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 the Division of Family Health programs for assessing the health status of MCH populations, and for planning and evaluating services. SSDI dollars fund the salary of the SSDI grant coordinator/epidemiologist to manage project activities related to data collection and analysis, and provide additional analytic support to programs working with Title V populations. SSDI funding also supports the 5-year MCH needs assessment (NA), 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. The SSDI project director and grant coordinator have made progress in completing the tasks outlined in our accepted work plan as illustrated below.

 

Goal 1: Strengthen capacity to collect, analyze, and use reliable data for the Title V MCH Block Grant to assure data-driven programming.

 

Objective 1.1: Convene Needs Assessment Leadership Team to review relevant data and develop a plan of action to guide the 2025 Needs Assessment.

 

The Needs Assessment Leadership Team (NALT) has been established and meets regularly to plan for the NA. New partnerships are also being developed to assess the needs of mothers and children who are unstably housed and to ensure the NA process is approached with a health equity lens.

 

The SSDI coordinator and project director reviewed and documented NA methodologies from other states’ BG reports to recommend processes for the 2025 NA. This written review has been shared with the NALT.

 

Objective 1.2: Assess the needs of MCH/CSHCN populations.

 

While most of the work on this objective will take place in 2024, the DRP developed and published a data indicator report to guide the NA and to inform stakeholders on the current state of MCH and CSHCN populations. The report provides a demographic comparison of key characteristics of Utahns to the U.S. and racial and ethnic comparisons within Utah. The report also provides national, state, and related Healthy People 2030 goals for NPMs, NOMs, and standardized measures released with the new Title V BG guidance. Each MCH/CSHCN domain has indicators for a variety of topics relevant to their respective populations and is presented by race and ethnicity when possible. Data sources for the indicator report come from a variety of publicly available data.

 

Objective 1.3: Identify state priorities and develop NPMs and SPMs.

 

The Data Indicator Report has been shared with stakeholders and meetings are held regularly to plan for the 2025 NA. Preliminary plans have been made for a Title V summit to be held in early 2025. Once the NA has been completed and new state priorities have been identified, DRP will help programs identify appropriate NPMs, SPMs, and ESMs.

 

Objective 1.4: Enhance WESTT to align with priority needs.

 

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, DRP developed and implemented the Web-Enabled Systematic Tracking Tool (WESTT). WESTT provides a user-friendly interface for BG contributors to report on activities for the reporting year, outline activities for the upcoming fiscal year, report on NPMs, SPMs, and ESMs, and update objectives for the coming year. Each year, a WESTT user feedback survey is used to identify ways to improve WESTT. Enhancements are made to WESTT based on the results of the survey.

 

Enhancements made to WESTT in 2023 included providing core writers the ability to add a new strategy to an ESM; add, delete, edit, or move ESMs; and add links to cloud-based supporting documents such as logic models and supplementary figures.

 

The DRP held a mandatory training session for BG contributors in March 2023 that included an overview of WESTT for new users and the enhancements that were made to the application. The training also included modules on health equity, 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 an introduction to standardized target setting methods. The SSDI coordinator developed and presented the logic model and RBA modules, and reviewed and provided feedback for other modules.

 

Goal 2: Strengthen access to and linkage of key MCH datasets to inform MCH Block Grant programming and policy development, and assure and strengthen information exchange and data interoperability.

 

Objective 2.1: Develop and implement a plan for data linkages.

 

The SSDI project director created a list of established and needed data sharing agreements (DSA) for data linkages and analysis. MCH has an overarching DSA with the Office of Vital Records and Statistics (OVRS) to obtain yearly statistical files and monthly provisional data from birth, fetal death, and linked birth-death records to support MCH programs including DRP. In 2023, the SSDI coordinator linked birth and death certificate files for an updated infant mortality data file (2015-2021).

 

DRP is in the planning stages of replicating a report published in 2018 on Severe Maternal Morbidity (SMM). DRP is working to establish a new DSA with the Division of Data Systems and Evaluation (DDSE) to obtain a linked and de-identified data set with hospital discharge and birth records for analysis.

 

Objective 2.2: Review options for linking data sets without social security number.

 

In prior years, DRP received social security numbers (SSN) when OVRS provided files through an internal data sharing process that allowed for a more deterministic approach to data linkage. However, because of privacy concerns OVRS no longer provides SSN to internal programs. To understand the impact of this change, the DRP epidemiologist and SSDI coordinator used current data to demonstrate linkage of Medicaid and birth record data without SSN and compared it with linkage rates from previous years when SSN was available (2012-2014). For the linkage without SSN, 30.3% of birth records matched to Medicaid, which is not much lower than previous years when SSN was available for linking with an average match rate of 33.8%.

 

Objective 2.3: Partner with Medicaid to link eligibility files and assess health of women enrolled in Medicaid.

 

A DSA was established in 2023 between the Office of Medicaid Operations and DRP to obtain Medicaid eligibility data. DRP linked birth records with Medicaid data for BG reporting. The SSDI program is also planning an analysis and report comparing birth outcomes between women whose pregnancies and deliveries are covered by Medicaid to the state overall.

 

Goal 3: Enhance the development, integration, and tracking of health equity and social determinants of health (SDoH) metrics to inform Title V programming.

 

Objective 3.1: Develop a data catalog of MCH/CSHCN indicators and SDoH.

