III.C.2.a. Process Description
III.C.2.a. Process Description
Maternal and Child Health Needs Assessment Methodology
The 2020 Needs Assessment was grounded in the Title V charge to improve outcomes for all children and families in Louisiana. Quantitative and qualitative methods to assess the strengths and needs of the Maternal and Child Health (MCH) population were based on the County Health Rankings (CHR) Model. The CHR model presents quantitative indicator data and qualitative contextual information together to emphasize the many factors that influence health outcomes for the overall population. To gain a more nuanced understanding of the health outcomes and factors specific to MCH populations, Louisiana Title V customized the model with the outcome and factor indicators relevant to each of the population domains.
The first step of customizing the CHR framework for each population domain was to conduct a qualitative desk review. Areas of focus this step were to identify:
- Primary frameworks, theories, and approaches used to define health and improve health outcomes for the respective populations;
- Major national, state, and local leaders, organizations, resources, funders, and key stakeholders that are working on behalf of the respective populations;
- Emerging themes, trends, and priority issues regarding this population, especially those being elevated by community- and/or family-led organizations;
- Relevant data sources, related needs assessments, and other population-level analyses conducted by Bureau of Family Health (BFH) programs and external organizations.
Findings from the desk review informed the selection of the most appropriate indicators and data sources to measure health status and behavioral, clinical, social and economic, and environmental factors for each population domain.
For the Women’s/Maternal, Perinatal/Infant, Child, and Adolescent domains, a total of 119 indicators from 11 sources were identified and mapped to the respective portion of the model. The BFH Data to Action Team (DAT) led a comprehensive data analysis, analyzing each indicator for trends, significant differences between state and national averages, disparities by gender, race, ethnicity, age, and other source-specific variables. DAT staff prepared summaries for each domain and reviewed key findings with Title V staff to help narrow down potential priority issues. During this step, the goal was to clarify what the data meant for informing the rest of the needs assessment direction.
Expanded Adolescent Health Needs Assessment
During the summer of 2019, BFH hosted two students through the National MCH Workforce Development Center Title V Internship Program to begin the needs assessment with a focus on the adolescent domain. The interns piloted the process described above utilizing the CHR model and desk review methodology to identify key themes. Findings were presented to staff and partners of adolescent-serving BFH programs, and participants provided input to narrow the focus of the qualitative portion of the assessment. A top theme emerged around building resilience to social and behavioral risk factors through supporting healthy relationships. The interns then developed and tested key informant interview tools with adolescent-serving professionals and parents of adolescents to gather qualitative data about experiences, perceptions, and recommendations regarding supporting healthy adolescent relationships.
Ongoing needs assessment activities over the last cycle revealed that Louisiana has also seen a steady increase in adolescent suicide rates since 2010. While BFH routinely monitors trends and investigates deaths for children <15 years of age through the Child Death Review process, BFH epidemiology staff conducted an expanded mortality data analysis to analyze trends, disparities, geographic variation, and top causes of death for adolescents ages 15-24.
CYSHCN Needs Assessment Methodology
BFH utilized The National Standards of Care for CYSHCN as the framework to assess Title V needs in relation to the legislative charge to ensure all CYSHCN and their families in Louisiana receive care in a well-functioning, family-centered, community-based, coordinated system of care. The assessment consisted of two key activities - a data analysis and an agency self-assessment.
The BFH CYSHCN epidemiologist utilized the National Academy for State Health Policy (NASHP) National Standards for CYSHCN Measures Compendium to guide the indicator selection. The analysis aimed to describe how well Louisiana’s system of care is meeting the needs of CYSHCN. The CYSHCN epidemiologist conducted a comprehensive analysis of available National Survey of Children’s Health (NSCH) data and prepared a summary of key findings by National Standard domain.
As the state’s Title V agency and entity responsible for ensuring a family-centered, community-based, coordinated system of care for CYSHCN in Louisiana, BFH assessed its progress in meeting this mandated charge. Ad-hoc workgroups comprised of Title V CYSHCN program staff and family liaisons completed the National Standards for Systems of Care Statewide Systems of Care Assessment Tool for each of the 10 Standard domains.
Title V staff facilitated a half-day meeting with all workgroup participants and BFH leadership to review key findings from the data analysis and self-assessments. Summaries of findings were presented for each Standard Domain, and after a group discussion and reflection, participants identified their top three CYSHCN priority issues for the next Title V cycle.
Assessing MCH Program Capacity
To assess BFH’s capacity to promote and protect the health of Title V populations, the Title V team adapted some of the tools of the AMCHP CAST-5 process. The first part of the Capacity Assessment made use of the CAST-5 Process Indicator tool. Staff were placed into one of three groups based on the 3 Core Functions of Maternal and Child Health: Assessment, Assurance/Research, and Policy. Each of the three workgroups included key staff whose work touches heavily on the Core Functions. The groups met separately to identify 5-7 agency capacity needs and 5-7 agency capacity strengths using the Process Indicator tool as a guide.
