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 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 provides a call to action message to help encourage women to play an active role in their maternal health.
DHSS recently began seeking applicants for the HWHB Zones mini-grants for Cycle 3 and Cycle 4. This was for new funding and recruiting for two new applicants using community-based approaches to improve maternal and infant health outcomes in Delaware. This was a new cycle of funding for an ongoing initiative that had its first funding cycle in 2019. This would be a 20-month cycle of funding that will run from November 1, 2022 through June 30, 2024. DHSS also wanted to celebrate the current cycle of HWHB Zones mini-grantees for their work and accomplishments over the last 3 years which was the last cycle of funding. A webinar, titled the “2022 HWHB New Mini-Grant Funding Cycle Kickoff” was held for interested applicants to learn more information and the recording of it along with the PowerPoint slides can be viewed on the HWHB program landing page here. The objectives were to recruit applicants for the latest cycle of HWHB Zones mini-grant funding, generate awareness of and participation of applicant webinar, and highlight the impact and word of the Cycle 3 HWHB mini-grantees. DHSS also sent out a Press Release to increase awareness of this mini-grant funding opportunity throughout Delaware. The following was the target audience:
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501(c)(3) organizations with actionable, community-based interventions designed to support identified high-risk communities across the state that must:
- Serve communities with the highest rates of infant mortality and where the health of pregnant people is most at risk.
- Focus on reducing racial/ethnic disparities related to maternal and child health in their communities.
- Develop strategies based on the perspectives of, priorities of, and partnerships with those living in the HWHB Zone.
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Additional criteria:
- Organization must have an operating budget under $3 million.
- Proposed program must be linked to reducing disparities related to maternal/child health.
- Target population is women of childbearing age (ages 15 to 44) who are considered high risk (living in a targeted HWHB Zone), as well as partners of these women.
“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.
A press release was recently published, sharing that Governor Carney signed a package of legislation which totaled to six house bills to help decrease maternal and infant mortality rates by expanding services in Delaware. Members such as Delaware Representative Minor-Brown, Senator Pinkney, and other members of the General Assembly worked on pieces of the legislation. The goal of these bills was to break down barriers and remove other obstacles some mothers and families have faced when receiving healthcare treatment in Delaware. These bills are also a part of the “2022 Delaware Momnibus, a series of 8 bills Rep. Minor-Brown is working on to improve maternal and infant healthcare statewide. Listed below are the House Bills that were signed:
- House Bill 340 revamps the Child Death Review Commission to include more focus on maternal concerns. The commission will be renamed the Maternal and Child Death Review Commission to reflect its existing dual focus. The definition of “maternal death” will also be updated and the Commission would reflect diverse membership that would include a midwife and one maternal and one child advocate from statewide non-profit organizations. In an effort to be transparent, the group will be required to publicly post its draft report and accept written public comment.
- House Bill 344(S) requires the Delaware Perinatal Quality Collaborative to establish a subcommittee to develop bias and cultural competency training for healthcare employees. The subcommittee will develop training guidelines designed for use in all healthcare fields and shall release the initial guidelines by July 1, 2023. The subcommittee will review data every year thereafter and revise the guidelines as necessary.
- House Bill 342 expands existing restrictions on the use of restraints on women who are giving birth or in labor to include pregnant women and those in the 13-week post-partum period.
- House Bill 345 ensures pregnant women or women who have given birth within the past six weeks who are subject to the custody of the Department of Corrections at Level IV or V have access to midwifery and doula services by requiring the department to make reasonable accommodations for provision of available midwifery or doula services.
- House Bill 343 requires the Division of Medicaid and Medical Assistance (DMMA) to present a plan to the General Assembly by November 1 for coverage of doula services by Medicaid providers. The services will be provided by a trained doula designed to provide physical, emotional, and educational support to pregnant and birthing persons before, during, and after childbirth. This will include support and assistance during labor and childbirth, prenatal and postpartum support and education, breastfeeding assistance, and parenting education.
- House Bill 234 requires DMMA to extend Medicaid postpartum coverage to 12 months from the end of pregnancy through the state plan amendment option created by the American Rescue Plan Act of 2021.
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
MCH and community partners recognized and celebrated the 10th anniversary of Black Breastfeeding Week between August 18th - August 25th, 2022. This observance is particularly important to address since black babies in Delaware are almost 3 times more likely to die than white babies before their first birthday. DEThrives created a blog post title “Back Breastfeeding Week 2022”, that listed free community events to help promote Black Breastfeeding partner events. These local events ranged from a community doula program, a community “Group Latch” about breastfeeding, a “Painting with a Twist” opportunity to paint a breastfeeding inspired canvas, a coffeehouse style book reading of “Free to Breastfeed: Voices of Black Mothers”, and online Zoom celebration title “The Big LATCH!”, and a documentary titled “Aftershock” which showcased the discussion of the black maternal health crisis followed by a panel discussion of women’s health and reproductive rights led by Delaware State Representative Melissa Minor Brown and other community partners. A Save the Date Flyer was also produced to help spread the awareness of the observance and the community events. Interviews on the topic occurred along with an e-blast email that was sent out to increase awareness of this observance and to increase awareness of the importance and benefits of breastfeeding, particularly in the black and brown population, for mother and their families.
