MCH Population Needs
MDPH conducts a comprehensive statewide needs assessment every five years and in interim years engages in activities to ensure that needs assessment is an ongoing process. Below are examples of efforts to monitor and assess the continuing needs of the MCH population in Massachusetts.
COVID-19 Community Impact Survey
Under the leadership of BCHAP staff, MDPH and stakeholders conducted the COVID-19 Community Impact Survey (CCIS) to better understand the immediate and long-term health needs of Commonwealth residents during the pandemic, including social and economic consequences. MDPH is using and sharing these data to create new, collaborative solutions with community partners.
The survey was conducted from September – November 2020 and there were over 33,000 adult respondents and over 3,000 youth (under 25) respondents. Findings reinforced that the COVID-19 pandemic is both exacerbating pre-existing public health concerns and creating new health crises to address. Even people who have not become sick with COVID-19 are managing stress, uncertainty, and isolation during this challenging time. Key findings relate to access to healthcare; access to testing; ability to mitigate individual risk of infection; impact on social determinants of health; mental health; employment; parents/guardians; and substance use. Results are being examined by race, ethnicity, sexual orientation, gender identity, transgender status, types of disability, income, education, language spoken, industry/occupation, geography, employment status, age, etc.
Additional information about the CCIS process and findings can be found in the Overview of the State and the State Action Plan Narrative by Domain.
MA Maternal, Infant, and Early Childhood Home Visiting (MA MIECHV)
MDPH contracted with Tufts Interdisciplinary Evaluation Research (TIER) to conduct the MA MIECHV 2020 Needs Assessment. MDPH’s goals were to generate a comprehensive understanding of the needs of families with young children, determine whether existing family support programs are sufficient to both meet families’ needs and effect change at a structural level, and to identify strategies to strengthen the state’s early childhood systems of care.
TIER’s mixed methods approach included synthesizing findings from other needs assessments conducted in Massachusetts; analysis of extant indicators to identify communities experiencing the greatest public health challenges; survey of home visiting programs across funding sources in Massachusetts; focus groups with families, providers, and other key stakeholders (some of this qualitative data collection was done as part of the Title V needs assessment); mapping of available treatment services for families experiencing substance use disorder (SUD)-related challenges; review of MA MIECHV site visit reports to describe SUD-related challenges from the perspective of home visiting programs; and case studies of two innovative home visiting approaches for parents in SUD recovery.
Key findings of importance to Title V include:
- Overall, the cities/towns facing the greatest challenges in Massachusetts were the same as in past MA MIECHV needs assessments. This is not surprising, given the structural inequities that have historically characterized these communities.
- Affordable housing, mental health, and involvement with child protective services consistently emerged as among the most pressing concerns for families.
- Families noted a lack of knowledge about and access to services like home visiting and expressed how challenging it is to navigate the complicated service systems in the state.
- Families experiencing substance-use disorder (SUD) continue to face challenges that are impacted by systemic limitations in the state. Home visiting programs are a primary support to families experiencing with SUD and can serve as critical liaisons with SUD-related services. Home visiting programs play an essential role in the implementation of the Title V substance use priority.
- There are racial inequities on almost every indicator, including poverty, education, employment, maternal morbidity, maternal mortality, homelessness, and infant death. Researchers, state agencies, home visiting programs, and home visiting staff have a role to play in addressing racism as a root cause of these inequities.
WIC Nutrition Program
An annual needs assessment identifies WIC-eligible populations in all 351 cities and towns. In 2017, WIC revised how it estimates eligibility using indication of Medicaid insurance on the birth certificate (which gives adjunctive eligibility for WIC) for prenatal care or labor/delivery, or WIC prenatal use as proxy of eligibility for WIC. These changes give a more accurate assessment of eligibility but preclude comparison with data from earlier years.
Using the new methodology, 203,077 women, infants, and children were eligible in 2019, compared to 207,249 in 2018, reflecting the decrease in the state’s number of births. Among those eligible in 2019, 47.9% of women, 79.6% of infants, and 48.9% of children participated in WIC. Local WIC agencies use needs assessment results for outreach plans to engage and enroll eligible families.
WIC also conducts an annual participant satisfaction survey. In January 2020, 9,841 surveys were completed, 30% in a language other than English. Overall, 66% of respondents were highly satisfied with WIC, with the highest percentages among non-English speakers. Among women who spoke Spanish and Portuguese, 81% and 77% respectively were highly satisfied, compared to 60% of English speakers. A majority (72%) of participants joined when pregnant, and most new participants learned about WIC from friends and family. Areas for improvement included acknowledging participants’ knowledge and experience as parents when providing nutrition education, clarifying available/allowed foods, and better customer service at WIC offices.
