The State Systems Development Initiative (SSDI) Grant is managed by the Data Resources Program (DRP) in the Office of Maternal and Child Health. The mission of the DRP is to provide analytic resources and statistical expertise to MCH and CSHCN programs for assessing the health status of maternal and child health populations, and for planning and evaluating services. SSDI funding pays the salary for a full time SSDI Grant Coordinator to manage project activities related to data collection and analysis, and provide additional analytic support to MCH programs. SSDI funding also supports the Five-Year MCH Needs Assessment, the submission of the Annual MCH Block Grant (BG) Report and Application, and application of data analysis to program planning for Title V related projects.

There have been staffing changes in the DRP. The SSDI Grant Coordinator position was vacant from October 2020 through March 2021 due to a staff resignation and recruitment time. The SSDI coordinator accepted another position as the Maternal Mental Health Specialist in May 2022. The DRP is currently in the process of filling that vacancy.

Due to these staffing changes throughout much of FY 2021, DRP was unable to provide as much analytic support as planned including: conducting analysis on factors associated with intrapartum transfers to hospital for delivery from planned out-of-hospital birth settings, linking birth certificate records by the mother, and serving as the Alliance for Innovation on Maternal Health (AIM) Data Lead.

Data linkages

DRP and the SSDI program plays an important role in ensuring timely and accessible linked MCH data systems. Historically, DRP staff, including the SSDI Coordinator, had access to the following data sources for data linkage projects: Vital Records Birth and Death data, Medicaid Data, WIC programmatic data, Hospital discharge data, and PRAMS data.

More specifically, the DRP Epidemiologist and the SSDI Grant Coordinator routinely links Vital Records Birth and Death data to obtain an infant death data set which is used for analysis by many programs. Additionally, DRP has routinely linked Vital Records and Medicaid data for birth outcomes for the Block Grant and many other state programs, papers, and local/national presentations and discussions, we have begun to link these data sets once again and will continue to do so in the future as an ongoing activity for the DRP and SSDI Project.

Additional linkage projects include the following:

• In FY2021, the SSDI Coordinator linked birth records by the mother to identify mothers who had a preterm birth, rather than solely relying on self-reporting for the Utah Women and Newborns Quality Collaborative (UWNQC). This linkage was used to assess utilization of 17-alpha hydroxyprogesterone in women with a previous preterm birth.
• In the last few years the DRP and the SSDI Coordinator have begun linking Vital Records data with WIC program data to analyze birth outcomes for vulnerable populations in Utah. These data are linked annually when the Vital Records data becomes available.
• DRP and SSDI Grant Coordinator provided Hospital Discharge data for work being done with the AIM project as well as monthly data analysis; DRP continues to link Hospital Discharge and Vital Records data for other programs, papers, presentations, and projects as the need arises.

Assessment and monitoring

The SSDI Coordinator plays an important role in Title V program assessment, monitoring, and reporting. In order to help streamline the collection and submission of the yearly requirements for BG Annual Reporting and the Application, DRP developed and implemented the Web-Enabled Systematic Tracking Tool (WESTT). WESTT provides a user-friendly interface for Block Grant Contributors to report on activities for the reporting year and outline activities for the upcoming fiscal year. WESTT also captures NPM, SPM, and ESM performance measures and updates objectives for the coming year. Each year, after the Block Grant has been submitted, a WESTT User Feedback Survey is developed by DRP and sent out to all Block Grant Contributors to obtain feedback on their experience using WESTT. The SSDI Coordinator programs and analyzes responses to the feedback survey and works with other DRP staff to identify and make enhancements to WESTT. Updates are made to WESTT annually based on the results of the survey with the goal of making WESTT as user friendly (for submitters and DRP staff) as possible.

In FY 2021 enhancements made to WESTT included closer alignment with updated MCH Block Grant guidance and adding fields for Block Grant Contributors to highlight challenges and emerging issues encountered in their programmatic work related to performance measures. DRP also added placeholders for new performance measures that came out of the 2020 needs assessment, and updated technical documentation in the manual for the WESTT system. DRP also completed a yearly training for grant contributors on use of the WESTT system.

More recent updates that were made to WESTT for the FY 2023 Application and FY 2021 Report include automating the required “achieved/not-achieved” statement for each NPM. Block Grant contributors now have a radio button located in the data form, which then populates the “achieved/not-achieved“ statement for the respective NPM/SPM. DRP also added fields for Block Grant Contributors to include work they are doing to understand and address health disparities for NPMs, SPMs, and ESMs. ESMs are also mapped to NPM/SPM strategies in the WESTT system.