Process Indicator workgroup participants and key members of the leadership team then reviewed, discussed, and refined the draft capacity needs. At the conclusion of the meeting, the participants were asked to score each draft capacity need using a Scoring Matrix that was adapted from the CAST-5 Prioritizing Worksheet. Five measures were included (Importance, Cost, Time, Commitment, Feasibility) and were scored on a 3-point scale (Low, Moderate, High). The Title V team then reviewed the results of the scoring survey and calculated a composite score for each priority capacity need.
Interface between Needs Assessment, Priority Needs, and State Action Plan
As BFH responded to the COVID-19 pandemic in early 2020, Louisiana Title V had to make significant revisions to planned Needs Assessment and grant preparation activities. Prior to statewide office closures, Title V contracted with a local agency to facilitate a collaborative priority-setting and state action planning process. The original plan included two full-day in-person sessions with stakeholders and key Title V staff and leadership to set priorities and build out State Action Plan strategies. In the revised plan, Title V staff led a virtual multi-step priority-setting process over four weeks. The contracted facilitators led a series of four two-hour State Action Planning sessions, which were conducted virtually over a three-week period.
The overarching aim of the planning sessions was to foster alignment and collaboration around priority population outcomes. The action planning groups worked during the first two sessions to develop at least one collaborative project in relation to their respective priority needs. During the last two sessions, groups identified strategies to incorporate meaningful family, youth, and/or community partnership into their work.
Level and Extent of Stakeholder Involvement
To solicit input on the FFY 2021-2025 Title V Priority Needs, a survey was sent to over 1000 stakeholders throughout the state. Stakeholders included members of Community Advisory & Action Teams (CAATs), medical providers, staff from other state agencies, and community-based organizations. Interactive PowerPoint slide decks were linked to the survey and presented data, key findings, and brief contextual narratives for each respective population domain. Stakeholders were then asked to rank the priorities using a short tool in SurveyMonkey. In total, 304 responses were collected.
Title V staff also attended summits and community forums designed to capture stakeholder input on issues affecting the Title V population. Although Title V did not lead these engagement activities, Title V staff provided support at the following events and received permission to utilize the stakeholder input to inform the Title V needs assessment:
- Maternal Mortality Summit (Hosted by LDH, August 2019);
- The Louisiana Better Birth Outcomes Summit (Hosted by March of Dimes, November 2019);
- 2020 Health Summit: Advancing Health Equity for Children and Families (Hosted by Louisiana Center for Health Equity and LDH OPH, March 2020).
Lastly, to inform priorities related to the adolescent health domain, Title V and the Adolescent School Health Program (ASHP) staff facilitated discussion groups with the 60 School Based Health Center (SBHC) directors about their experiences and perceived role in relation to four priority topics.
II.C.2.b Findings
III.C.2.b.i MCH Population Health Status
III.C.2.b.i. Findings - MCH Population Health Status
Women/Maternal
Women in Louisiana have a higher burden of chronic disease and poor health outcomes compared to the national average1. Women of reproductive age in Louisiana have higher rates of diabetes, obesity, and tobacco use when compared to national numbers.1,2 Louisiana has some of the highest rates of obesity in the country: over 36% of adults over 18 are obese, and 55.8% of women of reproductive age report being overweight or obese.1 Circulatory conditions like hypertension and heart disease are the leading cause of death in women of reproductive age in Louisiana.3 While heart disease is the leading cause of death of all women in the United States, Louisiana is an outlier in that heart disease and circulatory conditions are the leading cause of female death in the reproductive age range (15-44)4. Women in Louisiana are also more likely to report engaging in behaviors linked to the development of chronic disease, like tobacco smoking and drug use.2
In Louisiana, as in the rest of the country, mental health issues continue to rise for the general population and for women specifically. Since 2000, suicide rates in Louisiana have risen 29%.5 Suicide is the fifth leading cause of death for women of reproductive age in Louisiana.3 Rates of postpartum depression are also on the rise: 15.9% of postpartum women reported depressive symptoms in 2017 compared to 11.3% in 2016.6 State-level data on mental illness are limited, but national figures show that 22.8% of women over 18 years of age have a mental illness. Nationally, 17.6% of women aged 18-25 experienced a major depressive episode in the past year. In the same age range, 10% of women have at least one serious mental illness, but only 56.6% of these women received appropriate treatment.1,6 All 64 parishes in Louisiana are considered mental health care provider shortage areas7, so access to mental health treatment is likely a contributing factor.
