Data are collected by each domain from various sources. Domain leads met to discuss efforts to implement the workplan amid COVID-19. Meetings with stakeholders were postponed due to the pandemic and the resignation of the Title V Director. ADH conducted a training needs assessment among employees in January 2020. The findings revealed a need for the agency to increase high quality training opportunities for staff on the following topics: community public health, outreach/health improvement, diversity, and health equity. The pandemic diverted the training priorities for 2020.

Changes in Health Status and Needs of Arkansas’ MCH Population

In addition to the ongoing needs of the MCH population, many Arkansans were out of work due to closures, and children attended school virtually from March 17, 2020 through the end of the school year. Daycare centers were closed. The number of vaccinations given in March 2020 was 40% lower than in 2019.

Arkansas Title V capacity to serve clients was impacted by COVID-19 guidelines. Many clients were unable to travel to local heath units for services due to isolation or quarantine. The capacity to deliver telehealth services was increased in 2020. Essential services were delivered with a reduced staff capacity. Many staff members were working from home and others were in isolation or quarantine.

Arkansas’s Title V Partnerships and Collaborations

Arkansas’s Title V CSHCN Program is housed in the Department of Human Services’ Division of Developmental Disabilities (DDS). The year closed with 25 full-time employees, including a Parent Consultant, a Medical Records Supervisor, one extra-help position, three Area Managers, and one Nurse Manager. Two Registered Nurses retired at the end of Calendar Year 2020, leaving 13 Registered Nurses on staff. Nine nurses and CSHCN staff are stationed in some of the 13 Community-Based Offices (CBOs) located in Huntsville, Berryville, Fort Smith, Mena, Prescott, Hope, Mountain View, Conway, Little Rock, Pocahontas, Harrisburg, Jonesboro, and Marshall.

The University of Arkansas for Medical Sciences (UAMS) is a centralized point of referral for all medically complicated patients and provides medical and health education for the entire state. Except for communities on the eastern border that depend on the city of Memphis, Tennessee, all state communities relate to UAMS and Little Rock hospitals as sources of highly specialized medical care. UAMS's Regional Programs provide family medicine residency training in communities around the state. These programs have improved the distribution of PCPs. Family physicians provide most of the state's medical care and are by far the most numerous specialty practitioners in Arkansas. Specialists in obstetrics, pediatrics, internal medicine, surgery, and others have practices in the more urban communities.

The MCH program continually works with partners to meet the health care needs of the state. Changes are often driven by the planning of the larger institutions and agencies. An example of this is our work with Arkansas Children’s Hospital (ACH). ADH partners with ACH to provide home visiting services statewide and in other programs addressing teen suicide, injury prevention, Infant and Child Death Review (ICDR), infant hearing, and newborn screening. 

In March of 2018, a third satellite clinic of Arkansas Children’s Hospital (ACH) opened in Springdale in Northwest Arkansas. The clinic is in the fastest growing area of the state and allows more CSHCN access to pediatric specialty care. As part of our partnership, MCH plays a significant role in ACH’s community health needs assessment and the Natural Wonders Partnership Council.

The 83 general hospitals in the state provide the bulk of in-patient care. The ADH works closely with these local providers to ensure that standards of care are met. Apart from this regulatory relationship, ADH also partners with the Arkansas Hospital Association (AHA) on issues of common interest at the systems level, including the development of the breastfeeding toolkit for hospital use, the state’s Infant Mortality Collaborative Improvement and Innovation Network initiatives, and the Arkansas Perinatal Quality Review Committee.

The MCH program and Medicaid work together on multiple projects, including management of high-risk pregnancies, teen pregnancy, promoting the use of long-acting reversible contraceptives, providing colposcopies, and data sharing. The formal agreement between Medicaid and MCH is a Memorandum of Understanding (MOU) between the ADH and the Arkansas Department of Human Services (DHS). A new MOU developed to emphasize the role of MCH is attached.

With new staff in place and COVID-19 duties reduced, comprehensive efforts to address the findings in the needs assessment are planned for 2021. The domain leads are scheduled to meet with community stakeholders in the fall to address the current state and gather input from the groups.

Changes in Organizational Structure and Leadership

The Secretary of Health, Dr. Nate Smith, announced in June 2020 that he had accepted a position with the CDC. The new Secretary of Health, Dr. José Romero, began his tenure in August 2020. Angela Littrell left ADH in September 2020. Tamara Baker started in the position of Title V Director on November 30, 2020. Derica Mack started in the position of Women’s Health Section Chief on November 30, 2020. Senior leadership at DHS has remained the same. Cindy Gillespie is the DHS Secretary.