DRP held a mandatory virtual training session for Block Grant Contributors in March 2022. The training included an overview of basics for new WESTT users and updates that have been made to the application. This year’s training also included additional modules including: incorporating equity into all of the work MCH and CSHCN does; an introduction to logic models for future applications; and an introduction to standardized target setting methods. The SSDI Coordinator developed and presented the health equity module and reviewed and provided feedback for other modules.

Reporting

The Utah Department of Health and Human Services (UDHHS) highlights leading health issues in its monthly Utah Health Status Update (HSU) publication. HSUs are sent monthly to the Governor’s Office and 500+ others including policy makers, health professionals, and state and local health department staff. The SSDI team also contributes regularly to Health Status Updates published by the agency that focus on MCH/CSHCN populations.

Each year, a Department wide meeting is held to review ideas for potential HSU articles. The DRP Manager attends this meeting, along with other MCH/CSHCN staff. After the meeting, a finalized HSU annual publication schedule is developed and disseminated to programs.

During FY 2021, MCH/CSHCN staff published nine HSU articles including:

• Infant Mortality - September 2020
• Infant Sleep Safety - November 2020
• Infant Hearing - May 2021
• Trends in contraceptive use - January 2021
• COVID--serving children with special needs - January 2021
• Perinatal mental health by age - February 2021
• PRAMS Opioid survey - April 2021
• Oral health Challenges during pregnancy - May 2021
• Stillbirth Pilot Study Results – June 2021

Starting in January 2022, the SSDI coordinator also provided analytic support to authors of HSUs. Before publishing an article, the SSDI coordinator provided ‘de novo’ data check by independently writing code to replicate the data being presented in HSU articles. The following HSUs were published in FY 2022 and data checked by the SSDI Coordinator:

• Prenatal Care Experiences During the COVID-19 Pandemic - April 2022
• Pandemic Related Stressful events Experienced During Pregnancy - March 2022

UWNQC and AIM

As stated earlier, DRP experienced substantial staffing changes over the past two years with the SSDI position vacant between October 2020 and March 2021. Before departing, the former SSDI coordinator provided analytic support during FY 2021 to the Out-of-Hospital (OOH) birth subcommittee for the Utah Woman and Newborn Quality Collaborative (UWNQC). The SSDI coordinator provided quarterly data on transfers to hospitals among mothers who intended to deliver in an OOH setting. Work with the OOH subcommittee also included: updating Utah Best Practice Guidelines on transfers to hospitals for planned OOH births; submitting an abstract on analyzing risks associated with maternal transfer to a hospital; and the development of a patient facing survey to collect data from mothers who experienced transfer to a hospital for an OOH birth setting. This survey was meant to better understand patient experiences related to the OOH transfer process and improve the transfer process. The SSDI coordinator also programmed the survey into REDCap for implementation and assisted with submitting the project to the Institutional Review Board.

In FY 2021, the SSDI Coordinator also provided analytic support to the UWNQC Maternal Health subcommittee by using provisional birth data from the Office of Vital Records and Statistics to track and provide quarterly reports on preterm births among Utah mothers, the number and proportion of Utah mothers reporting a previous preterm birth, and the receipt of progesterone.

In FY 2022, the SSDI coordinator provided data collection and analytic support to Utah’s Alliance for Innovation on Maternal Health (AIM) and attended planning meetings, trainings, and learning groups for a new AIM Opioid Use Disorder Safety Bundle (which has since been updated to include all substance use disorders), and contributed to the development of county-specific resource guides for AIM.

In FY 2022, the SSDI Grant Coordinator also supported the UWNQC Maternal Subcommittee on a quality improvement project focused on undocumented women needing prenatal and postpartum care. The SSDI Grant Coordinator helped develop and implement key informant surveys and assisted with a qualitative analysis of the data with the goal of creating a toolkit for providers and undocumented women to navigate health services in a non-threatening manner.

Additionally, UDHHS used SSDI Aim Supplemental funds to hire a part-time AIM Analyst in April 2022. The AIM Analyst has begun working closely with the Quality Improvement Director in the Maternal and Infant Health Program, to implement the new Substance Use Disorder Safety Bundle. The AIM Analyst has been providing analytic support by refining structure and process measures on safety bundle implementation for participating birthing facilities. The AIM Analyst has worked closely with AIM to develop a new Utah AIM Dashboard and will upload structure and process data as well as SMM data cases for each participating facility in the AIM data portal.

Other Support for Title V Program Efforts

The SSDI team continues to assess ongoing data needs by reviewing Federally Available Data (FAD) data to identify trends and demographic disparities within the MCH/CSHCN domains and providing FAD to programs and assisting them with interpretation of the data, including goal setting methodologies as requested.