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, School Based Health Centers, Pregnancy Risk Assessment Monitoring Systems (PRAMS), Infant Mortality Elimination program, Family Health and Epidemiology, Title X/Family Planning, and the 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 six 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 health.
DPH has implemented 10 Healthy Women Healthy Baby (HWHB) Zones community-informed strategies that aim to increase awareness, educate, better serve women of reproductive age and amplify the voice of black maternal health grass roots organizations. The primary focus is innovation and to spread evidence-based programs and place-based strategies to improve the social determinants of health and equity in maternal and infant health outcomes, as a complement to our medical intervention, HWHBs 2.0. The first-ever mini grants support the shared initiative to narrow the wide variance in birth outcomes between black women and white women by building state and local capacity and testing small-scale innovative strategies. DPH worked with Health Management Associates (HMA), as the lead backbone entity, to develop a mini-grant process to fund local communities/organizations to implement interventions to address social determinants of health in priority communities throughout Delaware. Last year we added two new mini grantees, for a total of ten active mini grantees awarded including: Delaware Adolescent Program, Inc. (DAPI), Delaware Coalition Against Domestic Violence (DCADV), Delaware Multicultural and Civic Organization (DEMCO), Hispanic American Association of Delaware (HAAD), Kingswood Community Center (cycle 1 only), Black Mothers in Power, Parent Information Center (PIC), Delaware Breastfeeding Coalition, Rosehill Community Center, Life Impact, and Christina Cultural Arts Center. The two additional mini grantees addressed two priority areas including fatherhood/partner involvement and engagement and food insecurity.
Black Maternal Health Awareness Week was celebrated in several ways. State Representative Melissa Minor Brown, and appointed Delaware Healthy Mother and Infant Consortium (DHMIC) member, was invited to the White House to meet with President Biden and Vice President Kamala Harris to discuss the Delaware DPH and DHMIC HWHB Guaranteed Basic Income demonstration program.
Also for Black Maternal Health Awareness Week, Tiffany Chalk, Vice-Chair of the DHMIC, was invited to speak upon the BMHAW Resolution at Delaware’s Legislative Hall.
Lastly, U.S. Representative Blunt Rochester hosted a roundtable event on black maternal health crisis. DHMIC Vice Chair, Tiffany Chalk, was asked by Congresswoman Lisa Blunt Rochester’s team to provide a statement in support of Black Maternal Health Awareness Week because since she was a member of the US Congress Black Maternal Health Caucus. The invitation was also extended to Mona Liza Hamlin, Co-Chair of the DHMIC Well Woman/Black Maternal Health (WW/BMH) Committee to be a part of a roundtable highlighting the disparities in maternal and infant health outcomes in the black community during Black Maternal Health Week. State Representative Melissa Minor Brown, a DHMIC appointed member, was also asked to be a part of the roundtable as well. The invitation included Delaware healthcare leaders, Delaware State Representatives, and U.S. House members. Media coverage was done by Bay to Bay News and on Delaware Public Media.
“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, X, 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.
Several pending legislation updates are available for reporting, which aim to improve maternal and infant healthcare in Delaware. 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.
- SS 1 for SB 301: An act to amend the Delaware Code relating to providing medication abortion prescription drugs and emergency contraception. This Act requires public universities to provide access to medication for the termination of pregnancy and emergency contraception. The medication and contraception must be provided on-site, but consultation to provide them may be performed by a provider at the student health center or by a provider who is associated with a university-contracted external agency.
- HS 1 for HB 5: This Act amends the Delaware Code relating to reimbursement of school based behavioral health services. The State’s Medicaid Plan still limits the reimbursement of Medicaid-covered, school-based behavioral health services to those provided under an Individualized Educational Program (IEP) or Individualized Family Service Plan (IFSP), despite federal policy changes that allow for these services to be provided as a medical necessity without IEP or IFSP documentation.
- HS 2 for HB110: This Act to amend the Delaware Code relating to insurance coverage for termination of pregnancy.
- HB 274: An act to Amend the Delaware Code relating to insurance coverage of allergen introduction dietary supplements for infants. This Act requires that all health insurance plans subject to requirements under Delaware law, including Medicaid, provide coverage, at no cost when prescribed to infants, of at least 1 early peanut allergen introduction dietary supplement and at least 1 early egg allergen introduction dietary supplement.
- HB 345: This Act amends the Delaware Code relating to coverage for Doula services. This Act requires Medicaid coverage for additional postpartum visits with a doula upon recommendation of a licensed practitioner or clinician.
- HB 362: An Act to amend the Delaware Code relating to coverage for doula services. In 2023, the General Assembly passed a bill, which required the coverage of doula services under the State’s Medicaid plan beginning in 2024. This Act would require similar coverage under private health insurance plans.
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 at state and local levels
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.
Thanks to the collaborative efforts from the Department of Health, the Delaware Maternal and Child Death Review Commission (MCDRC), the Delaware Perinatal Quality Collaborative (DPQC), and the Delaware Healthy Mother & Infant Consortium (DHMIC), a new toolkit was created for Providers to share patient materials to promote and educate women and their families on the Urgent Maternal Health Warnings Signs. The toolkit included flyers, posters, double-sided tear off prescription pads, and a Provider Letter. These items can be ordered and delivered for free or can be downloaded here from the DEThrives site in English, Spanish, or Haitian Creole.