ADH Title V MCH Leadership:       

 DHS Title V Leadership:
 

Emerging Public Health Issues

The most prominent emerging public health issue in 2020 was the COVID-19 pandemic which affected all population sectors. ADH was the lead agency in responding with information, frequently updated guidance and regulations, vaccines, investigation, and tracking. The immediate mobilization of staff while continuing to provide essential services was necessary to the public’s safety. Details regarding COVID-19 in Arkansas can be found at COVID-19 Arkansas Department of Health.

The Arkansas Department of Health (ADH) conducted a training needs assessment among employees in January 2020. The findings revealed a need for the agency to increase high-quality training opportunities for staff on the following topics: community public health, outreach/health improvement, diversity, and health equity.  

In 2021, each MCH domain conducted virtual stakeholder meetings to report on Title V progress and reassess needs. The following paragraphs describe the findings.

To conduct a needs assessment for the Women’s Maternal Health Domain, the Title V MCH Program invited stakeholders to virtual meetings on November 2, 2021 and March 24, 2022. Participants included staff from the ADH Title V Program, the University of Arkansas for Medical Sciences (UAMS), the Arkansas Minority Health Commission and the Arkansas Department of Human Services’ (ADHS) Division of Medical Services. Participants were asked to select the identified priority needs from the 2020 Title V Women’s Maternal Health Needs Assessment they believed were still ongoing needs. The respondents selected one or more of the following priority needs:

• Access issues
• Medicaid expansion for postpartum coverage for one full year
• Mental health disorders

To conduct a needs assessment for the Perinatal Domain, the Title V Perinatal Domain invited stakeholders to a virtual meeting on December 9, 2021. Participants included staff of the ADH Title V Program, ADH Women, Infants, and Children (WIC), Arkansas Home Visiting Network, Arkansas Infant and Child Death Review, Arkansas Minority Health, Baptist Health Medical Center, and Arkansas Children’s Hospital (ACH). Stakeholders attended the interactive domain meeting, with IdeaBoardz being a well-liked method to gather anonymous real-time stakeholder input and feedback. Participants were asked how to help families served by existing programs. Collected feedback included the following:

• Provide education regarding next steps for follow-up care and connection to family-to-family support services
• Provide nutrition education and food benefits
• Think critically about ways to decrease burdens to service access
• Engage through families through information
• Provide more outreach to qualifying families
• Use local organizations to circulate information about programs, services, and events

Key program strategies to achieve MCH block grant objectives were reviewed with the stakeholders, and 100% of participants agreed the activities were achieving the desired results.

A Child and Adolescent Health Stakeholders meeting was held on October 7, 2021. A total of 33 evites were sent to partners from numerous Arkansas organizations: ACH, Arkansas Advocates for Family and Children, Arkansas Foundation for Medical Care, UAMS, WIC, and ADHS. All 17 participants (100%) ranked overweight and obesity as the top priority on the needs assessment. Activities including increased physical activities and additional nutrition education will be the focus for all school-age children. The second ranked priority is tobacco use including vaping (36%). Mental health education and screening (33%) emerged more strongly within the school-age children due to COVID-19 pandemic.

To conduct a needs assessment for the CSHCN Domain, the Title V CSHCN Program invited 78 stakeholders to a virtual meeting on October 13, 2021. Participants included CSHCN and ADH Title V staff, First Connections/Early Intervention, pediatricians, Arkansas Disability Coalition’s Family 2 Family, Centers for Exceptional Families, ADE’s Early Childhood Special Education, Arkansas Transition Services, the Arkansas Chapter of the American Academy of Pediatrics, and ACH. Thirty-one stakeholders attended the interactive domain meeting, with IdeaBoardz used to gather feedback. Participants were asked to select the identified priority needs from the 2020 Title V CSHCN Needs Assessment they believed were ongoing needs. Twenty-nine respondents selected one or more of the following priority needs:

• Understanding, financing, accessing, and navigating the health care system including Medicaid — 79% (selected by 23 out of 29 attendees)
• Finding respite care — 52% (selected by 15 attendees)
• Transportation — 52% (selected by 15 attendees)
• Accessing specialists and services — 48% (selected by 14 attendees)
• Technology issues with Internet access and computer use — 31% (selected by 9 attendees)

Key program strategies to achieve block grant objectives were reviewed with the stakeholders, and 100% agreed the activities were achieving the desired results.

