The primary purpose of the State Systems Development Initiative (SSDI) grant is to develop, enhance, and expand state Title V MCH data capacity to conduct needs assessment and performance measure reporting for the Title V MCH Block Grant program. The eight key MCH datasets identified in the SSDI grant are used for surveillance, needs assessment, planning, public education, and evaluation.

Access to Key Datasets: Form 12 provides information on Hawaii Title V ability to access these datasets electronically, routinely, and promptly. The form also tracks linkage of the datasets with birth records, where appropriate. This narrative reflects reporting on Year 5 of a five-year project period.

Generally, Hawaii had consistent access to most SSDI datasets with a few exceptions: Medicaid and hospital discharge data. Electronic datasets were available for newborn screening programs, PRAMS, and vital statistics.

Vital Statistics: In 2017, enforcement of a Hawaii Revised Statute related to data-sharing policies severely limited and stopped access to the Hawaii Vital Records office data. In 2018, FHSD helped pass legislation to amend the statute, and in March 2019, FHSD regained access to the electronic vital statistics dataset upon approval by a new DOH Institutional Review Committee established by the new statute.

PRAMS: While changes were made to the data sharing statute, the Hawaii PRAMS survey operations were halted for 18 months over 2017-2018 without access to birth records to draw the survey sample. Survey operations resumed in December 2018; thus, there is no Hawaii PRAMS data for 2017 and 2018. Additionally, issues with the 2019 sample resulted in only six months of usable data. Data for 2020 is the first full year of PRAMS data since 2016.

WIC: In 2020, WIC completed installation of its new data system. A private third-party vendor now houses, analyzes, and reports data for the WIC program. The FHSD WIC Branch no longer has direct access to the electronic dataset but does have regular access to standard and special data reports. WIC may also request a copy of specific elements of the program dataset for analysis.

Medicaid Data: In 2021, FHSD executed a new Memorandum of Agreement (MOA) with the state Medicaid program to comply with Title V requirements for an interagency agreement. The agreement formalizes existing agency collaborative efforts to improve the health of mothers, children, and families and includes provisions for FHSD to request and receive Medicaid data. The agreement states that the Medicaid program will respond to data requests within 60 days of submission. Currently, Medicaid provides data needed to complete the Title V annual report, including:

• Information for Form 6 (Deliveries and Infants Served by Title V and Entitled to Benefits Under Title XIX)
• SSDI Core Measures (child immunizations)
• Enrollment data (including numbers of children, pregnant women)
• Data for several federal Medicaid quality measures used for Title V performance measures on developmental screening and child wellness visits.

Hospital data: In 2021, FHSD received access to a new hospital data portal established between DOH and the new state hospital data administrator, the Laulima Data Alliance. The Data Alliance is a subsidiary of the Healthcare Association of Hawaii (HAH), the nonprofit trade organization serving Hawaii hospitals, skilled nursing facilities, assisted living facilities, home care companies, and hospices. The data portal only provides summary utilization reports. Record-level data is available for purchase for specific research needs. FHSD used SSDI funds to purchase hospital datasets when needed.

Data Linkage: FHSD successfully linked data to vital statistics birth records with the amendment to the data sharing law that now permits access to vital records for public health research. Hawaii Title V has access to four linked electronic datasets to birth records:

• Birth and infant death records
• Birth and newborn metabolic screening records
• Birth and newborn hearing screening records
• PRAMS

Currently, the FHSD research statisticians can draw and link the records for newborn screening and PRAMS. Every month, the statisticians physically go to the Office of Health Status Monitoring (OHSM), the vital statistics program, to draw down birth certificate records using a program developed by OHSM. The software program can link with infant death records and delete those records, so FHSD programs are not contacting those families. Data linkage for newborn screening is conducted in the CSHN Branch office. For PRAMS, the sampling frame is applied to the dataset to develop the sample in the FHSD office. The final analytic file includes a partial linkage of some variables from the birth certificate.The linkage for the birth and infant death file is conducted annually by OHSM and provided to FHSD for Title V reporting.