During the summer of 2020, WIC conducted a survey to assess participants’ needs and satisfaction with using WIC telehealth services which were established due to the COVID-19 pandemic. WIC participants can hold their appointments by telephone or video call and are able to access online education modules in multiple languages through the WICSmart app. Overall, 85% of WIC participants reported that the changes made to WIC made it easy or very easy to access WIC services during the pandemic.
Sexual and Reproductive Health Services
In the FY20 budget, the state legislature directed MDPH to “develop and implement a public information campaign to promote awareness of reproductive health care facilities in the commonwealth, including those that offer or perform abortions…[and]…educat[e] reproductive health care professionals, patients and the general public regarding any and all limitations placed on the use of federal Title X family planning program funds by the U.S. Department of Health and Human Services.” MDPH’s external marketing vendor conducted key informant interviews and an online survey of female and non-binary individuals aged 18-29 with incomes less than $50,000 per year. This information gathering resulted in a successful public information campaign called All of You that promoted the awareness of sexual and reproductive health care services that offered all pregnancy options information and referrals.
MDPH has identified the following emerging public health issues and Title V capacity and resources to address them.
Recovery from COVID-19
Mental health workforce
During the 2020 needs assessment, a frequently cited issue was an insufficient health workforce to meet the mental health needs of the MCH population, such as pregnant and postpartum people, LGBTQ youth, and youth and young adults with disabilities and special health needs. Mental health services can also be difficult to access due to long waitlists or providers not taking certain insurance. Central to the shortage is the lack of racial, linguistic, and cultural representation in the workforce. Providers often do not reflect the populations being served, and there is a need for workforce training about racism, implicit bias, and cultural sensitivity to improve capacity to serve diverse and marginalized populations in the state. This issue is exacerbated by the increase in mental health concerns resulting from the COVID-19 pandemic, as seen in the findings of the COVID-19 Community Impact Survey.
Title V will continue to refine its action plan to strengthen the capacity of the health system to promote mental health and emotional well-being, such as through education and training of providers and school personnel, promoting community social connectedness, and collaborating with MassHealth on policies including licensing and reimbursement of doulas and extending insurance coverage up to 12 months postpartum. In June 2021, MDPH also applied for HRSA’s Pediatric Mental Health Care Access Grant to enhance the MA Child Psychiatry Access Project’s (MCPAP) early childhood mental health capacity and provide training and resources to enable primary care providers to support the behavioral health needs of children under 6 years old and their families. MDPH would coordinate with the Department of Mental Health, the Office of Medicaid, and the Infant and Early Childhood Mental Health Policy Workgroup to ensure alignment within the behavioral health system.
Breastfeeding rates
In FY20, Massachusetts breastfeeding rates decreased and fall short compared to national prevalence and Healthy People 2020 goals. Moreover, disparities by race/ethnicity and socioeconomic status in breastfeeding outcomes including initiation, continuation, and exclusivity persist. According to the most recent CDC Breastfeeding Report Card (reflecting 2017 births), 80.7% of Massachusetts infants were ever breastfed compared to the national prevalence of 84.1% and the Healthy People 2020 goal of 81.9%. In addition, 58.1% of infants were reported as breastfeeding (in any amount) at six months, compared to the national average of 58.3% and the Healthy People 2020 goal of 60.6%. Although these decreases are not statistically significant, these data merit further exploration and renewed focus on how to promote breastfeeding across Title V programs. See the Infant Health domain for FY20 activities and FY22 plans to increase the percentage of infants who are ever breastfed and who are breastfed exclusively through 6 months.
Agency and Program Capacity
Organizational Structure, Leadership, and Staffing
MDPH is part of the Executive Office of Health and Human Services (EOHHS), where legal, human resources, and information technology are centralized. The EOHHS Secretary reports to the Governor. The Bureau of Family Health and Nutrition (BFHN) within MDPH is the Title V Agency, with overall responsibility for the Title V program and funds. The BFHN Director is also the Title V Director, a senior manager who reports to the Associate Commissioner of MDPH. A sister Bureau within MDPH, the Bureau of Community Health and Prevention (BCHAP) also includes MCH-related programs. BFHN and BCHAP work closely on many initiatives, including the Needs Assessment and annual Title V reporting. The Childhood Lead Poisoning Prevention Program and Office of Health Equity are also significant components of Title V and reside in the Bureau of Environmental Health and the Office of Population Health, respectively.
