The State Systems Development Initiative (SSDI) Grant is managed by the Data Resources Program (DRP) in the Office of Maternal and Child Health (MCH). The mission of DRP is to provide analytic resources and statistical expertise to Division 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/Epidemiologist to manage project activities related to data collection and analysis, and provide additional analytic support to MCH/CSHCN programs and other programs working with Title V populations. 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 were staffing changes in the DRP in FY 2022. The SSDI Grant Coordinator position was vacant from May 2022 to August 2022. Due to the SSDI Coordinator vacancy in FY 2022, DRP was unable to provide as much analytic support as planned including: conducting analysis on factors associated with intrapartum transfers to the hospital for delivery from a 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. Since hiring the new SSDI Coordinator, these tasks have resumed.

Data linkages

DRP and the SSDI program play an important role in ensuring timely and accessible linked MCH data systems. Historically, DRP staff, including the SSDI Coordinator, have 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 link Vital Records Birth and Death data to obtain an infant death data set that is used for analysis by many programs. Additionally, DRP has routinely linked Vital Records with Medicaid data for birth outcomes for the Block Grant. DRP is in the process of establishing a new data sharing agreement with the Office of Medicaid Operations to continue linking Vital Records with Medicaid eligibility data and plan to analyze birth outcomes among women whose births were paid for by Medicaid as compared to other women.

DRP is currently in the planning stages of replicating a report published in 2018 on Severe Maternal Morbidity (SMM). The previous report linked hospital discharge data with birth records from 2013-2015. DRP is in the process of establishing a new data sharing agreement with the Division of Data Systems and Evaluation to link hospital discharge data with birth records from 2016 to 2022. While it is possible to calculate SMM rates with hospital discharge data alone, linking to birth records provides a rich source of data for understanding risk factors for SMM that are only available on the birth record, including (but not limited to): pre-pregnancy weight and gestational weight gain, pre-existing chronic conditions of the mother, prenatal care, gestational age, and the number of other live births.

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 the 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, DRP develops a WESTT User Feedback Survey and sends it 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 2022, enhancements made to WESTT included adding the ability to more easily map ESMs to strategies as well as adding and editing strategies within an ESM. Block Grant contributors can now link to a cloud-based supporting document to provide additional materials for their Block Grant reporting.

DRP held a mandatory virtual training session for Block Grant contributors in March 2023. The training included an overview of the basics for new WESTT users and updates that have been made to the application. This year’s training also included additional modules: health equity, an introduction to the evidence continuum and a results-based accountability (RBA) framework for strengthening ESMs, an overview of logic models and how they can be used to conceptualize NPMs, and standardized target setting methods. The SSDI Coordinator developed and presented the logic model and RBA modules and reviewed and provided feedback for other modules.

The SSDI team continues to assess ongoing data needs by reviewing Federally Available Data (FAD) to identify trends and demographic disparities within the MCH/CSHCN domains and providing the FAD to programs and assisting them with interpretation of the data. For this year's Block Grant application and report, the SSDI Coordinator provided programs with a brief summary analysis of NPM and NOM trends and disparities using FAD, which are included in the state action plan. The SSDI Coordinator also assisted the DRP Program Manager and MCH Epidemiologist to consult with programs on their NPM and SPM targets, offering assistance using standardized target setting methodologies for programs wishing to update their NPM and SPM targets.

Reporting

The Utah Department of Health and Human Services (DHHS) 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 contributes regularly to Health Status Updates published by the agency that focus on MCH/CSHCN populations, and the SSDI project director coordinates potential HSU topics at the division level.

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

Starting in January 2022, the SSDI Coordinator also provided analytic support to authors of HSUs. Before publishing an article, the SSDI Coordinator provides either a careful review of the code or performs a ‘de novo’ data check by independently writing code to replicate the data being presented in HSU articles.