Arkansas’s Title V Partnerships and Collaborations

Arkansas’s Title V CSHCN Program is housed in the ADHS Division of Developmental Disabilities (DDS). The year closed with 24 full-time employees, including a parent consultant, a medical records supervisor, one extra-help position, three area managers, and one nurse manager. One registered nurse retired in February 2021, one in August, and another at the end of 2021, leaving 10 registered nurses on staff to begin calendar year 2022. At the close of 2021, 11 nurses and CSHCN staff were stationed in some of the 13 community-based offices located in Huntsville, Berryville, Fort Smith, Mena, Prescott, Hope, Mountain View, Little Rock, North Little Rock, Pocahontas, Harrisburg, Jonesboro, and Marshall.

UAMS is a centralized point of referral for all medically complicated patients and provides medical and health education for the entire state. Except for communities on the eastern border that depend on the city of Memphis, Tennessee, all state communities relate to UAMS and Little Rock hospitals as sources of highly specialized medical care. UAMS's regional programs provide family medicine residency training in communities around the state. These programs have improved the distribution of PCPs. Family physicians provide most of the state's medical care and are by far the most numerous specialty practitioners in Arkansas. Specialists in obstetrics, pediatrics, internal medicine, surgery, and others have practices in the more urban communities.

The MCH program continually works with partners to meet the health care needs of Arkansans. Changes are often driven by the planning of the larger institutions and agencies. An example is the partnership with ACH. The ADH partners with ACH to provide home visiting services statewide and through other programs addressing teen suicide, injury prevention, Infant and Child Death Review (ICDR), infant hearing, and newborn screening.

A third ACH satellite clinic is now open in Springdale in Northwest Arkansas. The clinic is in the fastest growing area of the state and allows more CSHCN access to pediatric specialty care. As part of this partnership, MCH plays a significant role in ACH’s community health needs assessment and the Natural Wonders Partnership Council.

The 83 general hospitals in the state provide the bulk of in-patient care. The ADH works closely with these local providers to ensure that standards of care are met. Apart from this agency regulatory relationship, the ADH also partners with the Arkansas Hospital Association (AHA) on issues of common interest at the systems level, including the development of the breastfeeding toolkit for hospital use, the state’s Infant Mortality Collaborative Improvement and Innovation Network initiatives, and Arkansas’s Maternal and Perinatal Quality Outcomes Review Committee.

The MCH program and Medicaid work together on multiple projects, including management of high-risk pregnancies, teen pregnancy, promoting the use of long-acting reversible contraceptives, providing colposcopies, and data sharing. The formal agreement between Medicaid and MCH is a Memorandum of Understanding (MOU) between the ADH and ADHS. 

Changes in Organizational Structure and Leadership

Arkansas’s Secretary of Health, Dr. José Romero, announced in April 2022 that he had accepted a position with the Centers for Disease Control and Prevention (CDC). Dr. Jennifer Dillaha now serves as Director of the Arkansas Department of Health, and Renee Mallory serves as Interim Secretary of Health.

ADH Title V MCH Leadership:       

 ADHS Title V Leadership:
 

Emerging Public Health Issues

The most prominent public health issue in 2021 was the COVID-19 pandemic. The ADH was the lead agency in responding with information, frequently updated guidance, and regulations, vaccine distribution, investigation, and tracking. Details regarding COVID-19 in Arkansas can be found on the ADH website at COVID-19 Arkansas Department of Health.

Maternal mortality is an area of increased focus in Arkansas. In the 2021 Arkansas Maternal Mortality Review Committee’s (AMMRC) Annual Report, the AMMRC recommends extending Arkansas Medicaid maternal coverage from the current coverage of 60 days postpartum to one year postpartum. The committee’s review found that nearly half (47%) of pregnancy-associated deaths in Arkansas in 2021 occurred between 43 days and one year after delivery.

III.C.  Need Assessment Update

Women and Maternal Health

To conduct needs assessment for the Women and Maternal Health domain, Title V invited stakeholders to a virtual meeting on March 24, 2022. Participants included staff from ADH, UAMS, the Arkansas Minority Health Commission, Arkansas Foundation for Medical Care (AFMC), Office of Oral Health, and Arkansas Department of Human Services’ (ADHS) Division of Medical Services. Participants were asked to select the priority needs from the Title V Women’s Maternal Health Needs Assessment that they believed were still ongoing priority needs.  The respondents selected one or more of the following priority needs:

• Access issues
• Medicaid expansion for postpartum coverage for one full year
• Oral health
• Mental health disorders

Current program strategies to achieve Women and Maternal Health MCH objectives were reviewed by stakeholders and agreed upon that Arkansas was achieving results.