Over the past year, the MA Title V program saw significant leadership changes. In January 2021, Elaine Fitzgerald Lewis became the Title V Director and Director of BFHN, following the departure of Craig Andrade in May 2020. Dr. Fitzgerald Lewis most recently held positions at the Education Development Center, Boston University School of Public Health, and the National Initiative for Children’s Healthcare Quality. In addition, Alison Mehlman, the BFHN Deputy Director and interim Title V/BFHN Director transitioned to become the Deputy Chief Operating Officer of MDPH in January 2021. Aaron Beitman is currently serving as the Acting Deputy Director. Further information about the Title V Partnership senior management team and their qualifications is provided in Attachment 2.
The organizational charts for BFHN and BCHAP are below and show the divisions and programs within each bureau. In January 2021, BFHN’s Office of Data Translation became the Division of Maternal and Child Health Research and Analysis. This new name clarifies what the division is responsible for and recognizes the breadth of its work. A MDPH organizational chart is attached, which shows the location of BFHN and BCHAP within the Department.
As of May 2021, approximately 188 full-time equivalent (FTEs) employees throughout MDPH work on Title V Partnership programs, with 107 FTEs paid from Title V Partnership funds. Approximately 21 of the Partnership-funded total are based in the MDPH regional offices or other off-site locations. There are approximately 81 FTEs working on MCH programs but paid through other federal grants. In addition, BFHN employs over 13 parents of children and youth with special health needs for the EI Parent Leadership Project, Family TIES, and Universal Newborn Hearing Screening Program. Additional details about how parents, families, and youth are involved in Title V programming are provided in the State Action Plan, Family Partnerships, and Attachment 3.
The share of total staffing supported by Title V remains stable due to successful efforts to cost-share staff with other federal discretionary grants. These totals and percentage distributions may continue to change during FY22 as efforts continue to bring the Title V budget into a more secure long-term equilibrium. The staff support may also be affected by the loss or reduction of federal discretionary grants.
Partnerships, Collaboration, and Coordination
MDPH is committed to building, strengthening, and sustaining partnerships with other organizations to better serve the MCH population and expand the capacity and reach of the Title V program. MDPH collaborates with families, public and private sector entities, federal, state and local government programs, clinical providers, academia, and public health organizations. The Family Partnerships section and Attachment 3 describe Title V’s partnership with families. Attachment 4 describes partnerships with external organizations, including government agencies, universities, and public health organizations and MCH programs within MDPH. These partnerships, collaboration, and coordination give depth and effectiveness to the MA Title V program and are integral to daily operations.
MCH Population Needs
MDPH conducts a comprehensive statewide needs assessment every five years and in interim years engages in activities to ensure that needs assessment is an ongoing process. Below are examples of efforts to monitor and assess the continuing needs of the MCH population in Massachusetts.
COVID-19 Community Impact Survey: Parents of CYSHN and Youth with Disabilities
In fall 2020, MDPH conducted the COVID-19 Community Impact Survey (CCIS) to better understand the immediate and long-term health needs of Commonwealth residents during the pandemic, including social and economic consequences. There were over 33,000 adult respondents to the survey, and over 3,000 youth (ages 14-24) respondents. MDPH is using and sharing these data to create new, collaborative solutions with community partners.
In November 2021, CCIS released data about the specific needs of parents of children and youth with special health needs (PCYSHN) during the pandemic. About 786 respondents were screened as PCYSHN using the MCHB definition. These data illuminate the toll of the pandemic on this population, and that certain groups – including but not limited to parents with disabilities, parents of color, parents under age 35, parents in rural counties, and parents who speak a language other than English – bore a disproportionate burden. Economic security was a major concern for PCYSHN; they were 45% more likely to report job loss, reduction of hours, or leave than other parents. Family caregivers experienced increased mental and behavioral health needs and faced significant barriers accessing healthcare; during the first 6-8 months of the pandemic, nearly 1 in 4 PCYSHN delayed healthcare and nearly half reported persistent poor mental health. Technology needs (25% of respondents) were also cited as a concern.
About 640 youth with disabilities (21% of the ~3,000 youth respondents) completed the CCIS. Youth with disabilities reported being deeply concerned and having been significantly impacted by the pandemic, especially youth of color and LGBQA youth. Many had been asked to take on more adult responsibilities, including providing financial support to their families (28% of youth with a mobility disability and 23% of youth with a cognitive disability). Youth with disabilities were 3 times as likely to be worried about basic needs compared to youth without disabilities. The pandemic has had a significant impact on mental health with 3 of 4 youth with any disability reporting feeling sad or hopeless every day for 2+ weeks. More than twice as many youth with disabilities (46%) reported 3+ PTSD reactions during COVID-19, compared to youth without a disability (22%).
