SSDI FY2022: Finishing up the FY2018 - FY2022 Cycle

SSDI funding in Colorado is used to expand and enhance the MCH-related data system in the state in order to better collect and interpret data to comprehensively describe the health of reproductive-age women, children, and youth, including children and youth with special health care needs. The three main goals of the previous SSDI project (FY2018 - FY2022) were to build and expand MCH data capacity to support Colorado’s MCH program activities and contribute to data-driven decision making, including assessment, planning, implementation, and evaluation; advance the development and utilization of linked information systems between key MCH datasets in the state; and support program evaluation activities that contribute to building the evidence base for the MCH program.

In FY2022, The MCH Epidemiologist updated the performance measure tracking sheets with the newest data as it became available. New data was shared with priority coordinators to assess progress and evaluate annual performance objectives. Year one (FY2021) evaluation summaries were completed for each priority, used to refine action plans, and submitted with the Block Grant. A revised format for Year two (FY2022) evaluation summaries was developed, focusing more on successes and challenges related to each objective. Based on local public health agency (LPHA) feedback, and ensuring a connection to the overall state evaluation, a local evaluation plan was developed. This plan included conducting interviews with local agencies to better understand their successes and challenges. The MCH Epidemiologist drafted the first three data briefs for three priorities. The Colorado Maternal Mortality Review Committee continues to review the Prescription Drug Monitoring Program report for every maternal death.

Current SSDI (FY2023 and FY2024)

In August 2022, the application and work plan for the current SSDI five year cycle (FY2023 - FY2027) was submitted. For this new cycle, there are four main goals each with their own set of objectives:

• Strengthen capacity to collect, analyze, and use reliable data for the Title V MCH Block Grant to assure data-driven programming
  • Objective 1: Provide support for ongoing data monitoring, objective setting and achievement of the NPMs, ESMs, SPMs, and SOMs.

One focus of SSDI is to provide ongoing data support related to the MCH measures: NPMs, ESMs, SPMs and SOMs. Progress on this objective will be measured by completion and submission of the Title V Block Grant report and application each year.

• Objective 2: Use data to inform updates to state and local action plans and state and local logic models using a racial equity and community inclusion lens.

Annually, state and local staff create action plans in each priority area to build on previous work and determine the next year’s efforts to achieve the short, intermediate and long term outcome measures identified in the logic model. The annual planning process occurs from April through July.

For both state and local planning and implementation, MCH staff engage in a process to create or update their logic models using data and practice-based evidence to determine short-term, intermediate, and long-term measures. The development of state and local action plans takes place in close partnership between priority coordinators, local MCH staff, and CDPHE evaluation staff to ensure that the objectives, strategies, and activities selected are data informed and measurable. Throughout implementation of the action plans, data is collected and reviewed to check progress and course correct, if necessary. By leveraging lessons learned and available date resources, barriers can be addressed, successes celebrated, and upstream impact can be made.

State priority coordinators finalized priority-specific action plans in June 2023. MCH staff leveraged relevant data to update their logic models and are working with MCH evaluators to craft racial equity in data initiative (REDI) data resources to enhance data briefs with crucial information. Priority coordinators will identify specific areas within the state action plans where there is historical, structural or social context that has been directly linked to health disparities in the data.

MCH evaluators and priority coordinators also work closely with the 12 local agencies that receive more than $50,000 in MCH funding annually to update their local action plans, which were completed in June 2023.

• Objective 3: Provide quantitative data collection and analytic support for the selection of Colorado’s Title V priority needs, strategic anchors (currently racial equity, community inclusion, moving upstream), the NPMs, ESMs, and SPMs as part of the 2025 MCH Needs Assessment.

One major focus of Colorado SSDI will be designing and completing the 2025 MCH needs assessment. Preparation for the assessment will ramp up in early 2024. Progress on this objective will be measured by completion of each component of the assessment, finalizing the new set of MCH priorities, and submitting the FY2026 Title V Block Grant Report and Application, including the MCH Needs Assessment. So far this year, the MCH Snapshot was updated and one data brief was completed. A needs assessment data work group has been launched and is made up of the MCH program’s director and deputy director, epidemiologist, evaluators, program specialists and one of the local liaisons. The work group began meeting monthly in April 2023 and will continue to meet regularly until the needs assessment is submitted. One outcome from the first three work group meetings includes a plan to review the data for the newly proposed NPMs. A subset of the data work group will develop data overviews for select NPMs listed in the revised grant guidance. These data overviews will complement the data briefs to inform priority selection during the 2025 needs assessment.  

• Objective 4: Annually evaluate progress on all seven MCH priorities and the strategic anchors (racial equity, community inclusion, moving upstream).