Perinatal and Infant Health

To conduct needs assessment for the Perinatal Domain, the Title V Perinatal Domain invited stakeholders to a virtual meeting June 9, 2022. Participants included ADH Title V Staff, ADH WIC, Arkansas Home Visiting Network, Arkansas Infant and Child Death Review, Arkansas Minority Health, Baptist Hospital, Arkansas Department of Human Services, the Arkansas Chapter of the American Academy of Pediatrics and Arkansas Children’s Hospital. Participants were asked how to help the families that are served by our programs. Collected feedback included the following:

• Provide new mothers with more information about infant mortality.
• Create a statewide safe sleep education plan.
• Plan statewide activities to increase breastfeeding rates.
• Use local organizations to circulate information about programs, services, events, etc. 

Key program strategies to achieve block grant objectives were reviewed with the stakeholders and 100% agreed the activities were achieving the desired results. 

Child and Adolescent Health

The Child and Adolescent Health domains held an annual meeting during the fall of 2022. Thirteen individuals attended the meeting representing the Arkansas’s Physician Associations, Family-Based Organizations, Department of Education, Children with Special Health Care Needs, Part C, Head Start Collaboration, Advocates for Children and Families and interagency departments within ADH (e.g., WIC and Chronic Disease). During the meeting, all priorities and evidence-based strategies were reviewed and assessed via an interactive poll. The majority of the attendees reported the current priorities were correct, measures and strategies were doable, but more time was needed to develop and see desired results.

Children with Special Health Care Needs (CSHCN) 

The Title V CSHCN Program conducts ongoing needs assessment for the CSHCN Domain in addition to the required 5-year State Needs Assessment. The program convened a virtual stakeholder meeting June 8, 2022, inviting cross agency collaboration from stakeholders from other Title V programs under the Arkansas Department of Health, pediatricians, AR Transition Services, parent information and advocacy groups such as Family 2 Family and the Center for Exceptional Families (TCFEF), Early Childhood Special Education (Arkansas Department of Education), program staff and staff from other DDS programs such as First Connections, Arkansas’ Part C early intervention program.

The June stakeholder engagement meeting reviewed key program strategies to achieve block grant objectives with the stakeholder participants. 100% (22 out of 22) of participants agreed the program’s activities were achieving the desired results. To promote engagement and to solicit input and feedback from stakeholders in attendance, this interactive domain meeting used online IdeaBoardz. Participants were asked if they felt the priority needs identified in the 2021 Title V CSHCN Needs Assessment were still an ongoing need of families of CSHCN and if any new needs had arisen as a result of the pandemic. Stakeholders in attendance responded (anonymously) on the IdeaBoardz (or not anonymously in the zoom chat) to identify that the following needs identified in 2021 are still a priority need:

1. Transportation.
2. Understanding, financing, accessing, and navigating the health care system including Medicaid.
3. Technological issues with Internet access and computer use to access teletherapy, virtual appointments, and online learning.
4. Accessing specialists and services.
5. Finding respite care.

Participants were asked to identify any new or emerging needs of CSHCN and their families or additional priority areas. Stakeholders at the meeting identified emerging and additional priority needs as:

Additional Priority Needs:

• Availability of respite services
• Trauma-informed care

Emerging Needs:

• TEFRA changes post-COVID may leave many children uninsured.
• Dental (State insurance not covering Arkansas’s children).
• Pay for conducting developmental screenings (there is a code now in Medicaid, but providers can’t bill).
• TeleMed access.
• ABA (Applied Behavioral Analysis) or other Evidence-Based Practices (EBP) for school-aged children.

An effective State Needs Assessment also looks at the strengths in the State and considers ways to use these strengths to overcome barriers to meet identified needs. To support this work, participants were asked, “how we can work together to support Access to Care?” Stakeholders shared ideas, with the most popular ideas (the ideas shared by stakeholders that earned the most votes on IdeaBoardz) involving:

• Clearly communicate timeline/expectations to families seeking services and provide more support in the application process.
• Building partnerships with other agencies and nonprofits outside of those the Title V CSHCN program usually partners with.
• Request CSHCN program information and a link to make a referral be placed on the new Part C Program (First Connections) website.