Epi Vacancies: SSDI data activity is limited due to the departure of FHSD’s two epidemiologists—Don Hayes, MPH, M.D., a CDC MCH Epidemiology Assignee and Tiana Garrett-Cherry, Ph.D., MPH, in 2018 and 2019 respectively. Hawaii continues to recruit for the position vacancies at national conferences, public health programs, and locally; but is unsuccessful to date. The SSDI Project Coordinator has been helpful with circulating the recruitment announcement.

Title V Data Support: Given staffing vacancies, University of Hawaii faculty and resources have helped strengthen and supplement FHSD data activities. From 2018-2021, Hawaii used SSDI funds to contract with the University of Hawaii Office of Public Health Studies (OPHS) faculty to complete the 2020 Title V needs assessment, review data, provide technical assistance for planning and evaluation, and help with ongoing assessment. OPHS also assisted with the development of several data publications. The FHSD epi vacancies hampered the latter effort.

An OPHS graduate assistant helped complete the 2021 Title V grant report as a summer intern for the Title V grant coordinator. FHSD was able to sponsor her attendance at the 2021 AMCHP conference. In 2022, her poster presentation was accepted by AMCHP on the importance of disaggregated race/ethnicity data to understand infant mortality disparities in Hawaii. After graduation, the student was hired to work on the FHSD Pediatric Mental Health Access grant. This experience highlights the importance of establishing an MCH academic pathway for FHSD and the larger MCH workforce in Hawaii.

Planning/Evaluation: In FY 2022-2023, SSDI funds were used to continue TA for staff by Nancy Partika. Ms. Partika served as faculty for the former MCH Certificate program at OPHS. She also has extensive public health experience working for the Department of Health and leading community nonprofits like Healthy Mothers, Healthy Babies. Her TA supported building staff's public health knowledge and helped staff assess and respond to the challenges posed by the COVID pandemic. Ms. Partika also assisted staff with reviewing research by the MCH Evidence Center (EC) to support strategy selection, assist with planning and evaluating strategies/activities, and update logic models.

There is no dedicated MCH faculty at OPHS, and faculty have declined further offers to work on Title V given other program demands and research interests. With limited faculty prospects at OPHS, Hawaii searched out-of-state for MCH epi support to assist with the Title V report.

MCH Centers of Excellence: With assistance from the MCH Bureau staff (the Hawaii Title V Project Officer, Data Scientist, SSDI Grant Coordinator, and Workforce Development program), Hawaii contacted several MCH Centers of Excellence (COE) for technical assistance. While COE Directors were very supportive, finding epi assistance was challenging due to a lack of qualified or available faculty. Hawaii was able to contract with recent COE epidemiology graduates to assist with reviewing and interpreting data for the Title V report. Although the support was helpful, the post-graduate epidemiologists were challenged working with the population-based data and diverse scope of MCH data contained in the Title V report.

In 2023, FHSD contracted the University of Alabama Birmingham (UAB) Public Health Program for data services. UAB is nationally one of a few public health programs with a robust MCH program and faculty. A team of several faculty and researchers from the Applied Evaluation and Assessment Collaborative are providing technical assistance to review and interpret the Title V data to present a clear story about the MCH population in Hawaii. Their work is reflected in the Needs Assessment update section of this year’s Title V report. Hawaii may also contract with UAB to plan/assist with the Title V 5-year needs assessment. Coming out of COVID, a comprehensive needs assessment will be critical to identify priorities for the next five years.

Oral Health data supports policy change: SSDI funds were used to purchase 2016-2020 data on Emergency Department (ED) visits related to oral health conditions in response to requests by the state oral health coalition. Other states have used the data effectively to reinstate Medicaid adult dental preventive benefits since EDs cannot treat dental issues except to prescribe pain medication.

FHSD helped fund data analysis by University of Hawaii John A. Burns School of Medicine epidemiologists. Title V also provided national guidance for data analysis developed by the Association of State and Territorial Dental Directors. The findings confirmed that many dental-related ED visits were made largely by adults aged 21-44 years old (62%), Medicaid beneficiaries (49%), and Native Hawaiians (26%). Additionally, the analysis showed Medicaid paid $12.3M for dental-related ED visits, funds that could be better utilized for preventive services.

