On July 1, 2022, the Utah Department of Health (DOH) and the Department of Human Services (DHS) merged to become the Utah Department of Health and Human Services (UDHHS). The vision for the new department is:

“The Department of Health and Human Services will advocate for, support, and serve all individuals and communities in Utah. We will ensure all Utahns have fair and equitable opportunities to live safe and healthy lives. We will achieve this through effective policy and a seamless system of services and programs.”

This past year brought new changes and challenges to Utah’s health and human services system. New organizational structures and policies are being created and updated to streamline and unify alignment of the two agencies. One of the main goals of the merger is to streamline services for citizens of the state, reduce redundancies making services more robust. The merger process has identified barriers and challenges to accessing care for those most in need and created opportunities to unify services, improve equity, and offer more efficient services. Performance driven measures, across all state agencies, allows for better alignment, promotes innovative strategies, and enhances our ability to support those who use our services.

For both Maternal and Child Health and Children with Special Health Care Needs Bureaus (now formally called Offices), the change will offer more opportunities to build partnerships. The new structure will also provide a opportunities to write grant applications with a more well-rounded group of stakeholders to meet communities needs in a more direct manner. Utah is looking forward to new opportunities to more efficiently serve our MCH and CSHCN populations, stakeholders and communities as a result of the merger.

 “Change is inevitable, change is constant, change is hardest at the beginning, messiest in the middle and the best in the end.”

-Maxwell and Sharma.

The new Division of Family Health in the DHHS has three Offices; the Office of Maternal and Child Health (MCH), the Office of Children with Special Health Care Needs (CSHCN), and the Office of Coordinated Care and Regional Support (CC&RS).

Utah Title V oversight is maintained by the Title V/MCH and CSHCN Office Directors. Both Directors and their staff serve as conveners, collaborators, and partners in addressing MCH/CSHCN issues. The mission of the MCH Office is to improve the health of Utah’s mothers, children and families. The mission of the CSHCN Office is to improve the health and quality of life for CSHCN and their families through early screening and detection, data integration, care coordination, education, interventions, and life transitions. Together, with other Department programs, our goal is to improve the health outcomes of all Title V populations.

The Office of CC&RS's mission is to provide intensive care coordination to children, youth and families with serious emotional disorders, conduct independent review for residential placement, improve access to evidenced based treatment, identify service gaps, develop service plans and identify resources and services.

The MCH/CSHCN Offices assess the health of our populations, provide education, assess current and long-term needs, implement programs, convene stakeholders, and prioritize the issues for our populations. We navigate the public health and political climate of our state and strive to provide the best services with limited dollars. Stakeholder and family involvement is a key component in all of our efforts and provides us the direction and focus for our work.

Utah works to prioritize spending and services in the context of limited resources. We receive limited state general funding to support our programs yet we consistently identify priorities for vulnerable populations and shift resources when able.

There have been many changes in Utah over the past 3-5 years that have significantly impacted on service delivery and Title V roles and responsibilities. The transformation of the Block Grant, internal UDOH changes, the UDOH/UDHS merger, and moving programs between buildings and Offices has impacted our ability to do business as usual. The changes at times create instability, delay growth and measurement of successes. And at the same time this allows us the opportunity to “think outside the box” and create a “new normal” for prioritization and provision of services and programs.

The MCH/CSHCN Offices work with Department staff, LHDs, and stakeholders, to accomplish NPM/SPM goals. There is a lead staff person responsible for each NPM/SPM and that person coordinates activities, documents progress for Block Grant reporting, tracks data, and monitors current evidence related to their performance measure.

Utah’s LHDs were actively involved in the 2020 Needs Assessment process and their activities are aligned with the NPM/SPM’s selected for the upcoming 5-year period. The Title V/MCH Office Director meets with the Nursing Directors bi-monthly to provide updates and to assess their progress on meeting objectives. The LHDs provide year-end reports to document outcomes.

The provision of services for Title V populations are provided through Department staff, LHDs, memorandums of agreement, service contracts, bids for proposals (when needed) and in-kind contributions from partners and stakeholders.

Title V Framework

Utah aligns its programs and activities with the “10 Essential Public Health Services to Promote Maternal and Child Health” framework. This model provides a well-rounded strategy which allows Utah to incorporate assessment, policy development, and assurance components within all of its programs. Utah ensures the State Action plan activities are linked to the 10 Essential MCH Public Health Services. Utah is stronger in some of the areas, but we are working to improve and become equally aligned across all services. A few examples are provided for each of the 10 Essential Services.