Relatedly, drug abuse, violence, and domestic abuse pose serious risks to Louisiana’s women. In Louisiana, women experience a disproportionate share of interpersonal violence. More than 33% of Louisiana women experience intimate partner violence (sexual or physical) and/or stalking in their lifetime.8 Homicide is the leading cause of maternal mortality and is the 6th leading cause of death of women of reproductive age.3,12 Louisiana ranks 2nd in the nation for females being murdered by males in single-offender incidents, and rates of these murders have steadily risen for six consecutive years.9 In 2017, 94% of female homicide victims in Louisiana were killed by someone they knew - 60% of those murders were committed by a former or current partner.10 Substance abuse in women of reproductive age is also on the rise. Drug overdose is the leading cause of injury-related hospitalizations, the second leading cause of death, and the leading cause of pregnancy-associated death of women of reproductive age in Louisiana.11, 3, 12
In recent years, Louisiana has received a significant amount of media attention around our poor maternal health outcomes. Pregnancy-related deaths in Louisiana increased between 2011 and 2017. The leading causes of Pregnancy-Related death were cardiovascular and coronary conditions, cardiomyopathy, preeclampsia and eclampsia, and embolism. The leading causes of Pregnancy-Associated death were homicide, cardiovascular and coronary conditions, motor vehicle crash, and accidental overdose. Pregnancy-related mortality is 5 times higher in Black women than white women in Louisiana, and pregnancy-associated mortality is 2 times higher.12
Infant/Perinatal
Similar to the maternal domain, birth outcomes emerged as a significant issue for Louisiana infants throughout the Needs Assessment process. Louisiana has above-national-average rates of preterm birth, low birth weight, and very low birth weight births.3 In 2019, Louisiana ranked 49th in the nation for low birth weight and preterm births.13 In 2018, about half of very low birth weight births in Louisiana resulted in infant deaths, and rates of these births have been increasing over the past five years. In 2018, 13% of births in Louisiana were preterm deliveries. In Louisiana, the neonatal period (between 0 and 28 days after birth) is the period with the most infant deaths (deaths that occur between birth and 1 year of age). Low birth weight and preterm birth account for many of the deaths in this category.3
Sleep-related injury and sudden unexpected infant death syndrome (SUID) continue to pose serious risks to Louisiana infants. Louisiana has the second-highest rate of post-neonatal mortality in the country, and SUID is still responsible for 42% of post-neonatal infant deaths in Louisiana.14 A significant majority of injury-related infant deaths in Louisiana are related to the sleep environment. In 2017, more than 1 in 4 babies (26%) in Louisiana were exposed to three or more risk factors for sleep-related death. Thirty-two percent of Louisiana mothers said they sometimes, often or always bed-share with their baby, which is the greatest risk factor for sleep-related infant deaths.12
Despite significant improvements over the past several years, Louisiana has low breastfeeding rates compared to the rest of the country. The breastfeeding initiation rate in Louisiana is 70% compared to 84% nationally. Ethnic disparities in breastfeeding initiation persist. Only 60% of black mothers initiate breastfeeding in Louisiana, compared to 79% of white mothers. At six months, 16% of Louisiana women are breastfeeding exclusively (no formula) compared to 25% nationally.15
Child
Louisiana ranks poorly on early education and developmental screening measures. According to the National Survey of Children’s Health (NSCH), approximately 4 out of 5 Louisiana children ages 9-35 months were not screened for developmental needs using a standardized screening tool.16 Children in Louisiana are less likely to receive IDEA Part C Services or access Early Head Start compared to the national averages.17 Nearly half (49%) of all young children in Louisiana are not in Pre-K, and low income children are even less likely to be in preschool than their peers.18 Louisiana has some of the lowest 4th grade reading achievement levels in the country (ranked 48th), and research shows that children who reach fourth grade without being able to read proficiently are more likely to drop out of high school.19
Louisiana ranks 4th highest in the nation for child mortality. About half (49%) of childhood deaths occurring between the ages 1 and 14 are due to injuries, and most of these deaths are considered preventable. The majority of injury deaths are due to motor vehicle crashes, drowning, and homicide. Louisiana’s rates for each cause are approximately double the national averages. Children ages 1-4 had the highest rate of injury-related mortality among all children. The greatest disparity between Louisiana and U.S. child mortality rates is found within this age group.3, 14
Abuse and maltreatment pose a significant threat to the safety of Louisiana’s children. Approximately 17% of child deaths in Louisiana are due to homicide. In 2017, 9.3 children per 1,000 were victims of abuse or neglect in Louisiana (total: 10,356). Of these children, 85.9% were neglected, 15.2% were physically abused, and 5.2% were sexually abused.20, 21
Adolescent