To ensure that Arkansas’s Title V CSHCN program is effectively partnering across agencies to support Access to Care and aligning key strategies with other initiatives and work in the state, the June 2022 meeting provided an opportunity for participants to share “what’s going on” to identify these State strengths which could be used to support CSHCN and their families in accessing care, supports, and services. Stakeholders in attendance who represented other programs and agencies serving the Children and Youth with Special Health Care Needs (CYSHCN) population were asked to identify initiatives or strategies their program is doing (or planning to do) that support access to care for this domain population. Stakeholders suggested extending/enhancing access to services through more effective collaboration between divisions in the lead agency and with other State departments. Stakeholders also identified current initiatives and work in the State that the Title V CSHCN program could align strategies with to improve Access to Care, including:

• The State’s work to promote the ‘Learn the Signs. Act Early.’ tools (LTSAE)
• Pritzker Initiative/Grant goal of increasing percentage of young children (0-5) who receive developmental screenings.
• National Wonders First 2100 Days Initiative
• Family 2 Family launch of Project Accelerate

In the area of Transition from Pediatric to Adult Health Care, participants had opportunities to share “what’s going on” to identify State strengths that could be used to support CSHCN and their families in preparing for and experiencing a smooth transition from pediatric care systems. All stakeholders in attendance were asked about their ideas for supporting Transition for not only this domain population but all youth. Ideas shared in the meeting included:

• Sharing resources from the Got Transition website with pediatric providers.
• Share clear state goals and partner with additional stakeholders for broader dissemination.
• Enlist the help of the Arkansas AAP to encourage all practitioners to complete the CHC Core Elements of Transition survey, for the state to have more complete data.
• Identify leaders in pediatric to adult transitions, collect stories, and share them widely.

Stakeholders participating had additional ideas to support the transition of all youth into adult health care through collaboration with education professionals (school-based nurses, regular and special education, school-based mental health, parent centers/groups), a key program strategy. Ideas for collaboration involved going beyond sharing information at school transition fairs to include:

• Hosting parent information meetings at schools on the importance of transition and how to prepare
• Share health care assessments for students/families to complete to discover goals and activities for students to accomplish while in high school
• Getting CHC Transition booklets into more youth's hands through partnership with schools to include as part of all Health classes
• High schools incorporate core elements of transition in student graduation planning from 9th-12th grade.

Thirty-four stakeholders attended the stakeholder engagement meeting in June. The program is identifying strategies to engage more of the 111 individuals invited so that stakeholders participating include more families of CSHCN and stakeholders involved are representative of the demographics of the clients served and of the State as a whole.

III.C.  Need Assessment Update

The Title V Maternal and Child Health (MCH) Block Grant needs assessment occurs every five years.  This year, the Title V staff conducted an interim needs assessment survey among its domain workgroup stakeholders and partners.  The intent was to gain input and insight on problem areas, gaps in services, and emerging issues.  The survey tool was based on the questionnaire used in the 2019 Arkansas Title V needs assessment.  The survey utilized REDCap, a secure web application for building and managing online surveys and databases. The REDCap survey link was emailed on March 20, 2024, to 150 stakeholders and partners serving on the Title V MCH domain workgroups. A 2-week reminder email and a final reminder email were sent to increase responses, and recipients were encouraged to share the survey link with others. The survey closed on April 21, 2024, with a total of 113 (75%) participants. (Table 1)

Table 1:  Types of Organizations Participating in the Survey

Participants were asked to describe the type of organization they served in 2023, county of residence and service, MCH population(s) they served, age, race and ethnicity, and gender. Based on their MCH population selection(s), participants were asked a series of questions regarding last year’s greatest public health problems, gaps in public health, what public health did well, strengths and weaknesses, and emerging issues for those MCH populations. Quantitative data were analyzed using SAS software, and qualitative data were examined for common themes using MS Excel.

Multiple activities contributed to the ongoing needs assessment. Listed below are a few activities essential to determining program outcomes. Other activities are listed in the data capacity and domain narrative section of the application.

• Arkansas Maternal Mortality Review Committee (AMMRC):  The Arkansas Maternal Mortality Review Committee (AMMRC) continues to identify maternal deaths, abstract data from a wide-range of sources, and review deaths with a multidisciplinary committee to develop evidence-based recommendations to prevent future pregnancy-related deaths. The Committee meets quarterly to review deaths and releases a legislative report annually in December. AMMRC recently released the Arkansas Maternal Mortality Review Committee Legislative Report (December 2023):  2018-2020 Data and Recommendations, which can be accessed at https://www.healthy.arkansas.gov/images/uploads/pdf/MMRC_Legislative_Report_2023.pdf.

• Pregnancy Risk Assessment Monitoring System (PRAMS Survey):  The PRAMS survey at the Arkansas Department of Health continues to collect information from new mothers about their experiences and behaviors before, during, and after their pregnancy that might affect the health of their baby. This information includes such topics as pregnancy intention, smoking, drinking, prenatal care, breastfeeding, safe sleep practices, and flu vaccinations. The 2021 PRAMS Surveillance Report can be accessed at https://www.healthy.arkansas.gov/images/uploads/pdf/2021_AR_PRAMS_Surveillance_Report_Final.pdf.