Examples of how Utah’s Title V programs promote Maternal and Child Health are presented below:

Utah’s Title V Program supports staff participation in partner workgroups and advisory committees. This collaboration allows staff to share their expertise while also learning about issues facing MCH/CSHCN populations. Their participation assures that the Utah’s Title V program priorities are known and that efforts are collaborative, not duplicative. Title V staff participate in the following:

• Autism Council of Utah
• Baby Watch Early Intervention Interagency Coordinating Council
• Coordinating Council for Persons with Disabilities
• Early Childhood Utah Governor’s Commission
• Early Childhood Utah Council (which reports to the Early Childhood Governor’s Commission)
• Family to Family Network-Utah Parent Center
• Intermountain Adult to Youth Committees
• Intermountain Healing Hearts
• Maternal Mental Health Policy Group
• Medical Home Portal Advisory Committee
• Help Me Grow Utah
• Utah Children’s Care Coordination Network
• Utah Developmental Disabilities Committee
• Utah Down Syndrome Foundation
• Utah Oral Health Coalition

Additionally, Title V programs convene/lead numerous committees that work to serve Title V populations. These include:

• Children’s Hearing Aid Advisory Committee
• CSHCN Advisory Committee
• Cytomegalovirus Workgroup
• Early Childhood Utah Council (Subcommittees include - Promoting Health and Access to Medical Homes, Early Care and Education, Social Emotional and Mental Health, Parent Engagement Support and Education, and lastly, Data Research and Policy)
• Early Hearing Intervention & Detection, Baby Watch Early Intervention, Parent Infant Program thru Utah School for Deaf & Blind Work Group
• Fetal Alcohol Spectrum Disorder Collaborative Committee
• Kurt Oscarson Children’s Organ Transplant Fund Board
• Medical Home Stakeholder Group
• Newborn Screening Advisory Committee
• Pediatric Audiology Work Group
• Perinatal Mortality Review (infant and maternal mortality)
• Transition to Adult Stakeholder Group and Sub-Committees
• Utah Women and Newborns Quality Collaborative
• Newborn Hearing Screening Advisory Committee
• Utah Autism Initiative Committee
• Utah Registry for Autism and Developmental Disabilities (URADD) Committee
• Well Women Coalition

Utah aligns its CSHCN services with AMCHP’s National Consensus Standard for Systems of Care for CYSHCN. Utah supports a coordinated care model which is inclusive of the family. The Integrated Services Program holds weekly meetings in which a variety of State stakeholders and partners come together to work on medical home, transition and care coordination efforts in order to reduce the burdens of the system's diversity on families. Additionally, utilizing virtual technology has reduced travel, coordination of scheduling, and allowed for different service providers to be on calls with families. Utah uses evidence-based approaches and values data in supporting initiatives to ensure a solid and robust foundation.

MCH/CSHCN staff work collaboratively with the Office of Health Equity and the American Indian/Alaska Native Health Liaison to identify and address the needs of Utah’s diverse populations. Additionally, when an emerging issue or need arises, MCH/CSHCN staff assess if other programs are currently addressing the same issue with other populations and discuss how to collaborate. MCH and CSHCN Offices take an active role in creating and engaging committees to ensure a diversified perspective is understood in order to effectively implement programmatic activities.

During 2022, select Department staff are participating in the Region VIII Tribal Relations Community of Practice initiative. This initiative is the result of a technical assistance request submitted by Region VIII MCH programs to HRSA. The goal of the Tribal Relations Community of Practice is to increase knowledge, skills and strategies, cultural responsiveness and engagement with Tribal populations. Teams from each of the Region VIII states are participating in multiple meetings during the 2022-2023 year with specific tribal consultants. Participants are learning from and with colleagues, while providing mutual support. Individual state technical assistance is available from trainers and Utah will use this resource.

In this past year, the Office of Health Equity offered professional development trainings led by the Health Equity Strategist. Topics currently include:

• Introduction to Equity, Diversity, Inclusion, & Accessibility
• Introduction to Health Equity
• Health Equity Strategies
• Intersectionality
• Stereotypes & Bias.

Training is open to any employee who is interested in expanding their knowledge of Health Equity. The purpose of these training is to assist teams, and make the Department a more welcoming, equitable, and inclusive organization.

On a larger State level, Utah’s Governor Spencer Cox is committed to providing the best programs and services for customers. The Governor’s “One Utah Roadmap'' (https://drive.google.com/file/d/1ql9q5pNKYXDnlIcWk4wcIPmxOhaHFgSd/view) outlines policy priorities for the State of Utah including improving government efficiency to become more responsive to the state’s customers by streamlining and modernizing state government, addressing social determinants of health, improving racial and gender disparities, education innovation, health security and many others. The roadmap is contributing to goals and outcomes being put forth with the merger of the Department of Health (DOH) and the Department of Human Services (DHS).