Due to the large sample size of the survey, CCIS provides a unique source of data on the challenges faced by caregivers and youth in Massachusetts and validates some of the anecdotal data that programs have received. Additional information about the CCIS process and findings can be found in the Overview of the State and the State Action Plan Narrative by Domain.
COVID-19 Disparities Community Evaluator Project
MDPH is contracting with the Tufts Interdisciplinary Evaluation Research (TIER) team to conduct a series of community-based evaluation projects with funding from the CDC National Initiative to Address COVID-19 Health Disparities Award. TIER will hire and train a cohort of Community Evaluators in community-based participatory research to help design and implement evaluation projects and translate findings into program and policy recommendations. The projects are focused on understanding and addressing the effects of COVID-19 on Massachusetts residents, and on making sure that people directly affected by COVID-19 are part of both the evaluation process and public health response.
Three initial projects have been selected and will be executed in FY23. These projects include collecting qualitative data from pregnant people and parents of youth aged less than 5 years from specific communities with lower COVID-19 vaccination uptake to understand barriers and facilitators to COVID-19 vaccination among pregnant people and parents deciding whether to vaccinate their young children; evaluating community acceptance of a new telehealth kiosk being used to provide a safe, easily-accessible, and confidential space for community members to access health and other social services; and diving deeper into some of the qualitative data from the CCIS to learn more about how frontline workers in restaurants and childcare settings have been impacted by COVID-19.
Perinatal-Neonatal Quality Improvement Network (PNQIN) COVID-19 Vaccination Survey
The Perinatal Neonatal Quality Improvement Network of Massachusetts (PNQIN) aims to improve rates of delivery of COVID-19 vaccinations to pregnant and postpartum people and their families by addressing health systems barriers to effective vaccination counseling and provision. In October/November 2021, PNQIN administered a provider survey to better understand barriers to COVID-19 vaccination for pregnant and postpartum people.
The survey was sent to providers from 40 birthing hospitals; 42 providers across 38 birthing hospitals responded. Results indicated that there is large variability in provider-types who counsel pregnant and postpartum patients on vaccination status, including physicians, midwives, nurse practitioners, nurses, and medical assistants. Only 30% (n=33) of institutions reported that their providers receive training on how to counsel pregnant and postpartum patients about COVID-19 vaccination, while 92% (n=36) of responding providers indicated that their institution was interested or potentially interested in receiving virtual training for providers. Providers also cited provider time and energy, patient vaccine hesitancy, misinformation, absence of onsite vaccination, and inconsistent messaging as barriers to COVID-19 vaccination for pregnant and postpartum patients. PNQIN will use results of this survey to develop strategies to support facilities to implement protocols for COVID-19 vaccination of pregnant and postpartum people and their families.
PNQIN Family Engagement Survey
PNQIN is developing a Hospital Family Engagement Collaborative Practice Survey for NICU/Special Care Nursery and Obstetrics and Gynecology teams to assess hospital and patient family engagement definitions and practices. As of April 2022, PNQIN has conducted a narrative literature review of validated survey instruments (e.g., Family Voices and the MA Family Engagement Framework) and is working with the Betsy Lehman Center to revise and import the survey questions into REDCap. The survey will be administered to all birthing hospitals and findings will inform opportunities for improvement and support decision making around specific topics for learning collaboratives or technical assistance that will be offered to interested hospitals.
WIC & Breastfeeding Needs Assessments
An annual needs assessment identifies WIC-eligible populations in all 351 cities and towns and guides the statewide distribution of funds. In 2020, 197,444 women, infants, and children were eligible for WIC, compared to 203,077 in 2019, reflecting the decrease in the state’s number of births. Among those eligible in 2020, 48.5% of women, 82.2% of infants, and 52.6% of children participated in WIC. Local WIC agencies use needs assessment results for outreach plans to engage and enroll eligible families.