Mental and behavioral health problems are steadily increasing for adolescents in Louisiana. Louisiana’s adolescents are dying at a much higher rate than the US average, and the top causes of death are unintentional injury, homicide, and suicide.3 Louisiana youth are burdened with increasing rates of: depression and serious mental illness, suicidal thoughts and ideation, intentional self-harm, and death by suicide.1,22 Risk factors of mental illness such as bullying, trauma, and substance abuse are also on the rise.1,16,22 Suicide attempts among high school students in Louisiana are more than double the average for the U.S., and self-harm is the second leading cause of injury hospitalizations for adolescents in Louisiana.11,22 Over 31% of Louisiana high school students report experiencing depression symptoms. Over 22% of adolescents 18-24 have been told they have a form of depression. Among older adolescents (18-25), rates of any mental illness, serious mental illness, and serious thoughts of suicide are increasing.1 The rise in mental illness is further exacerbated by a lack of accessible treatment. National numbers show that in 2017, 70% of children 12-17 with mental or behavioral health conditions did not receive any counseling or treatment.16 The entire state of Louisiana can be considered a mental health professional shortage area.7
Louisiana adolescents have above-national-average rates of alcohol abuse, heroin and meth use, injection drug use, and prescription pain medication misuse, and the rates are increasing.2, 22 Drug overdoses are now the second leading cause of injury-related hospitalizations and a leading cause of death among adolescents in the state.3, 11 Over 25% of high school students in Louisiana currently use any form of tobacco, which is significantly higher than the US average. Compared to the national average, more Louisiana high school students report ever taking prescription pain medicine without a prescription. Alcohol use disorders are also increasing among 12-17 year olds in Louisiana, and these rates are higher than the US average.22
Sexual and reproductive health outcomes for Louisiana's adolescents lag behind the national figures. Louisiana youth experience above-average rates of sexually transmitted infections, teenage pregnancy, and teen dating violence. Rates of gonorrhea and chlamydia are increasing in Louisiana, and are some of the highest in the country for teenagers (15-19). Although overall HIV rates are decreasing, Louisiana still has high rates compared to the US average, and adolescents have the highest rates of new infection.23 Similarly, while overall teen pregnancy is decreasing, Louisiana still has the 3rd highest rate of teen pregnancy in the country.24 Reproductive and sexual health also includes healthy emotional relationships. In 2013 (the last year Louisiana collected data on this subject), Louisiana had the highest rates nationally of physical teen dating violence, with 14.8% of high school students reporting experiencing physical dating violence. It is important to note that this dating violence is not limited to female partners: 16.1% of females and 12.6% of males in Louisiana experience dating violence in high school.25
CYSHCN
Louisiana has one of the highest percentages of CYSHCN in the country, with nearly 24% of children ages 1-17 having a special health care need. Of these children with special needs, 94% live within primary care provider shortage areas and 26.5% live under the federal poverty level (FPL). Additionally, the 2017-2018 National Survey of Children’s Health reveals that Louisiana has the highest percentage of children age 3-17 years with a mental, emotional, developmental or behavioral (MEDB) problem in the nation. The entire state of Louisiana is a designated mental health provider shortage area, and 32.6% of children with a MEDB problem live under the FPL. Furthermore, only 17.6% of CYSHCN in Louisiana receive care in a well-functioning system, with just over half (50.8%) of CYSHCN receiving coordinated, ongoing, comprehensive care within a medical home.16
Two-thirds of CYSHCN in Louisiana have two or more health conditions, and 57% report one or more functional difficulties More than half (52%) of all CYSHCN report that their health conditions either moderately or consistently affect their daily activities, compared to 6% of non-CYSHCN. Compared to children without special health care needs, CYSHCN are also more likely to have at least one Adverse Childhood Experience (ACE).16
III.C.2.b.ii. Title V Program Capacity
III.C.2.b.ii.a. Organizational Structure
III.C.2.b.ii.a. Findings - Title V Program Capacity - Organizational Structure
Louisiana's Title V grant is administered through the Louisiana Department of Health (LDH), Office of Public Health (OPH), Bureau of Family Health (BFH). LDH is one of the executive branch departments that report to the Governor, and is charged to protect and promote health and to ensure access to medical, preventive, and rehabilitative services for all citizens of the state. Louisiana has a largely centralized statewide public health system. OPH leadership and programmatic offices are located in Baton Rouge and New Orleans; Regional Administrators/Medical Directors oversee local public health responses and public health services through the 64 OPH Parish Health Units in each of the state's nine LDH administrative regions.
In 2016, all Title V MCH and CYSHCN programs were consolidated administratively under OPH BFH. The administrative alignment of all Title V programs under BFH has fostered collaboration between staff, development of shared strategies, and synergistic work. Between 2017-2019, BFH revised its mission and vision, identified a new set of values, established guiding strategies or “pillars”, and updated its organizational structure. In 2019, BFH’s new organizational structure went into effect, which consists of five functional teams:
- Strategy, Policy, Alignment, Communications, and Equity (SPACE) Team: The SPACE team facilitates strategy development and alignment for its policy, legislative, health systems, and communication operations Bureau-wide.