To help spread the news that the Urgent Maternal Health Warning Signs Toolkit was available to order and/or download on the DEThrives site, an interview (part 1, part 2) was held with WDEL during their Del-Aware segment. Another interview was held with WJBR on their public affairs program Focus on the Delaware Valley and could be listened on WJBR’s website here. Lisa Klein, a Coordinator for the MCDRC and Meena Ramakrishnan, MD, an Epidemiologist for the MCDRC, were interviewed. To showcase these interviews on social, 30 second snippets of the interview were taken and made into two separate reels so the visual parts of the toolkit were showcased and the audio for the reel were pieces of the interview.
Two Home Visiting themed campaigns ran concurrently – the Home Visiting (HV) Campaign and Nurse Family Partnership (NFP) Home Visiting campaigns – had different goals set, depending on the timeframe. For the first three months of the HV campaign (known as flight 1) had the goal of generating awareness, brand recognition, and explained the purpose of the HV program to users. For the last two months of the campaign (known as flight 2) the goal was to encourage a user to consider signing up for the program and follow the call to action. The NFP campaign also had the goals of awareness during flight 1 and consideration during flight 2. Thirty second, 15 second, and 6 second videos were created for this campaign where four different videos were shown during a certain timeframe to help showcase the HV services from the NFP program specifically in high-risk zip zone areas particularly in the New Castle.
The HV campaign ads were placed on platforms such as on Facebook/Instagram newsfeeds as pictures and videos, Reddit, radio (in English and Spanish), website ads as images and videos, and on game apps. For the NFP HV campaign, ads were mainly displayed as short videos on Facebook/Instagram, YouTube, gaming apps, and on Spotify.
With a long-term goal of progression toward universal developmental surveillance and screening, Delaware’s early childhood community emphasizes a coordinated, comprehensive, and holistic approach which takes into account the impact of the social determinants of health of the child and. 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, three community-based organizations were awarded mini-grants. Down Syndrome Association of Delaware (DSADE), Children’s Beach House (CBH), and Teach Zen were awarded mini-grants. Tomaro’s CHANGE (Creating Healing Answers & Necessary Guidance for Excellence) decided to continue their efforts with the support of the PIC to implement their project in year 2 since they were not able to get their project implemented in year one. These four organizations that were awarded developed skills that will further sustain their projects after the funding has ended. These organizations enhanced their skills so that they can compete and apply for future grant opportunities to grow their efforts in serving CYSHCN.
Serving as a leader, convener, collaborator, & 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.
Delaware will develop a crosswalk through our MCH Title V Block Grant and develop an alignment with the CYSHCN Blueprint for Change. The 6 Core Indicators will be implemented throughout the domains and national performance measures in the delivery of service.
The Director of CYSHCN along with the Parent Information Center - Family SHADE project team will strategize with our MCH Title V team to make sure that we are touching on all 6 core indicators and health equity, quality of life and well-being, access to services and financing of services. We will align the current work and priorities that we are doing to serve CYSHCN and their families and improve where we would like to improve the system with and address the needs that have been identified in our needs assessment. This approach will assist and guide our Title V programs in aligning current work and priorities with the Blueprint for Change: Guiding Principles for a System of Services for Children and Youth with Special Health Care Needs (CYSHCN) and Their Families. This table below is a starting point for our state to identify where we are and where we want to go in improving the system of services for CYSHCN. This approach will allow us to do a crosswalk in the Title V Needs Assessment and assist in reporting future Block Grant application related to Blueprint activities.
On April 17th, the Delaware Healthy Mother & Infant Consortium (DHMIC) held its 18th 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, ethnic, and geographical disparities that are present in high-risk zip zones to reduce poor health outcomes in mothers and their infants. This year’s theme was IMAGINE. IMPACT. INNOVATE. Driving Equity in Infant and Maternal Health. This year, the summit sold out, people were placed on a waitlist, and the summit earned 406 registrants maxing out the venue’s capacity (maximum capacity at 360) with nearly 304 in-person attendees which included about 25 walk-ins. 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 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 11 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 State of Delaware’s Department of Health and Social Services celebrated Trauma Awareness Month during May 2024. DHSS chose to highlight the importance of Self-Care, especially within our staff. DHSS leadership recognized that many of its employees serve in roles where there is potential for vicarious and secondary trauma and/or compassion fatigue, in addition to the personal and public traumas anyone may be facing. Self-Care is an excellent strategy to build resilience which can protect everyone from the impact of traumatic events and help heal.
To help spread the word about Self-Care resources available to employees through our benefit package and within the community at large, DHSS hosted a 3K/5K Wellness Walk at a location in each county on May 17th. The Wellness Walk included a “Self-Care Map” that led to vendor tables where everyone received valuable information on the services offered while enjoying the great outdoors and getting some exercise! All staff (merit, exempt, casual/seasonal) and staffing agency workers in all our Divisions were encouraged to participate in this event for up to 2 paid hours as part of the workday.
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.
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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