The CT DPH’s State Systems Development Initiative (SSDI) is designed to develop, enhance, and expand state Title V Maternal and Child Health (MCH) data capacity for its needs assessment and performance measure reporting in the Title V MCHBG program. The three SSDI program goals for the FY 2018-2022 project period are to:

1. Build and expand state MCH data capacity to support the Title V MCH Block Grant program activities and contribute to data-driven decision making in MCH programs, including assessment, planning, implementation, and evaluation.
2. Advance the development and utilization of linked information systems between key MCH datasets in the state.
3. Support program evaluation activities around the NPMs that contribute to building the evidence base for the Title V MCH Block Grant program.

As part of the Title V MCHBG requirements, the DPH must complete a statewide Needs Assessment (NA) every five years. This assessment is a systematic examination of the health behaviors, conditions, and risk factors of each of the three Title V target populations (i.e., Pregnant Women, Mothers, and Infants; Children and Adolescents; and Children with Special Health Care Needs) using indicators that can be tracked over time for each of the five identified population health domains (Women’s/Maternal Health; Perinatal/Infant’s Health; Child Health; Children with Special Health Care Needs; and Adolescent Health). The CT MCHBG NA serves as an important foundation for data-driven planning efforts in the state and builds upon earlier efforts such as the Healthy CT 2020: State Health Improvement Plan (SHIP), a plan for improving the health of all CT residents in the current decade. The next 5-year NA will be completed in 2020 and submitted with the FFY2021 Application/FFY19 Annual Report. In subsequent years, ongoing interim needs assessment activities will be conducted to reexamine the health status of Title V target populations and identify any necessary changes to state priorities or activities. SSDI Project staff are the leads responsible for overseeing the completion of the upcoming MCHBG NA, as well as ongoing needs assessment activities. The SSDI Project Director, Project Coordinator, and other MCH staff will provide analytic support and technical assistance to assess the needs of the MCH population groups using quantitative and qualitative data.

The goal of the new SSDI Performance Measure, The percent of programs promoting and facilitating state linkage capacity for direct annual access to MCH electronic health data, is to ensure state capacity for accessing electronic MCH health data to support planning, monitoring, and evaluation on a timely basis. At baseline, linkages to birth records using vital records death, newborn bloodspot, and newborn hearing screening data are being done on a consistent, annual basis. SSDI funds have been used to help support the vital records birth and death modules in the Connecticut Vital Records System (ConnVRS) to facilitate improved availability and timeliness of vital records data to MCH programs. SSDI staff continue work to support the availability and use of the indicators identified in the Minimum/Core Data Sets (MDS), as well as attempt to reduce barriers to the data linkages outlined in the new SSDI Performance Measure. Many factors are outside the control/auspices of SSDI Project staff. Therefore, while SSDI staff may advocate for certain steps to be taken to increase the availability of data and performance of data linkages, SSDI staff has limited authority.

One of the largest, ongoing challenges we’ve faced is in obtaining linked birth-Medicaid data.

For the past several years, Connecticut has not had access to linked birth-Medicaid data. In the past, the Connecticut Department of Social Services (DSS) had provided linked birth data to Medicaid status at the time of delivery; this linkage was completed by a DSS sub-contractor. The last birth year for which data were provided was 2012 because DSS’s subcontractor was defunded. Because of this, Connecticut had not been able to report updated data for MCHBG Form 6 (formerly Form 8): Deliveries and Infants Served by Title XIX since the FY 2015 application. Marc Camardo, Connecticut Title V MCH Director and SSDI Project Director, worked with staff in the Community, Family Health and Prevention Section (CFHPS), Vital Records, and the DPH Legal Office during the previous project year to successfully execute a Memorandum of Understanding (MOU) with DSS, which also serves as the Inter-Agency Agreement (IAA) required by the MCHBG. While this did enable Connecticut to receive aggregate data for Form 6 (formerly Form 8) for birth years 2013-2018, DSS did not agree to provide the Department of Public Health (DPH) with the linked data set. Mr. Camardo and internal colleagues will be pursuing this in the upcoming project year.

PRAMS is another key data source included in the new SSDI performance measure for access and timeliness to data. SSDI funds have been allocated to help support the implementation of PRAMS, therefore helping to ensure regular access to statewide MCH data not available from any other source. In addition to supporting the implementation of surveillance activities, SSDI staff also perform analysis and dissemination of PRAMS data. The SSDI Project Coordinator also serves as the PRAMS PI, Project Director, Project Coordinator and Analyst. She regularly provides data to the Title V MCHBG and other internal and external partners to support their work with the MCH population. She will continue to do so during the upcoming project year.

During the FY 2015-2017 SSDI Project Period, one of the required areas of focus was to support the State’s Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality. The CT CoIIN team focused its efforts on the Preconception/Interconception network.

Every Woman CT (EWCT) is a learning collaborative made up of clinical and community-based partners who serve women of childbearing age in 8 communities across CT. This initiative was born out of the convergence of several statewide projects and plans focused on improving women’s health and birth outcomes including the CT CoIIN, MCHBG, State Plan to Improve Birth Outcomes, and the State Health Improvement Plan. The main goal of the EWCT learning collaborative is to increase expertise and self-efficacy in implementing routine pregnancy intention screening and appropriate care, education, and services to ultimately improve birth spacing, increase pregnancy intentionality, and the proportion of CT women who deliver a live birth who report discussing preconception/interconception health with a healthcare worker.

As part of their work, a plan was developed which identified clinical and non-clinical partners in the greater New Haven area to implement a preconception and interconception health intervention called the One Key Question (OKQ), first developed by the Oregon Foundation for Reproductive Health. EWCT encourages clinical and non-clinical providers to ask women of reproductive age, “Would you like to become pregnant this year?” Providers will then have tools to guide next steps depending on the woman’s response of ‘yes’, ‘no’, or ‘maybe/unsure’. The ultimate goal is to increase the number of healthy birth outcomes.

As EWCT/OKQ has evolved, CT CoIIN team members identified the need for evaluation, specifically: 1) assessing outstanding needs related to implementation planning of OKQ and setting up appropriate systems to track their implementation progress, and 2) identifying and tracking key indicators of collective impact. CT SSDI staff have chosen to focus its efforts under Goal 3 to meet this need.

For the MCHBG, the number of communities participating in EWCT is CT’s Evidence-Based Strategy Measure 3.1. Currently, 8 communities participate, with an annual objective of achieving 9 communities by 2019 and 10 communities by 2021. However, before expanding the number of sites, having evaluation data available to assess and improve implementation at existing sites is a critical first step. Also related to EWCT/OKQ is CT State Performance Measure 3: The proportion of births occurring within 18 months of a previous birth among females 15–44 years. Because EWCT/OKQ supports improved preconception and interconception health and optimal birth spacing, evaluation of these efforts will contribute to building the evidence base for activities conducted under the Title V MCHBG, as well as those by statewide partners.

A multi-stage evaluation of the EWCT/OKQ initiative will begin in October 2019. The evaluation plan is structured such that it is a collective impact evaluation that examines both process and outcomes of the initiative.