During FY 2022, MCH/CSHCN staff published five HSU articles including:

• Use of tele-audiology for diagnostic testing after failed newborn hearing screening - February 2022
• COVID-19 pandemic-related stressful events experienced during pregnancy - March 2022
• Prenatal care experiences during the COVID-19 pandemic - April 2022
• Autism spectrum disorder and suicidal ideation - April 2022
• Newborn hearing screening in underserved populations - June 2022

DHHS has a self-administered hormonal contraceptive standing order which is issued by the Executive Medical Director. The standing order authorizes participating pharmacists and pharmacy interns to dispense self-administered contraception (pills, patch, or ring) to women ages 18 or older without a prescription. Pharmacists are required to report to the state on how many women they counseled and how many received contraceptives under the order annually. DRP manages the REDCap database used to collect this information and produces a yearly dispensing report highlighting the number of pharmacists and interns who enrolled in the program, the number and types of contraceptives dispensed, and a breakdown of age groupings of women receiving contraceptives under the order.

UWNQC and AIM

The SSDI Coordinator provides analytic support to the Out-of-Hospital (OOH) birth subcommittee for the Utah Women and Newborns Quality Collaborative (UWNQC). During FY 2022, this included drafting and sending letters to hospitals with available data on transfers from intended out-of-hospital births, and aggregate data from analysis of a patient facing survey, which collects feedback data from mothers who experienced a transfer to a hospital from an OOH birth setting. In FY 2023, the SSDI Coordinator began to develop transfer letters similar to those sent to hospitals that will be sent to freestanding birth centers, and a report using six years of data on a variety of out-of-hospital birth outcomes in Utah.

In FY 2022, the SSDI Coordinator provided data collection and analytic support to Utah’s implementation efforts of the Alliance for Innovation on Maternal Health (AIM) safety bundles. The SSDI Coordinator attended planning meetings, trainings, and learning groups for the AIM Substance Use Disorder (SUD) Safety Bundle, and contributed to the development of county-specific resource guides for AIM. The SSDI Coordinator is currently managing data collection for process and structure measures for the SUD bundle from participating hospitals in a secure REDCap database. The coordinator also works with an analyst in the Division of Data Systems and Evaluation to provide outcome measures on severe maternal morbidity using hospital discharge data. This data is uploaded into the secure AIM Data Portal so that hospitals can compare themselves to hospitals with a similar volume of births in an effort to improve care for mothers.

Other Support for Title V Program Efforts

The SSDI Coordinator has begun planning for the upcoming five-year Needs Assessment. The coordinator has made progress on developing an indicator report that will be used during the Needs Assessment process to inform stakeholders on the current state of MCH and CSHCN populations. The report compares indicators between the State of Utah and the U.S. as well as racial and ethnic comparisons. Each MCH/CSHCN domain has indicators for a variety of topics relevant to their respective populations. Data sources for the indicator report include: Census and American Community Survey, PRAMS, Vital Statistics, BRFSS, NIS, NVSS, NSCH, YRBS, and programmatic data.

The SSDI Team also completed a literature review of seven other states’ 2020 five-year Needs Assessment summaries from the 2020 Block Grant application. We selected the seven states based on Block Grant funding received from HRSA that was similar to Utah. During the literature review, we provided a synopsis of common methodologies used by other states, as well as highlighted innovative methodologies used for the 2020 Needs Assessment to inform the upcoming 2025 Needs Assessment.

The SSDI Coordinator attends, and occasionally presents at, monthly meetings for the DHHS Health Equity Workgroup and Health Equity Studios, a presentation and discussion format hosted by the same group. The Health Equity Workgroup strategizes ways to build organizational capacity to advance health equity and provides training to representatives from operational units throughout DHHS. As part of this group, the SSDI Coordinator will attend the Utah Regional Health Equity Conference this year.

The SSDI Coordinator also had an abstract accepted for the Council of State and Territorial Epidemiologists (CSTE) 2023 Annual Conference, which analyzed data from the National Survey for Children’s Health to assess risk factors for being bullied among children and adolescents in Utah.

Finally, the new five-year grant cycle for SSDI began in December 2022 and includes a new work plan of activities that the program will focus on. Current and upcoming SSDI grant activities include continued assistance with the five-year Title V needs assessment activities, strengthening data linkages, developing an MCH/CSHCN agency data catalog which includes data sources for social determinants of health, and enhancing capacity for timely data collection to inform emergencies and emerging issues for MCH and CSHCN populations.

Related to the upcoming 2025 five-year Needs Assessment, the SSDI team has already made significant progress on an indicator report highlighting a variety of health indicators for the five Title V population domains, which will help identify new priority areas for the next five-year Title V grant cycle.