In addition, a single image newsfeed ad was published recognizing Black Breastfeeding Week. Once the ad was clicked, it redirected the user to the “Black Breastfeeding Week 2022” blog post which shared a list of community events and resources celebrating this observance. The ad targeted women aged 18-35, proxy pregnancy and new parent audiences living in Delaware. The objective of the ad was to drive traffic to the “Black Breastfeeding Week 2022’s” blog post on the DEThrives site.
MCH also ran a Home Visiting campaign via DEThrives, which targeted high-risk zip zones in Delaware with an emphasis in the Wilmington and Newark areas. The target audience for this campaign included: pregnant women, new parents, or parents of children aged 0-5 years old since that is one of the qualifications a person must meet to be enrolled in a Home Visiting program in Delaware. The campaign consisted of traditional and digital media. The traditional media that was included in the campaign were items such as:
- Framed posters, ceiling posters, self-standing banners, and window clings were distributed to laundromats, hair and nail salons, pharmacies, grocery stores, and convenience stores which was slated to be in about 125 locations statewide in Delaware.
- A radio ad (in both English and Spanish) was shared on top stations targeting women ages 18 – 34 years old, under the contemporary hits, urban, and Spanish radio stations
- Direct mail such as postcards were mailed to the targeted zip codes for pregnant women and new parents with a household income of less than $75K in the high-risk zip zones.
Digital advertisements were placed on apps, with exposure to YouTube and Connected TV. Some examples of distribution include AppleTv, Comcast, firetv, Roku, Vizio, Amazon echo, Samsung, TMobile, Xbox, Playstation, etc. Ads also had a chance to populate on games from apps. Ads gave in-app bonuses for engaging with the
campaign content. For example, if someone was playing the app game called “Candy Crush”, the user could watch an add about HV in an exchange to earn an extra life in the game. HV ads were also displayed on banner ads on websites as well as Native ads, which were displayed on websites. Native ads are displayed in a way where it doesn’t disrupt the user’s experience when viewing content on a webpage. Lastly, paid social media posts on Facebook, Instagram, and others were displayed as story ads or newsfeed ads.
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.
Through the Family SHADE project, two community-based organizations were awarded mini-grants. Jay’s House and Tomaro’s C.H.A.N.G.E. (Creating Healing, Answers, & Necessary Guidance for Excellence) were awarded mini-grants. The Family SHADE project, focused on providing these two community agencies with technical assistance on implementation and evaluation of their project so that they were in alignment with our selected National Performance Measures. They each developed an implementation plan and an evaluation plan with the technical assistance of the PIC team and through the Family SHADE project. They received technical assistance through the Learning Communities offered by the Family SHADE project. The scope of work included the recruitment and retention of children and families in the Wilmington area.
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.
On April 18th, 2023, the Delaware Healthy Mother & Infant Consortium (DHMIC) held its 17th annual summit to discuss ways to prevent infant and maternal mortality and to improve the health of women of childbearing age and infants throughout Delaware. The DHMIC focuses on understanding and addressing the racial and geographical disparities that are present in high-risk zip zones to reduce poor health outcomes in mothers and their infants. The 2023 theme was “RENEW. RECONNECT. RECHARGE. Join our journey as we strengthen our commitment to healthy women, babies, and communities”. The event drew in many healthcare professionals, policymakers, community influencers, community partners, stakeholders, and citizens such as nursing students who were interested in learning ways on how to provide access to proper care for all Delaware mothers, before, during, and after pregnancy, their babies, and families no matter their socioeconomic, racial, or ethnic status.
In between the three keynote speakers, there were group breakout sessions and a panel discussion moderated by DHMIC members and DPH leadership, innovation stations that showcased the Healthy Women Healthy Babies (HWHB) mini-grantees, a visual artist that captured the day’s theme, topics, and experiences in illustration and graphic form which will be used for media use, and multiple activities that encouraged group discussions among attendees and education with the innovation stations.
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. However, professional development is an ongoing process to ensure staff have the tools needed to perform all job functions with the highest level of execution. We have utilized a variety of training platforms for professional development including the MCH Navigator, FranklinCovey and our internal DPH training office.
This past year, we offered two essential roles of leadership courses, “Create a Shared Vision” and “Strategy and Execute Your Team’s Strategy and Goals”. Both trainings were provided in ½ day in person off site training center. These trainings were selected as we are kicking off strategic planning for the Family Health Systems sections and the Bureaus within the Section and we want all team members to be active participants in the process. Training and development of our workforce is one part of a comprehensive strategy to improve the competence of, and services delivered by DPH. Fundamental to this work is identifying gaps in knowledge, skills, and abilities through the assessment of the employee’s individual needs and addressing those gaps through targeted training and development opportunities.
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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