- Business Operations and Finance Team: Business Operations sets the standards for BFH’s accountability, efficiency, and stewardship of the public dollar, providing instrumental support for health promotion initiatives across the Bureau.
- Data to Action Team: Data to Action sets standards for BFH’s data quality and security, leading data interpretation and translation for systems change and leveraging quality data collection, analysis, and communication to foster positive change in health outcomes.
- Clinical Services and Systems Team: Clinical Services and Systems sets the standards for BFH’s support, linkage, and provision of high quality, client-centered care in clinical settings.
- Family and Community Systems Team: Family and Community Systems sets the standards for BFH’s development, coordination, and provision of family and early childhood systems of care in Louisiana.
III.C.2.b.ii.b. Agency Capacity
III.C.2.b.ii.b. Findings - Title V Program Capacity – Agency Capacity
The Title V Block Grant supports the capacity of BFH programs to promote and protect health and well-being across the five population health domains. It funds health services, health education and promotion, monitoring and evaluation capacity, professional training, and policy development support.
Women’s/Maternal Health – BFH’s long-standing health education program, Partners for Healthy Babies, provides a website and toll-free helpline to pregnant women and families with young children, as well as access to resources through social media and texts. BFH promotes and protects the health of women and mothers through comprehensive reproductive health services. BFH engages in data-driven monitoring of the health of women and mothers by collecting and reviewing data on pregnancy experiences and maternal mortality. Through the Louisiana Perinatal Quality Collaborative (LaPQC), BFH partners with clinicians, hospitals, policy makers, governmental entities, and community members to implement evidence-based hospital quality improvement initiatives throughout the state. BFH also supports the coordination of policies and program development for women and mothers by facilitating and providing administrative support for various boards and commissions, including the Louisiana Commission on Perinatal Care and Prevention of Infant Mortality and the state’s Healthy Moms, Healthy Babies Advisory Council.
Perinatal/Infant Health – Through the hospital designation and quality improvement program, The Gift, BFH works with hospitals and communities to ensure that moms, babies, and their families receive high quality services in birthing facilities. The state’s evidence-based home visiting programs (MIECHV) support pregnant women and their families to the child’s second birthday for the Nurse-Family Partnership model and to age five for the Parents as Teachers model. Through a multimedia statewide campaign and website, Give Your Baby Space, BFH provides education and professional training at the community level to reduce infant deaths due to unsafe sleep environments. BFH monitors the state of infant health and well-being through routine analysis of Vital Records data, the Fetal Infant Mortality Review, and the Sudden Unexpected Infant Death (SUID) Case Registry. BFH offers training to medical, childcare, and other professionals who work with families with young children, with a particular focus on infant mental health, prevention of infant deaths, and family health and safety.
Child Health –MIECHV services continue through early childhood. Title V supplements the federal MIECHV funding and supports Infant and Early Childhood Mental Health (IECMH) consultation services. BFH coordinates Louisiana’s system-level strategy to improve developmental outcomes in young children through the facilitation of the State Young Child Wellness Collaborative. BFH is actively working with state and local early childhood entities to develop and implement a comprehensive early childhood system in Louisiana. BFH also builds community awareness around ACEs, trauma, and resilience science through the ACE Educator Program. State and local panels monitor and review the unexpected deaths of children <15 years of age and provide recommendations for prevention. BFH is also involved in initiatives to improve health policies and practices in childcare settings, prevent child injury, improve pediatric emergency healthcare, increase access to developmental screening and early intervention services, and strengthen child and family well-being and resiliency.
Adolescent Health – To support preventative and behavioral health services delivery at the community level, BFH coordinates efforts to improve the quality, relevance, and uptake of available services at 60 school-based health centers around the state. BFH also provides accessible, low-cost reproductive health services and evidence-based pregnancy prevention information to educate adolescents about responsible decision-making, family planning options, and healthy behaviors. BFH analyzes and supports translation of data on injury, non-fatal suicide attempts, and young adolescent mortality. BFH is also involved in initiatives to improve screening of suicide risk for adolescents in hospital emergency departments and schools, address shared risk and protective factors related to injury prevention, and prevent sexual violence.
CYSHCN – BFH provides family-centered, comprehensive, coordinated services for CYSHCN who meet medical and financial criteria through regional CSHS subspecialty clinics. These clinics provide services for CYSHCN who receive SSI Title XVI benefits and meet state legislated medical eligibility criteria. Social workers and care coordination staff at these clinics link patients with a medical home, and provide transition services to YSHCN to optimize vocational and healthcare independence. The 2020 Needs Assessment affirmed that BFH-supported direct and enabling services are implemented in accordance with the National Standards for Systems of Care for CYSHCN. To support coordinated care and health services delivery at the community level, Title V links families to community resources and family support services in partnership with regional Families-Helping-Families (FHF) organizations. CYSHCN-serving programs also provide: newborn hearing and genetic screening and follow-up; care coordination in academic clinics; technical assistance and resources to embed medical home concepts into physician practices and resident training programs; active birth defects surveillance and monitoring; and transportation assistance when Medicaid assistance is not available.