 

One planned activity within this objective is to develop and publish new indicator reports in Utah’s Public Health Indicator-Based Information System (IBIS-PH). In addition to updating existing reports for prenatal care and preterm birth, the SSDI coordinator also worked with an analyst in DDSE to develop an SMM indicator report.

 

Another planned activity is the development of a queryable catalog of data systems related to Title V populations. The SSDI program coordinator, DRP health informaticist, and SSDI project director collected information about relevant data sources from IBIS-PH and colleagues throughout the department. Information collected included a description of the data system, years of availability, how and where the data are stored, and contact information for the data steward. The SSDI coordinator is working with the health informaticist to develop a queryable system that includes these data sets.

 

These plans were paused when the DRP health informaticist learned of widespread interest in producing a data catalog for the entire agency, which would include MCH/CSHCN data. This would be under the purview of the Department of Technology Services, and DRP will provide consultation if it is pursued.

 

Objective 3.2: Analyze and write up health equity and trend analysis of BG National Performance Measure and provide to programs.

 

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, providing the FAD to programs, and assisting with interpretation of the data. In 2023, the SSDI coordinator provided programs with a FAD summary analysis of NPM and NOM trends and disparities and encouraged programs to integrate the analysis into their domain reports. The SSDI project director, coordinator, and MCH epidemiologist also made recommendations for NPM and SPM target adjustments using standardized methods.

 

Analyses of data from the National Survey of Children’s Health (NSCH) revealed that small counts for non-white racial groups in Utah limit our ability to fully assess health equity within these populations. To address this, DRP/SSDI worked with the Census Bureau to secure an oversample of Utah households for the 2024 NSCH. This oversample includes both a general oversample and a targeted oversample that focuses on census tracts with more racial and ethnic minorities. This oversample will be combined with additional years of NSCH data for a more meaningful analysis of health disparities by race, ethnicity, special health care need status, economic status, and other important social determinants of health.

 

Objective 3.3: Work with OVRS and MCH programs to conduct a non-response analysis of optional birth certificate fields.

This objective is scheduled for 2025, when more years of data are available to compare the results with previous years before the fields were optional.

Goal 4: Develop and enhance 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 4.1: Develop a process for identifying emerging issues of MCH/CSHCN populations and publish Health Status Updates.

 

The Utah (DHHS highlights leading health issues in its monthly Utah Health Status Update (HSU) publication. The SSDI team contributes regularly to HSUs published by the agency that focus on MCH/CSHCN populations, and the SSDI project director coordinates potential HSU topics at the division level.

 

During FY 2023, MCH/CSHCN staff published four HSU articles including:

• COVID-19 vaccination during pregnancy - January 2023
• Trends and characteristics of gestational diabetes - April 2023
• Out-of-hospital births in Utah: Newborn hearing screening, diagnostics, and cCMV testing - May 2023
• Sociodemographic factors associated with frequent bullying - May 2023

 

In addition, the SSDI coordinator and project director calculated point-in-time estimates for the number of pregnant women, children, and children with special health care needs in various age groups to support local health departments (LHDs) in emergency planning efforts. The estimate of the number of pregnant women was calculated using a methodology developed by the CDC and fact sheets summarizing the estimates were distributed to LHDs.

 

Objective 4.2: Assist the Maternal and Infant Health Program and the Utah Women and Newborns Quality Collaborative by enhancing their analytic capacity.

 

The SSDI coordinator provides ongoing analytic support to the Out-of-Hospital birth subcommittee for the Utah Women and Newborns Quality Collaborative (UWNQC). During FY23, this included drafting a report using six years of data on a variety of birth outcomes for both hospital births and out-of-hospital births in Utah.

 

In FY23, 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 selected AIM Patient Safety Bundles. The coordinator is currently finalizing data collection for process and structure measures for the Care for Pregnant and Postpartum Patients with Substance Use Disorder bundle from participating hospitals, and planning for the newly selected Perinatal Mental Health Conditions bundle. Hospital data are collected through surveys that are designed and shared through a secure REDCap database. The coordinator then processes the data to meet reporting requirements and uploads it to the AIM Data Center. In April 2023, the coordinator also composed letters to each participating hospital that visualized and interpreted the data they had provided up to that point, allowing for comparison with other de-identified participating hospitals.

 

The SSDI coordinator also worked with a DDSE analyst to upload hospital-level data on SMM outcomes to the AIM Data Center.

 

Finally, the SSDI coordinator regularly attends meetings for the Maternal Mental Health and Unhoused Women and Newborn UWNQC subcommittees.

 

Other support for Title V program efforts

 

The SSDI coordinator participates in a department-wide Health Equity Workgroup that includes representatives from each division and office in DHHS. The workgroup strategizes ways to advance health equity and helped develop the Building Organizational Capacity Assessment to Advance Health Equity (BOCA-HE) tool that guides offices through an evaluation of their current health equity practices across several domains, followed by the development of an action plan to advance these practices.

 

The SSDI coordinator helped the Office of MCH complete the BOCA-HE assessment and identify action items to improve health equity practices in the office. The goals identified by the MCH BOCA team include the following: 1) Revise the MCH mission and vision statements to include health equity principles; 2) Facilitate an internal workgroup to plan and implement health equity efforts; 3) Develop office guidelines for options to compensate community partners. The SSDI coordinator facilitates the workgroup to complete their project goals.

 

The SSDI coordinator also attended the Utah Regional Health Equity Conference in May 2023.

 

Finally, the SSDI coordinator 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. She attended the conference in June 2023 and presented her analysis.