Center for Birth Defects Research and Prevention Strategic Planning
The Center for Birth Defects Research and Prevention (CBDRP) initiated a strategic planning process and engaged a consultant to lead this process. The purpose of the Center’s Strategic Planning process is to: 1) refine the Center’s mission and vision; 2) update its goals and objectives; 3) identify opportunities to: a) add new activities, b) enhance/strengthen current activities; and 4) create and/or strengthen Center collaborations. As a first step, small group discussions were held with Center Epidemiologists, Center Trainees (current and former), the Center’s Medical Record Abstractors, Center’s Research Study Staff, external collaborators, and advisory committee members; while individual meetings were held with the Center leadership, leadership in other BFHN Divisions, and Bureau leadership. Discussion topics include assessment of the Center’s strengths and weaknesses; emerging issues or trends in science, public health or technology that present opportunities for the Center; leadership opportunities for the Center; and identifying ways that the Center can strengthen the advancement of health equity through the work its does. A total of 29 interviews with 42 individuals were held during the Fall of 2021 and a summary report is being drafted. The final strategic plan will include an implementation plan, as well as a monitoring and evaluation plan.
MDPH has identified the following emerging public health issues and Title V capacity and resources to address them.
Staffing Challenges
Like many industries across the country, state and local MCH programs and organizations are experiencing tremendous challenges in hiring and retaining staff. At the local level, programs such as WIC and home visiting struggle to appropriately staff client-facing services, limiting their ability to meet the needs of families. This challenge is experienced at MDPH as well, where many staff have left the Department or state service over the past year, leading to a loss of institutional knowledge and necessitating additional staff time and resources to fill vacancies. BFHN is leveraging this as an opportunity to recruit and hire new staff with a racial equity lens and using a healing-centered approach. More information about these hiring efforts can be found in the discussion of the racial equity priority in the Crosscutting domain. In addition, see MCH Workforce Development for information about efforts to strengthen the MCH workforce.
Inflation and Cost of Living
The rising inflation and cost of gas, food, and other goods in Massachusetts and across the country are adversely affecting families served by Title V. As result of the COVID-19 pandemic, many people in Massachusetts were already struggling with important basic needs, like housing, food, medicine, technology, and childcare. The recent infant formula shortage has added additional stress and hardship for families. Title V programs will support families in accessing concrete supports to meet these needs and assess the impact of public benefits and programs that promote economic stability, including Paid Family and Medical Leave, the Earned Income Tax Credit, and Supplemental Security Income benefits. The WIC program will continue to play a critical role maximizing the number of families with young children who have access to food resources for which they are eligible.
Early Identification of Developmental Delays
There are increasing concerns in Massachusetts about the impact of the COVID-19 pandemic on developmental delays and the early identification of delays. Findings from a fall 2020 needs assessment, conducted by the Association of University Centers on Disabilities and CDC, found that early childhood programs across the country report that the pandemic has greatly affected early identification of developmental delays and disabilities among children birth to age 5 years. Title V is well-positioned to respond to this issue through its priority to strengthen the capacity of the health system to promote mental health and emotional well-being, using NPM 6 to monitor developmental screening. Key strategies include scaling the Learn the Signs Act Early Developmental Milestone Checklist Program to WIC clinics statewide and working with state and community partners to promote understanding of infant and early childhood mental health, effective social emotional screening and follow-up in pediatrics, and services and referrals.
Agency and Program Capacity
Organizational Structure, Leadership, and Staffing
MDPH is part of the Executive Office of Health and Human Services (EOHHS), where legal, human resources, and information technology are centralized. The EOHHS Secretary reports to the Governor. The Bureau of Family Health and Nutrition (BFHN) within MDPH is the Title V Agency, with overall responsibility for the Title V program and funding. The BFHN Director is also the Title V Director, a senior manager who reports to the Associate Commissioner of MDPH. A sister Bureau, the Bureau of Community Health and Prevention (BCHAP) also includes MCH-related programs. BFHN and BCHAP work closely on many initiatives, including the Needs Assessment and annual Title V reporting. The Childhood Lead Poisoning Prevention Program and Office of Health Equity are also significant components of Title V and reside in the Bureau of Environmental Health and the Office of Population Health, respectively.
Over the past year, BFHN experienced significant leadership changes. The former BFHN Deputy Director, Aaron Beitman, left MDPH in November 2021. Stephanie Doyle joined the Department in March 2022 as the BFHN Deputy Director of Strategy and Implementation and Snaz Pierre became the Administration and Finance Director. Further information about the Title V Partnership senior management team and their qualifications is provided in Attachment 2.
The organizational charts for BFHN and BCHAP are below and show the divisions and programs within each bureau. A MDPH organizational chart is attached, which shows the location of BFHN and BCHAP within the Department.
