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’s ability to access these datasets electronically, routinely, and in a timely manner. The form also tracks linkage of the datasets with birth records, where appropriate. This narrative reflects reporting on Year 4 of a five-year project period (12/01/2020 – 11/30/2021).

Generally, Hawaii had consistent access to most of the SSDI datasets on a regular basis with a few exceptions: Medicaid and hospital discharge data. Electronic datasets were available for newborn screening programs, PRAMS, and vital statistics. In 2020, FHSD lost access to the WIC electronic dataset.

Vital Statistics: In 2017, enforcement of a Hawaii Revised Statute (HRS) related to data-sharing policies severely limited and stopped data sharing from the Hawaii Vital Records office. In 2018, FHSD helped pass legislation to amend the statute and in March 2019, FHSD was able to regain 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 are no Hawaii PRAMS data for the years 2017 and 2018. Additionally, issues with the 2019 sample resulted in only six-months of useable data. 2020 will be 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.

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’s hospitals, skilled nursing facilities, assisted living facilities, home care companies, and hospices. The data portal has proven difficult to navigate; FHSD continued to use SSDI funds to purchase hospital datasets, when needed.

Data Linkage: Hawaii has annual access to one linked electronic dataset: birth and death records. Currently, Hawaii has no plans to establish any new data linkages without epi staff and because COVID-related priorities. In the past, newborn screening and WIC datasets were linked to vital statistics. These linkages may be explored again when feasible. Hawaii SSDI linkage activities in project years one through three focused on the development of a state All Payers Claim Database (APCD), which includes Medicaid, Medicare, and State Employee Union claims data. The project is being managed by the Data Analytics Group at the state Medicaid program; however, no updates from were available on this project.

Epi Staffing: 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. Hawaii continued to recruit for the position vacancies but was unsuccessful to date. FHSD contracted with Dr. Garrett-Cherry in 2020 to provide data analysis to complete the 2020 Title V needs assessment and draft several data products. Although the needs assessment was completed in 2020, the final publication of the factsheets was not completed due to COVID-related issues.

Needs Assessment: SSDI funds were used to contract Elizabeth McFarlane, Ph.D., a University of Hawaii Public Health faculty member, to assist with ongoing needs assessment work since the 2020 Title V assessment was completed before the COVID pandemic. Dr. McFarlane specializes in MCH and completed Hawaii’s Maternal, Infant, and Early Childhood Home Visiting needs assessments. She also routinely provides technical assistance and serves as a Title V grant reviewer for the Pacific Jurisdictions Title V programs.

While there is little 2020 health data available at this time, Dr. McFarlane assisted with the review of available data from the U.S. Census Pulse survey, state socio-economic, and data from a few 2020 Hawaii surveys conducted to assess COVID impacts. The data helped support the selection of four new Hawaii Title V priorities: child wellness visits/immunizations, child/youth mental health, food insecurity, and telehealth access.

Additionally, Dr. McFarlane helped design and administer a survey of all Hawaii Title V programs to capture systematic information on COVID impacts across FHSD programs and neighbor island offices. Results of the assessment are summarized in the Overview and Needs Assessment narratives of this report. A final report will be completed by November 2021.

Lastly, Dr. McFarlane will finalize the 2020 needs assessment data publications that were drafted by Dr. Garrett-Cherry.

Planning/Evaluation: FHSD continued to use SSDI funds to contract for technical assistance (TA) to help Title V issue leaders/staff with evaluation and planning for the Title V performance measure strategies. From 2018-2020, Hawaii partnered with University of Hawaii Office of Public Health Studies (OPHS) faculty to develop logic models for each of the Title V priorities to assess program progress, achievement of short- and long-term outcomes, identification of barriers/challenges, and ensure the alignment of strategies with Title V measures. This followed a recommendation from a 2018 AMCHP skills-building session.

In FY 2021, 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 as well as leading community nonprofits like Healthy Mothers, Healthy Babies. Her TA supported building staff public health knowledge and helped staff assess and respond to the challenges posed by the COVID pandemic. Ms. Partika also assisted staff with the review of research by the MCH Evidence Center (EC) to support strategy selection and promote health equity. She developed a resource list of best practices for staff to advance health equity.

MCH Data Tracker: The SSDI grant also helped fund a contract with the Hawaii Children’s Action Network (HCAN) to plan and design a high-level MCH data tracker. The intent of the tracker is to provide a quick overview of data to help monitor key health MCH indicators and population demographics as the 2020 data becomes available. Most available health data is from 2019, pre-pandemic. Going forward, it will be important to monitor COVID-19 impacts on MCH health across a broad spectrum of indicators and to make this data easily accessible. The tracker will draw upon data from the SSDI MCH datasets, including vital statistics, PRAMS, as well as Title V measures and Census data. HCAN is also the new state Kids Count administrator and is exploring the revision of the Kids Count website to make it more user friendly. Thus, there is an opportunity to coordinate data reporting for community use.

After an initial meeting with the Kids Count advisory committee, it was decided an internal FHSD data advisory group should be convened to develop the scope of the MCH data tracker and then meet with the Kids Count advisory committee for coordination. The Hawaii MCH Family-to-Family Center director will facilitate FHSD discussions to also include a family perspective.

Oral Health data: SSDI funds were used to purchase 2020 data on Emergency Department (ED) visits related to oral health conditions in response to requests by the state oral health coalition. The data will be analyzed and shared with stakeholders later this year to determine the impacts of COVID on access to preventive dental care since ED dental-related visits are largely preventable.

Child/Youth Mental Health data: Another small contract with HCAN was executed to assist with compilation of data on child/youth mental health in response to growing concerns over the impact of COVID restrictions on this area of health, particularly with the cancellation of in-person learning for Hawaii’s public schools. Most of the available data was from 2019: Youth Behavioral Risk Survey, National Survey on Child Health, and Medicaid Quality Assurance Measure for Child Mental Health. FHSD was able to partner with the DOH Injury Prevention program epidemiologist to analyze Hawaii ED data for 2020 for youth suicide-related ED visits. Also, results from a 2020 DOH survey to assess mental health needs of adults, sponsored by the behavioral health program, was also included. The data was used to support Hawaii’s grant application for the HRSA Pediatric Mental Health Access grant and will be used for a factsheet planned for FY 2022.

Data Products/resources:

Without epi staff, FHSD data products have been somewhat limited.

Factsheet

• Fok, C.C.T., Awakuni, J., & Shim, M. J. Unintended Pregnancy Fact Sheet. Honolulu, HI: Hawaii State Department of Health, Family Health Services Division; 2020.

Manuscripts

• Fok, C. C. T., & Shim, M. J. Prevalence and Risk Factors for Adolescent Suicide Attempts in Hawaiʻi, YRBS 2015-2017. Submitted to Hawai‘i Journal of Health & Social Welfare.

2020 Preparedness Summit Poster

• Disaster preparedness among postpartum women in Hawaii, Results from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2016 (Penelope Strid, Carlotta Ching Ting Fok, Marianne Zotti, Holly Shulman, Jane Awakuni, Duane House, Brian Morrow, Danielle Vassalotti, Judy Kern, Matthew Shim, Sascha Ellington).

Websites/Data Trackers