The data provided evidence of overutilizing costly ED services across the state for otherwise preventable oral health conditions. Data products included a PPT presentation for the State Coalition, a journal publication, and development of a factsheet and other materials to support advocacy efforts to reinstate adult Medicaid preventive dental benefits. In 2022, the Coalition’s recommended appropriation ($25.9M) was successfully included in the state Medicaid base budget to ensure sustained funding for the program. The Medicaid program is now working to contract for the services. The Coalition is working on a campaign encouraging more dentists to register as Medicaid providers.

Child and Family Mental Health data: In May 2023, national mental health month, FHSD partnered with the Hawaii Health Data Warehouse (HHDW) to launch an MCH mental health dashboard on the HHDW website. Mental health emerged as a growing concern coming out of the COVID pandemic. The dashboard provides a user-friendly summary of over 40 mental health measures from the major public health surveillance surveys, including the (Adult) Behavioral Risk Factor Survey, the Youth Behavioral Risk Survey, PRAMS, and the National Survey on Child Health. Healthy People 2030 targets are provided when available. Other measures include suicide fatality data and behavioral health workforce data. The advisory committee for the FHSD Pediatric Mental Health Access grant and other behavioral health partners provided input to the dashboard development.

Data Products/resources:

Without in-house epidemiology staff, FHSD data products are somewhat limited.

Publications

• Fok, C. C. T., Shim, M. J. Race and Depressive Symptoms are Associated with the Prevalence of Adolescent Suicide Attempts in Hawai‘i, Youth Risk Behavior Survey 2015-2017. Hawaii J Health Soc Welf. 2022;81(6):155-161. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9168932/?report=classic
• Matsunaga, M.; Chen, J.J.; Donnelly, P.; Fok, C.C.T.; Partika, N.S. Emergency Room Visits with a Non-Traumatic Dental-Related Diagnosis in Hawaii, 2016–2020. Int. J. Environ. Res. Public Health 2022, 19, 3073. https://doi.org/10.3390/ijerph19053073
• Strid P, Fok CCT, Zotti M,et al. Disaster preparedness among women with a recent live birth in Hawaii–results from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2016. Disaster Med Public Health Prep. https://doi.org/10.1017/dmp.2021.274

Factsheet

• Matsunaga, M, Chen, John. Adult ER Utilization for Oral Health Conditions in Hawaii, Hawaii Oral Health Coalition, 2021. https://www.hiphi.org/hawaii-oral-health-coalition/
• Hawaii Oral Health Coalition, Reinstating Hawaii Adult Medicaid Dental Benefits in 2022.

Presentations

• Study of Adult Emergency Room Visits with a Dental-Related Diagnosis in Hawaii: 2016-2020. October 2021 Masako Matsunaga, PhD. & John Chen, Ph.D. Presentation to Hawaii Oral Health Coalition.

Poster Presentation

• Baloran, R., & McFarlane, E. (2022, May). Infant Mortality and Birth Outcomes in Hawaii: The Importance of Data Disaggregation by Race and Ethnicity. Poster presented at the Associate of Maternal and Child Health Programs (AMCHP), 2022 Annual Conference (Virtual).

Websites/Data Trackers (Dashboards)

Hawaii State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System. Data for 2000-2019. https://hhdw.org/data-sources/pregnancy-risk-assessment-monitoring-system/

Hawaii State Department of Health, Pregnancy Risk Assessment and Monitoring System (PRAMS). https://health.hawaii.gov/fhsd/home/hawaii-pregnancy-risk-assessment-monitoring-system-prams/.

Hawaii State Department of Health, The Hawaii Primary Care Needs Assessment Data Tracker www.hawaiihealthmatters.org/Dashboards/PCNA. This convenient online tool allows users to compare common health statistics across all 35 primary care service areas in Hawaii. It includes over 45 indicators of population characteristics and health status to monitor an area's social determinants of health. The tracker includes a short section on Maternal Infant health utilizing vital statistics of birth and infant death data.

Hawaii State Department of Health, The Oral Health Data Tracker Hawaii Health Matters :: Indicators :: Oral Health Tracker This convenient online tool allows users to review data across 30 oral health indicators for children, pregnant women (PRAMS), and adults.

Hawaii State Department of Health, The MCH Mental Health Data Tracker https://www.hawaiihealthmatters.org/indicators/index/dashboard?alias=MentalHealth This convenient online tool allows users to quickly review data across over 40 mental health indicators for pregnant women, children, adults, and families.