III.C.2.b.ii.c. MCH Workforce Capacity
III.C.2.b.ii.c. Findings - Title V Program Capacity - MCH Workforce Capacity
Title V serves as the foundation for core public health functions and strategy for MCH in Louisiana and directly supports 180 BFH staff members (160.93 full-time equivalents) across the state. BFH utilizes braided funding mechanisms for most management, programmatic, and cross-cutting infrastructure positions. Therefore, all BFH programs, initiatives, and staff receive Title V-funded infrastructure support, even if salaries and benefits are provided through alternate funding sources.
All senior management positions are fully- or partially-funded by Title V. As such, Title V mandates and priorities are considered in all BFH activities. Below are the names and qualifications of BFH senior level management that oversee the agency’s planning, evaluation, data analysis, and business operations:
Amy Zapata, MPH. BFH Director, Title V MCH and CYSHCN Director.
- Experience: 27 years in public health focusing on women and children’s health, HIV, and public health surveillance.
Lakisha Flagg, DrPH, CPH, PHNA-BC. Strategy, Policy, Alignment, Communication, Equity (SPACE) Team Lead.
- Experience: 26 years of experience in healthcare delivery and public health operations.
Gina Easterly, PhD, CCC-SLP. Family and Community Systems Team Lead.
- Experience: 25 years of experience working with families and young children with and without disabilities and early intervention; early childhood program development and implementation; grant/program administration and supervision of staff with diverse backgrounds and experiences; 5 years public health; administration and oversight of evidence-based family support and coaching and mental health consultation programs.
Jane Herwehe, MPH. Data Action Team Lead.
- Experience: 31 years of experience in public health, health systems, and health informatics.
Gail Gibson, RN BSN, MN, CPM, FABC. Clinical Systems Team Lead.
- Experience: Over 33 years of professional nursing experience leading women’s and pediatric services; this includes six years of experience working with statewide systems and programs impacting families, women, and children.
Tracy Hubbard, MPH. Business Operations & Finance Team Lead.
- Experience: 21 years of Public Health Administration experience.
Quinn Eubanks, JD, BS. Business Operations & Finance Deputy Chief.
- Experience: 15 years of Business Administration, Public Health Policy, Budget, Finance and Procurement experience.
Rebecca Majdoch, MPH. Executive Officer.
- Experience: 19 years of Health Communications, Legislative/Policy, and Public Health experience.
Title V Family Staff
Prior to SFY 2021, BFH contracted with Families Helping Families (FHF) to directly employ parents of children with special health care needs and a youth with special health care needs parent/youth liaisons. The parent/youth liaisons supported families within BFH CSHS clinics and Children’s Hospital Family Resource Center, and attended community events disseminating appropriate resources.
Beginning in SFY 2021, BFH implemented revised contracts designed to build organizational capacity in and outside of BFH, to support CYSHCN and their families. The new deliverable-based contracts shift supervision of the parent and youth liaisons from BFH to regional FHF organizations. The goal of the new contracts is to ensure all CYSHCN families have access to all services provided by FHF. Historically, FHF served individuals with disabilities. The new scope of work was developed to help FHF expand reach to all children/youth with special health care needs and their families. BFH currently maintains contracts with all FHF organizations in the state.
BFH currently employs one family member full-time as a Statewide Family Consultant. The role of this consultant is to provide family peer support and community resource expertise to BFH, serve as the Bureau’s representative on state and regional advisory boards, and function as the designated liaison for the FHF – BFH scope of work.
Adapting to MCH Workforce Trends
Like many health departments, over the past decade, LDH has been shifting away from sustaining a large civil service workforce. With this change, Louisiana’s Title V program has turned to partnerships with quasi-governmental entities, such as the Louisiana Public Health Institute and several Area Health Education Centers, to employ much of the Title V workforce that is embedded within BFH. This contracting mechanism has simplified hiring and promotion processes and has facilitated recruitment of a diverse, talented, well-educated, and adept workforce to augment our cadre of Civil Service staff. This capability has enabled Louisiana’s Title V program to become more agile in its hiring practices thereby better able to respond to the evolving public health workforce needs.
III.C.2.b.iii. Title V Program Partnerships, Collaboration, and Coordination
III.C.2.b.iii. Title V Program Partnerships, Collaboration, and Coordination
Louisiana Title V has an extensive history of coordination, collaboration and partnership with organizations and programs that serve Louisiana’s MCH and CYSHCN populations. As Title V investments united administratively under BFH, numerous programs discovered that they worked with the same partner organizations, and they began exploring how to better coordinate these shared partnerships. During the agency strategic planning and reorganization process, BFH identified the need to build capacity to leverage partners and resources more effectively, resulting in a core strategy to “build coordinated partnerships toward action.”