• State School Nurse Survey & School-Based Health Coordinator Data Tracking:  The Arkansas Department of Education (ADE) conducts an annual survey among all state school nurses to collect data on school teen pregnancies, high-risk pregnancies, drop-outs due to teen pregnancy, chronic disease and medication managements, and several other indicators of adolescent health. In addition to the State School Nurse Survey, the ADE tracks data from school-based health coordinators, including major reasons for school health clinic visits. The Arkansas Department of Health and ADE use these data to monitor utilization of school health clinics and major and emerging health issues affecting public school adolescents.

• Infant Hearing Program (IHP) Quality Improvement Reports, Surveys, & Focus Group:  IHP collects data on all infant hearing screenings and diagnostic and treatment follow-up. The program heavily relies on data reports to hospitals and clinics to ensure compliance with reporting timeliness standards and to improve processes and outcomes for infants. In the fall of 2023, IHP worked in collaboration with Arkansas Hands & Voices and the University of Arkansas for Medical Sciences (UAMS) to conduct a survey among families at events and families receiving letters from the program. The purpose of the QR code survey was to explore barriers that keep families from following up on failed newborn hearing screens. Similar questions were asked during focus group sessions with families of screened infants.

• Child Health Advisory Committee (CHAC):  The CHAC oversees implementation of Coordinated School Health Programs and their implementation of school nutrition, physical education, and wellness standards.  A report is issued to the Arkansas legislature annually.

• Student Wellness Advocacy Group (SWAG):  SWAGs are aimed at helping students in 7 - 12th grades learn to advocate for themselves and for healthier campuses. Each year the Arkansas Department of Health funds up to 12 campuses to host SWAGs, providing them with funding, presentations on varying health and advocacy topics, and guidance on advocacy projects in their school, community, or state. In a SWAG survey, students are asked their health concerns and what health topics they would like to learn more about.

• CSHCN Parent Survey:  The Title V CSHCN program developed and distributed a brief survey assessing the overall experience with services provided by the Title V program and to help determine what improvements in services and service delivery should be made. Survey responses were collected from parents/caregivers whose children and youth were currently enrolled in the Title V program. Results from this brief survey will help the program to continue improving how families are served, which in turn, also helps Title V provide the best quality services to families with CSHCN.

Findings

Women’s/Maternal Health

Maternal Mortality: The 2023 AMMRC Legislative Report showed 38 cases were determined to be pregnancy-related, which equated to a pregnancy-related mortality ratio of 35.0 per 100,000 live births for years 2018-2020. The leading cases of pregnancy-related deaths were disorders of the cardiovascular system: cardiomyopathy, cardiovascular conditions, hypertensive disorders of pregnancy, infections, and hemorrhage. Non-Hispanic (NH) Black women were 1.8 times as likely to die a pregnancy-related death than NH White women. (https://www.healthy.arkansas.gov/images/uploads/pdf/MMRC_Legislative_Report_2023.pdf)

Well-Woman Visits: In 2022, 73.9% of Arkansas women between the ages of 18 and 44 years reported having a routine check-up in the past 12 years. NH Black women had the highest percent of preventive visits (80.3%) compared to their Hispanic (75.1%) and NH White (73.3%) counterparts.

Family Planning: Data from the Arkansas PRAMS Survey 2021 Surveillance Report shows only 46.4% of mothers were trying to get pregnant when they became pregnant. Among those women who were not trying to get pregnant, 63.3% did not use a method to prevent pregnancy. Main reasons for not using contraception were (1) did not mind getting pregnant (57.0%) and (2) thought they couldn’t become pregnant at the time (40.9%). Arkansas has the highest teen pregnancy rate in the nation.

Prenatal Care: Birth data from 2022 shows the percent of women receiving early prenatal care (PNC) is 71.4%. Early PNC is drastically low among NH Native Hawaiian/other Pacific Islanders (16.9%), followed by Hispanics (58.4%). Less than half of uninsured women (47.6%) receive early PNC.

Dental Care: 2021 PRAMS data revealed only 41.3% of pregnant women reported having a dental cleaning during their most recent pregnancy. This is an increase from previous years. There is great disparity by education (high school graduate 26.6% versus college graduate 59.6%), insurance status (Medicaid 29.6% versus private 50.9%), and race/ethnicity (NH Black 33.1%, Hispanic 35.6%, NH White 44.3%).