Similar to previous years, priority evaluation reports were completed this year. This year’s evaluation summaries cover FY2022 (October 2021 - September 2022). There is a cross-cutting summary on the overall performance of the block grant including the strategic anchors, and a summary for each priority highlighting data, successes and challenges. Two-year objectives were written, with the timeframe ending in FY23 (Sept 30, 2023). Status of objectives as of the end of FY22 (Sept 30, 2022) is reported. Of the 37 objectives in the action plans, 24 (65%) were completed, 10 (27%) are in progress, two (5%) were put on hold, and one (3%) was not measurable due to a change with the data source. Even though two years isn’t sufficient time to show much change in performance measures, two NPMs are improving, two show no change, and one NPM (4A, 4B) is split, with one measure improving and the other showing no change. One SPM is improving, two SPMs show no change, and one SPM is getting worse.

• Strengthen access to, linkage of, key MCH datasets to inform MCH Block Grant programming and policy development, and assure and strengthen information exchange and data interoperability
  • Objective 1: Identify and support use cases about various data interoperability activities to increase equitable access and resources.

The Colorado MCH program values linking MCH datasets in meaningful ways that can help improve MCH-related needs assessments, program development and evaluation. Several new data linkages are included in the new SSDI work plan and monitoring of other potential linkages will occur on an ongoing basis. The developmental screening and e-Referral project is a data linkage project that is highlighted in the III.A.3  MCH Success Story section in this year’s MCH annual report.

• Enhance the development, integration, and tracking of health equity and social determinants of health metrics to inform Title V programming
  • Objective 1: Plan and implement the Racial Equity in Data Initiative to better frame and interpret racial inequities identified in the data briefs and other data products.

MCH program staff recognized the need to be more explicit in providing context that accompanies data deliverables (e.g. priority data briefs) to ensure that a racial equity lens is employed in reporting and analyzing data within the historical, social, and structural systems that contribute to health inequities. For example, the initial draft of the positive child and youth development data brief did not have sufficient information about how systemic racism contributes to lower breastfeeding rates amongst Black people (e.g. provider bias, historical mistrust of healthcare institutions, the practice of wet nursing, etc.). The data briefs by themselves did not paint a complete picture and MCH program staff realized this was an opportunity to contextualize the data. Priority coordinators, with support from strategic anchor leads, agreed to develop a one-page document to accompany each priority’s data brief with concrete examples related to the race equity, community inclusion, and moving upstream strategic anchors that would be helpful foundational knowledge for someone reading the data brief. Priority coordinators will research and review existing materials, receive consultation from the strategic anchor leads, and create one-pagers with additional historical, social, and systemic context to supplement the data briefs. Priority coordinators will have the one-pagers completed by December 2023. Several priority coordinators have already begun research/review, and/or have had consultations. However, none of the one-pagers have been fully completed as of the block grant submission date.

The MCH Epidemiologist drafted a brief currently titled Guidance for Interpreting Data on Racial Inequities. This three-page brief provides guidance on interpreting data on racial inequities specifically related to the MCH data briefs. The brief is currently under review and once finalized and formatted, the brief will be released with the priority data briefs and the one-pagers mentioned above.

• Objective 2: Improve the availability of social determinants of health data in population-based data collection systems and integrate the measures into programmatic implementation and evaluation.

The new MCH priorities include varying levels of upstream work to improve the social determinants of health (SDoH). The MCH data team has been assessing SDoH data availability related to living conditions since selecting the new priorities and determining what else needs to be collected. The SDoH supplement added to the 2022 Colorado Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire includes questions on financial stability, food security, transportation, provider treatment, and stress. The tax credit team has been learning about tax return data available for analysis on an annual basis, and hopes to access provisional data for more real time program evaluation. The community vitals signs dashboard will be updated with new SDoH data for use with 2020 maternal mortality case review. This will all be completed by the end of 2024.

• Develop systems and enhance data capacity for timely MCH data collection, analysis, reporting and visualization to inform rapid state program and policy action related to emergencies and emerging issues/threats, such as COVID-19.
  • Objective 1: Link maternal deaths (starting with 2021) to COVID-19 case data to inform rapid data analysis during emergencies and future programs and policies.

In January 2023, 47 maternal mortality cases (from 2021) were sent to the COVID-19 data team for matching. Eleven cases were identified as having tested positive for COVID-19 at some point prior to the death. This information was then incorporated into the case narratives for the Maternal Mortality Review Committee.

• Objective 2: Support surveillance systems to collect data in emergency situations through development of protocols for data collection and analysis and dissemination of COVID-19 data with a focus on marginalized populations.

The Health eMoms COVID-19 survey, conducted in early 2021, has been providing rich qualitative data through free text fields. Quotes from participants referencing a wide variety of situations during the pandemic are being integrated into various data products including the MCH Snapshot, the Areas of Well-being Reports, and the MCH Data Briefs.

The Colorado Health Institute requested aggregated data from the CYSHCN COVID-19 Survey in May 2023 to support work of the Colorado Department of Early Childcare.

See the full Colorado FY2023 - FY2027 SSDI work plan for more details.