During the 2016-2020 cycle, Title V began investing in cross-cutting Strategy Manager positions to facilitate partnerships, collaborations, and coordination efforts and drive high-level strategy around specific initiatives, topic areas, and/or population groups. Current strategy manager positions include: Health Systems Strategy Manager, Early Childhood Systems Strategy Manager, Title V Strategy Manager, Health Equity Strategy Manager, Supportive Services Project and Strategy Manager, and a newly developed Trauma & Resilience Strategy Manager.
Below is a summary of BFH’s partnerships and collaborations with other federal, state and local entities that serve the MCH population in Louisiana. Partners marked with an asterisk (*) are Title V partners that are under the administrative purview of BFH.
TYPE |
TITLE V PROGRAM PARTNERS |
Other MCHB Investments |
|
Other Federal Investments |
|
Other HRSA Programs |
|
State and Local MCH Programs |
|
Other Programs within the State Department of Health |
|
Other Governmental Agencies |
|
Tribes, Tribal Organizations |
|
Public Health and Health Professional Educational Programs and Universities |
|
Other state and local public and private organizations that serve the state’s MCH population |
Hospitals and Providers
|
Other state and local public and private organizations that serve the state’s MCH population |
State Professional Associations
|
Other state and local public and private organizations that serve the state’s MCH population |
Boards, Councils, and Commissions
|
Other state and local public and private organizations that serve the state’s MCH population |
Community-based Partners
|
III.C.2.c. Identifying Priority Needs and Linking to Performance Measures
III.C.2.c. Identifying Priority Needs and Linking to Performance Measures
Once the data collection and analysis phase concluded, the Title V team synthesized the findings from all population needs assessment activities to identify 3-6 draft priorities for each population domain. Factors considered when selecting the draft priorities included:
- Significant data findings, such as trends, disparities, high prevalence, and national ranking;
- Issues elevated by community members and key stakeholder groups;
- Evidence and/or expert consensus on impact of issue on health outcomes.
Title V staff first presented the draft priorities to BFH leadership and key agency staff for input, and then members of that group individually scored each draft priority based on three internal capacity criteria: resources available to address need, existing partnerships related to the need, and internal political will. A composite “capacity score” was calculated for each priority.
As described in the Needs Assessment Process Description, a ranking survey and interactive PowerPoint summaries for each of the draft priorities were administered to over 1000 stakeholders throughout the state. Stakeholders rank the priorities using a short tool in SurveyMonkey. In total, 304 responses were collected, and a composite “stakeholder preference” score was calculated for each priority.
Title V staff then mapped priorities using a priority matrix tool to identify the priorities that fell into the “High Capacity” + “High Stakeholder Preference” category. This process produced 10 priorities that were further consolidated into five priority needs for the state action planning sessions.
Linking Priorities to Performance Measures
Population Priorities
Improve birth outcomes for birthing persons and infants.
While improving birth outcomes has always been an inherent priority focus for Title V, Louisiana is explicitly naming birth outcomes as a Priority Need for the 2021-2025 cycle. It is clear that strategic, multi-level, collaborative responses are needed to “move the needle” on complex factors that contribute to the negative birth outcomes. Additionally, there is national and local momentum and increased investment in improving birth outcomes, especially addressing the racial disparities that exist. Louisiana will be closely monitoring all national outcome measures related to maternal and infant birth outcomes. Infant birth outcomes are strongly influenced by maternal health, and most State Action Plan strategies related to this priority are described in the context of the Maternal/Women’s Health Domain. The National Performance Measure associated with this priority need is NPM 2: Low-risk Cesarean Deliveries.
Promote healthy development and family resilience through policies and practices rooted in core principles of development.
This new Priority Need builds off the previous strategies related to the 2016-2020 priority to “improve social and behavioral health supports, with a focus on child and family well-being and resiliency.” Three themes continuously emerged throughout the needs assessment - reduce toxic stress, increase resiliency, and support healthy, responsive relationships. These themes emerged across all domains, but most prominently in early childhood development. While these themes are not new to Title V, the new Priority Need represents an expansion of focus from just service provision to holistic systems-improvement strategies. The priority is rooted in the Harvard University Center on the Developing Child framework, “Three Principles to Improve Outcomes for Children and Families.” The three principles (Support responsive relationships for children and adults; Strengthen core life skills; Reduce sources of stress in the lives of children and families) align directly with three of the top themes identified through the needs assessment, and will guide both practice and systems-level strategies that holistically support healthy development and resiliency. The National Performance Measure associated with this priority need is NPM 6: Developmental Screening for the Child Domain.
Reduce child injury and violence.