Survey Findings for Women’s/Maternal Health: The survey found that across all five domains, mental health issues were consistently cited as an important public health problem. Respondents felt that mental health disorders were the number one public health problem facing Arkansas women, followed by lack of access to early and adequate prenatal care, and overweight/obesity. Responses showed that women need more assistance navigating through health systems, and that maternal and mental health provider access and availability are limited. When asked about emerging issues affecting women’s health, respondents reinforced the concern about access to maternal health providers and mental health services. Strengths of the public health system for women’s health included programs and resources such as the Arkansas Department of Health’s family planning, WIC/nutrition program, and maternal programs. Respondents also said availability of local health unit locations and extended were strengths.

What the Public Health System Did Well for Women’s/Maternal Health:  More than half of respondents felt that public health performed well in offering vaccination clinics. Others felt the system offered family planning services and referrals for tobacco cessation program/help line well. (Table 2)

Table 2:  What the Public Health System Did Well for Women’s/Maternal Health

Perinatal/Infant Health

Infant Mortality: The infant mortality rate has increased in recent years from 7.0 deaths per 100,000 live births in 2019 to 8.6 per 100,000 in 2021. The increase was seen in both neonatal deaths (4.3 per 100,000 in 2019 to 5.1 per 100,000 in 2021) and post neonatal deaths (2.7 per 100,000 in 2019 to 3.5 per 10,000 in 2021). Disparity race and ethnicity continues for years 2019-2021, IMR for NH Black infants (12.3 per 100,000) is much higher than that for NH White infants (6.7 per 100,000) and Hispanic infants (5.0 per 100,000).

Safe sleep practices: The percentage of infants placed to sleep on their back has been steadily increasing in Arkansas since 2007 (54.7%) to 79.1% in 2019.  In 2020, the percentage decreased for the first time since 2011 down to 65.9%. The percent of infants placed to sleep on a separate approved sleep surface and without soft objects or loose bedding continues to increase (2020 - 36.8% and 44.3%, respectively).

Findings for Perinatal/Infant Health: Almost half (46%) of respondents said premature deliveries were the great problem facing perinatal/infant health, followed by unsafe sleep practices, and non-initiation or early termination of breastfeeding. Respondents expressed that health systems navigation assistance, transportation, and health care provider availability were gaps in the health system for perinatal/infant health. The public health system needed to improve parental education regarding misinformation about vaccinations, best practices for pregnant and new mothers, navigation, transportation, providers, and well-child visits. For emerging health needs, respondents expressed concerns about parental education (i.e., parenting skills, infant care, developmental milestones, pediatrician recommendation), maternal opioid use / neonatal opioid withdrawal syndrome, and maternal mental health.

What the Public Health System Did Well for Perinatal/Infant Health:  Most respondents felt that public health performed well in offering the WIC and the newborn screening programs (83% and 71%, respectively). (Table 3)

Table 3:  What the Public Health System Did Well for Perinatal/Infant Health

Child Health

Overweight/Obesity: 2021-2022 NSCH data shows that one out of four (23.2%) students ages 6-11 years were obese. 2022-2023 body mass index (BMI) measurements collected by public schools showed more than 25% of middle and high school students were obese (K – 15%, 2nd grade – 21%, 4th grade – 26%). Approximately 18% of adolescents were overweight (K – 15%, 2nd grade – 15%, 4th grade – 17%). The percentage of obese children decreased slightly from 2019-2020 to 2022-2023 for grades K, 2, and 4.

Survey Findings for Child Health: Survey responses showed that the top priority public health problems for children’s health were developmental and behavioral disorders (81%), being overweight/obese (42%), and physical inactivity (25%). Similar to perinatal/infant health, respondents selected lack of assistance to navigate through complex health systems as a major gap in health care for children. Respondents expressed concerns about mental and behavioral health and services (availability, access, resources, school involvement), poor parenting skills, and drug, tobacco and alcohol use as emerging health issues facing children.

What the Public Health System Did Well for Child Health:  Almost half of respondents said the public health system performed well in supporting school-based health care services. One-third of respondents cited providing access to preventive health care services for children. (Table 4)

Table 4:  What the Public Health System Did Well for Child Health

Adolescent Health

Adolescent Suicide and Bullying: Mortality data shows the suicide rate among adolescents decreased from 2017-2019 (9.3 per 100,000 adolescents ages 10-19) to 2020-2022 (7.4 per 100,000).  2021-2022 data from the National Survey for Children’s Health (NSCH) shows that one out of every three (33.4%) high school students experienced being bullied. This was a slight decrease from 35.6% in 2019-2020. NH White youth (37.3%) experienced higher rates of bullying compared to NH Black youth (24.5%) and Hispanic youth (29.1%).

