, Instagram and blog posts to educate, inform, and provide resources, services and links to the Delaware maternal and child health population and our partners. MCH is using this strategy to engage and inform our population with up-to-date information pertaining to various needs and topics.
Healthy Women Healthy Babies (HWHB) Zones mini grantees were awarded funding (the latest two or three mini grantees were provided second cycle funding on 1/1/21) for local communities/organizations to share their strategies aiming to improve health outcomes for women of childbearing age and their babies to address the root causes of infant mortality across Delaware. This funding for existing mini grantees will continue their HWHB zone programs through June 2022. A new cycle of funding was just announced in July 2022. This cycle of funding will begin 11/1/22 and will be for 20 months of funding through 6/30/24. Through this process, we are seeking to engage new potential mini-grantees, including those who may not already be at our table, but who are well connected to communities with the highest rates of infant mortality and where the health of pregnant people is most at risk. We are seeking actionable, community-based interventions designed to support identified high-risk communities across the state. We feel strongly that community input and buy in is critical, so we have included components of that as part of our process. Based on historical system inequities, we are requiring applicants to focus on reducing racial/ethnic disparities related to maternal and child health in their communities.
MCH responded quickly to the infant formula shortage dilemma the nation continues to face. In response to HRSA’s Infant Formula Shortage letter, MCHB immediately shared this important resource at the top of DEThrives as a call out bar. The letter was also distributed electronically via MCH email networks (Title V, Home Visiting, HMG, HWHB partners, DHMIC, etc.). MCH also worked with DPH and other leaders to create consistent messaging, updated consumer friendly flyers (planned to be distributed in grocery stores, drug stores/pharmacies, smaller stores), a press release, multiple social media posts on the topic, and a blog post.
MCH promoted a Facebook post for the Formula Shortage blog post. DEThrives Facebook page ran a single image newsfeed ad to increase awareness of the shortage blog post. The ad targeted people who indicated interest and self-declaration within the Facebook platform that they are parents or show interest in grandparents’ content, they are 18+, and living in Delaware. The post was seen on Facebook & Instagram Feeds, Stories and Instant Articles as well as on partner app sites as a native ad unit.
In terms of website traffic, the DEThrives site has seen a 49% increase in new users visiting the site within the past year. That means, DEThrives content has not only been able to reach new users but it also sparks their interest in some way for them to visit. The blog and order material sections of the website ranked as the top two sections that have received the most pageviews within the past year. The most popular searched for blog post within the past year is titled “The Importance of Developmental Screening for Children” which also happened to rank as the top searched for blog post in 2020. In addition, within the past year, the most popular searched for term on the DEThrives site was “dental”.
Between 6/21 and 6/22, the DEThrives social channels which consist of Facebook, Instagram, and Twitter saw an increase of fans (or followers) on both FB and Instagram, but a decrease of fans on Twitter. Over the past year, there has been a 4.6% net follower increase on all of DEThrives’ social media accounts. That means, platforms such as Facebook and Twitter have remained steady in the number of followers and the audience has grown on the DEThrives Instagram page within the last year. New tactics could be done to keep and entice our Facebook and Twitter followers and to continue and build up to entice our Instagram followers by continuing to post relevant, relatable content Instagram users want to see.
We are currently in phase V (Site Development and Production) out of VII for the status of DEThrives website rehaul project. Webpages have been built and staging links are in the works of being confirmed and passed along to DPH stakeholders to review in depth. We feel there is content that is still missing on the site and we are open to adding additional content as the site grows. We are working with our vendor to create a plan on ways to help promote the site once it goes live. Promotion may even occur three months after the site goes live to help bring awareness of the revamped site.
The Delaware Division of Public Health (DPH) is pleased to be recognized by the Office of Disease Prevention and Health Promotion (ODPHP) within the U.S. Department of Health and Human Services (HHS) as a Healthy People 2030 Champion for its commitment to furthering health and well-being.
As a Healthy People 2030 Champion, DPH has demonstrated a commitment to helping achieve the Healthy People 2030 vision of a society in which all people can achieve their full potential for health and well-being across their lifespan. ODPHP recognized Delaware’s DPH as part of a growing network of organizations partnering with it to improve health and well-being at the local, state, and tribal levels.
Supporting coordinated, comprehensive, and family-centered systems of services
Early identification and intervention for developmental delays to improve birth outcomes for children birth to 8 years continue to be the north star for the Early Childhood Comprehensive Systems (ECCS) program. Over the past five years, Delaware has leveraged multiple funding sources from state and federal programs such as ECCS, Title V, Maternal Infant Early Childhood Home Visiting (MIECHV) and the Preschool Development grants to drive its efforts to improve these developmental health outcomes and family well-being. In July 2021, the ECCS program within DPH lost its funding from Federal Health Resources and Services Administration. The bulk of the funding supported local place-based community partners to promote developmental health and screening within their communities. It therefore meant a scaling back of developmental health activities, especially at the local level. That said however, Federal Title V funds are currently being used to support the program in addition to state general funds.