This Priority Need reflects high-ranking issues from the infant, child, and adolescent domains. Injury is a leading cause of hospitalization and mortality for infants, children, and adolescents in Louisiana. According to the 2015-2017 Louisiana Child Death Review (CDR), Louisiana has the fifth highest infant mortality rate in the country. A significant majority of injury-related infant deaths were classified as SUIDs and were related to the sleep environment. Additionally, adolescents in Louisiana are dying at a much higher rate than the national average, and the top causes of death are unintentional injury, homicide, and suicide. During the 2021-2025 cycle, Title V will implement injury and violence prevention strategies to address this Priority Need and target performance improvement in relation to NPM 5: Safe Sleep in the Perinatal/Infant Domain and NPM 7: Injury Hospitalizations for the Adolescent Domain.
Improve adolescent mental health and well-being.
This Priority Need emerged in response to the steady increase in suicide, self-harm thoughts and behaviors, and mental health disorders among adolescents in Louisiana. It also reflects the need to address the toxic stressors and adverse childhood experiences of Louisiana’s adolescents that can precipitate mental health issues, including those that are linked to various forms of violence and injury. Title V will introduce new strategies targeting adolescent mental health outcomes with an emphasis on shared risk and protective factors related to injury and violence prevention, especially self-harm. The National Performance Measure associated with this priority need is NPM 7: Injury Hospitalizations for the Adolescent Domain.
Ensure all CYSHCN receive care in a well-functioning system.
This Priority Need represents the outcome of CYSHCN and families that receive care in a well-functioning system. While access to care and care coordination ranked highest in terms of which aspects of the system need to be prioritized, stakeholders were clear that all components of the system must be considered holistically in order for CYSHCN and their families to receive coordinated, family-centered care. The 2020 Needs Assessment revealed that Title V was implementing the National Standards for Systems of Care for CYSHCN primarily through direct and enabling services, but these services reach a narrow sub-population of the state’s CYSHCN. The focus for the 2021-2025 cycle will be to “move down the MCH pyramid” to strengthen the system of care for all CYSHCN in Louisiana. The National Performance Measure associated with this Priority Need is NPM 11: Medical Home for the CYSHCN Domain.
Cross-cutting/Systems Building Priorities
Boldly work to undo systemic drivers of disparities and institutionalize equitable policies and practices.
This revised strategy builds off the previous progress and work related to the 2016-2020 priority to “advance understanding of drivers of disparities in MCH and CYSHCN outcomes and boldly work toward equity.” Over the past five years, Louisiana Title V continued work to understand the origins of racial disparities in health outcomes, deepened the organizational understanding of the structures and systems that contributed to these persistent disparities, and built a robust Health Equity Action Team to begin integrating equity-focused strategies into staff development and core infrastructure processes. During the 2021-2025 cycle, BFH will actively address the upstream, systemic drivers of health disparities among individuals, children, and families in Louisiana, and build a more equitable and effective Title V agency. In alignment with this revised Priority Need, Title V is introducing a new Cross-cutting/Systems Building SPM to measure BFH’s progress towards institutionalizing equity within BFH policies and practices.
Ensure equitable access to high quality and coordinated clinical and support services.
This continued Priority Need maintains the intention of the 2016-2020 priority to “improve access to and quality of primary care, reproductive health, and specialty clinical services including care coordination,” which reflects Louisiana’s commitment to the Assurance essential public health function. In addressing this Priority Need, Title V will serve as a provider of high quality services when needed, elevate the quality of services available in the state, and work to improve access, by all people, to the health and social services needed to be healthy. This Cross-cutting Priority Need is associated with Systems Building strategies as well as strategies related to NPMs across the population domains.
Ensure Title V strategies are outcomes-focused and rooted in Essential Public Health Services.
This new Priority Need is related to the 2016-2020 priority to “ensure high performing essential MCH screening and surveillance systems,” however, the new scope expands past screening and surveillance system performance to encompass functions across all of the updated Essential Public Health Services. This Priority Need demands that Title V strategies and investments not just be high-performing, but that they should be outcomes-focused and effective. Rooted in the updated Essential Public Health Service to “communicate effectively to inform and educate,” Title V is introducing a new Cross-cutting/Systems Building SPM to measure BFH’s progress towards implementing audience-tested message frames in alignment with health communications best practices.
Partner with families, youth, and communities at all levels of systems change.
This revised Priority Need expands upon the 2016-2020 priority to “actively and meaningfully engage youth and families, building local level leaders across the state.” While this revised Priority Need maintains the intention of Title V programs to bridge the gap between those creating health programs and policies and those affected by them, the focus is shifting from building family leaders across the state to enhancing internal and systems capacity to meaningfully, ethically, and effectively partner with families, youth, and communities. To promote accountability in relation to this revised Priority Need, Title V is introducing a new Cross-cutting/Systems Building SPM to measure BFH’s organizational commitment to family engagement in systems change.
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