Mental Health and Mental Health Treatment: KFF’s analysis of Substance Abuse and Mental Health Services (SAMHSA) restricted online data analysis (RDAS), National Survey on Drug Use and Health (NSDUH), and Substance Abuse and Mental Health Data Archive indicate that 17.3% of Arkansas adolescents reported a major depressive episode in the past year.  This percentage was more than four times greater among females (28.9%) compared to males (6.2%). The 2022-2023 Arkansas School Health Services Survey revealed more than 8,200 students visited school nurses’ offices for depression. Approximately 32,500 students received mental health services on campus and 8,500 students received mental health services off-campus. Almost 15,200 students received mental health services involving a team-based approach between the school nurse and school counselor.

2021-2022 NSCH data show 16.1% of adolescents, ages 12 through 17, with a mental/behavioral condition who needed treatment did not receive it. Females were less likely to receive treatment (14.8%) than males (17.9%). Students believe mental health is an important issue and desire to learn more, according to data collected from SWAG-participating students.

Overweight/Obesity: 2021-2022 NSCH data shows that one out of five (19.2%) students ages 12-17 years were obese. 2022-2023 body mass index (BMI) measurements collected by public schools showed more than 25% of middle and high school students were obese (6th grade – 28%, 8th grade – 28%, 10th grade – 26%). Approximately 18% of adolescents were overweight (6th grade– 19%, 8th grade – 18%, 10th grade – 17%). The percentage of overweight and obese adolescents has remained relatively unchanged since the 2019-2020 school year.

Survey Findings for Adolescent Health:  Like with other MCH populations, mental health was a strong health concern. Almost 85% of respondents to the interim needs assessment survey said mental health disorders were the most important public health problem affecting adolescents.  Mental health resources, providers, and inpatient treatment access for teenagers were cited as emerging health needs. Other areas of health problems were overweight/obesity, tobacco use (including vaping) and illicit or other drug abuse, and dental health for teenagers. When asked about the strengths of the public health system for adolescents, respondents mentioned access to vaccinations, preventative health services, and school-based health services.

What the Public Health System Did Well for Adolescent Health:  Sixty percent of respondents said the public health system performed well in offering vaccination clinics for adolescents. (Table 5)

Table 5:  What the Public Health System Did Well for Adolescent Health 

Children with Special Health Care Needs (CSHCN)

Transition to Adult Health Care: Between 2021 and 2022, 25% of Arkansas CSHCN, ages 12 through 17, received services to prepare for the transitions to adult health care.  The least met component was anticipatory guidance (24.2%), followed by time alone with provider (45.1%), and active work with child (84.5%).

Systems of Care: 2021-2022 NSCH data showed 14.1% of CSHCN, ages 0 through 17, met criteria for receiving care in a well-functioning system. The least met component was preparation for transition to adult health care among adolescents (25.0%) and the most met component was easy access to services. Among adolescents ages 12-17, the percent of CSHCN receiving care in a well-functioning system was 6.8%.

Medical Home: According to data from the 2021-2022 NSCH, 45.6% of CSHCN, ages 0-17, met the criteria for having a medical home. The least met components were care coordination and referrals (66.0% and 72.2%, respectively), and the most met components were family-centered care and usual source of care (81.0% and 80.8%). For the youngest children (0-5 years), families living below federal poverty level, and NH Blacks, two out of three children with special health care needs did not have a medical home.

Survey Findings for CSHCN: Survey respondents indicated obtaining personal care services/respite services and other in-home supports (40%) and lack of engagement of evidence-base practices related to transition to adult health care (40%) were the most important public health problems for children with special health care needs. Respondents stressed mental and behavioral health services for CSHCN as a major gap and weakness in the public health system and listed equal access and equity to mental health services as an emerging health issue. Other frequently mentioned areas of concern were availability of transportation to providers and resources; and easier and equal access and navigation to services, therapies, medications, supplies, and equipment; and case management needs. Respondents felt that case management services including those offered by Title V; availability of resources, services, and supporting agencies; and provider availability and access were strengths of the public health system, and that public health functioned well in offering health insurance and vaccination clinics.

What the Public Health System Did Well for CSHCN Health:  Four out of ten respondents said public health systems performed case management for CSHCN well.  Health insurance availability, vaccination clinics, and education on Medicaid eligibility categories of assistance were also thought be successes for the health system.

(Table 6)

Table 6:  What the Public Health System Did Well for CSHCN Health