With a long-term goal of progression toward universal developmental surveillance and screening, Delaware’s EC community emphasizes a coordinated, comprehensive and holistic approach which takes into account the impact of the social determinants of health of the child and his/her family. This entails focusing on the integration of a host of multi-sector programs in the health and early learning and education settings. To this end, the developmental screening effort places emphasis on collective impact with a goal toward shared measurement and agenda, in addition to the use of continuous quality improvement methods to address the gaps identified within the system.
1. Jay’s House serves families of children with Autism in New Castle County, with resources in the community to assist with providing a better quality of life for all family members. Their mission is to provide support to children and families affected by Autism.
2. Tomaro’s CHANGE has a history of providing therapy services to youth and families. Also, the organization has provided charity services to teens and adolescents who had low or no income. Services such as, parent/child relationship building, supplying basic needs such as hygiene products, clothes/shoes, cribs, and car seats. Tomaro’s CHANGE provides holistic care to youth and families, particularly those who are uninsured or underinsured.
DPH believes everyone – regardless of race, religion, and economic or social condition – has the right to a standard of living adequate for health and necessary social services. In recent years, DPH has strived to improve health equity with the help of many community leaders, non-profit organizations, state agencies, and stakeholders. One example is improving prenatal education and care to reduce the infant mortality rate. Another is educating parents and guardians how to protect children with asthma to keep them in school and out of the hospital.
The State of Delaware’s Department of Human Resources implemented a Workplace Wellness Policy and Procedures in June 2022. The Workplace Wellness Policy provides guidance on the foundation and infrastructure for Executive Branch agencies to establish and maintain workplace wellness initiatives. Workplace wellness initiatives focus on promoting a healthy lifestyle — including exercise, healthy eating, tobacco cessation, and preventive care — as well as supporting employees’ social and emotional wellness — including stress management and mental health. As the state’s largest public employer, the State of Delaware, has a responsibility to lead by example by promoting a culture of health; reducing health care costs, unplanned absences, and disability and workers’ compensation claims; improving health-related productivity; and enhancing morale and staff retention.
Serving as a leader, convener, collaborator and partner in addressing MCH issues
Partnerships are a unique and a fantastic asset in Delaware and our Title V MCH is a leader and convener of a broad spectrum of partners to address the needs of women, infants, children, adolescents, and children with special health care needs. Delaware prides itself in building and maintaining partnerships and collaborations with both state and federal organizations. Many organizations and coalitions are working to improve maternal and child health in the state of Delaware. In working to improve the lives of women, children and families, leadership is an essential role for maternal and child health programs. Leaders must have a vision, take initiative, influence people, solve problems, and take responsibility in order to make change happen.
In addition, regardless of your title and level in the organization, everyone at every level on the DPH Title V MCH team is engaged in the process of leadership. We conduct our work and our interactions with others using the 10 Principles of Leadership (LeadQuest) and these values as guideposts for our personal behavior, professional practice, and public health decisions. DPH has been focused on creating a culture of leadership for over 10 years, using this framework. Title V MCH has a proven track record of creating unity, building trusting relationships to help achieve success by working with others rather than stepping on or over people. We work on bringing people together, to establish a common vision and set of values along with programmatic systems and operations, such as planning, goal setting, communications and quality improvement. Examples of our role as Title V leaders and conveners are discussed throughout the application, including the DHMIC, Help Me Grow and Early Childhood Comprehensive Systems work.
The strengths of the MCH leadership and core team lie in our depth of professional experience, educational background, and passion for the work. Therefore, we feel that it is in our best interest to pursue a collaboration with the Office of Performance Management to identify the training needs of MCH staff. Together OPM and MCH could develop a training plan that would strengthen Title V staff’s capacity for data-driven and evidence-based decision making. Especially due to the pandemic, virtual and/or hybrid trainings would be afforded to each participant.
This past year, we completed a training series through FranklinCovey titled 6 Critical Practices for mid-level managers and above. This program was developed to equip first-level leaders with the essential skills and tools to get work done with and through other people. Staff also have access to the FranklinCovey all access pass provides access to content and technology, as well as a deep bench of experts to design and deliver unique learning experience tailored to our team’s needs. Course examples include Leading at the Speed of Trust; The 4 Essential Roles of Leadershp; and The 6 Critical Practices for Leading a Team.
Through the power of partnerships, we continue to integrate our programs where it makes sense, find the connections to make sure we are not duplicating work, focus on doing things right. Public Health success will depend on health leaders working closely with both the private and public sectors, and over the next year, we are making a concerted effort to tap new and non-traditional partners (i.e., business community, transportation, housing, planning, including faith-based organizations, etc.), particularly as we address social context issues impacting the health of women, infants and children.
[1] Lu, M. and Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: a life course perspective. Maternal Child Health Journal, 7(1), 13-30.
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