As of June 2022, approximately 174 full-time equivalent (FTEs) employees throughout MDPH work on Title V Partnership programs, with 94 FTEs paid from Title V Partnership funds. There are approximately 80 FTEs working on MCH programs but paid through other federal grants. In addition, BFHN employs 14 parents of children and youth with special health needs for the EI Parent Leadership Project, Family TIES, and Universal Newborn Hearing Screening Program. Additional details about how parents, families, and youth are involved in Title V programming are provided in the State Action Plan, Family Partnerships, and Attachment 3.
The share of total BFHN staffing supported by Title V is slightly lower (54% versus 57% last year) due to successful efforts to cost-share staff with other federal discretionary grants. These totals and percentage distributions may continue to change during FY23 as efforts continue to bring the Title V budget into a more secure long-term equilibrium. The staff support may also be affected by the loss or reduction of federal discretionary grants, including ARPA funding.
Partnerships, Collaboration, and Coordination
MDPH builds, strengthens, and sustains partnerships with other organizations to better serve the MCH population and expand the capacity and reach of the Title V program. MDPH collaborates with families, public and private sector entities, federal, state and local government programs, clinical providers, academia, and public health organizations. The Family Partnerships section and Attachment 3 describe Title V’s partnership with families. Attachment 4 describes partnerships with external organizations and MCH programs within MDPH. These partnerships, collaboration, and coordination give depth and effectiveness to the MA Title V program and are integral to daily operations.
MCH Population Needs
MDPH conducts a comprehensive statewide needs assessment every five years and in interim years engages in activities to ensure that needs assessment is an ongoing process. Below are examples of efforts to monitor and assess the continuing needs of the MCH population in Massachusetts.
PNQIN Family Engagement Survey
PNQIN developed a Hospital Family Engagement Collaborative Practice Survey for NICU/Special Care Nursery and Obstetrics and Gynecology teams to assess hospital and patient family engagement definitions and practices. This effort was led by the Title V Director who serves as the chair for the PNQIN Family and Community Subcommittee. With support from the Betsy Lehman Center, the Family Voices’ Family Engagement in Systems Assessment Tool (FESAT) was adapted, and survey questions imported into REDCap. The survey was administered to 26 perinatal units from 41 hospitals. Results from this survey demonstrate that there is considerable variation in family and community engagement across Massachusetts obstetric and neonatal hospital units. Findings from this baseline assessment will inform supports, technical assistance, and resources PNQIN can offer to help hospitals strengthen and deepen their engagement activities. PNQIN will begin this process by convening a patient and family advisory council to co-develop PNQIN projects and initiatives, including supports related to patient, family, and community engagement. PNQIN will support and integrate family members from diverse backgrounds into PNQIN committees and workgroups so that the perspectives of pregnant and postpartum people with lived experiences inform PNQIN’s strategy and projects. Following the creation of this advisory body, and the integration of family members into PNQIN activities, PNQIN will co-develop a new initiative to support hospitals as they strengthen their family engagement efforts.
WIC & Breastfeeding Needs Assessments
An annual needs assessment identifies WIC-eligible populations in all 351 cities and towns and guides the statewide distribution of funds. In 2021, 193,361 women, infants, and children were eligible for WIC, compared to 197,444 in 2020. Among those eligible in 2021, 48.1% of women, 80.9% of infants, and 58.2% of children participated in WIC. These coverage rates represent small decreases in coverage for women and infants but significant improvement for the coverage of children. Local WIC agencies use needs assessment results for outreach plans to engage and enroll eligible families.
Center for Birth Defects Research and Prevention Strategic Planning
The Center for Birth Defects Research and Prevention (CBDRP) initiated a strategic planning process and engaged a consultant to lead this process. The purpose of the Center’s Strategic Planning process is to: 1) refine the Center’s mission and vision; 2) update its goals and objectives; 3) identify opportunities to: a) add new activities, b) enhance/strengthen current activities; and 4) create and/or strengthen Center collaborations. The Center engaged consultants in the fall of 2022 to lead the Strategic Planning process. An application was distributed to Center staff to identify members for a core working team; simultaneously, an application was distributed to family leaders to identify individuals with lived experience to participate in this process. A kick-off meeting was convened in January of 2023, where staff and family leaders were grounded in the process and oriented family leaders to the work of the Center. The core group drafted content for the strategic plan and brought it to the family leaders and staff through an iterative process to get feedback and revise the plan. Part way through the process, the plan was brought to the Bureau’s Senior Leadership Team and internal and external collaborators for additional input. One of the main changes to arise from the process is an update to the Center’s name, given the growth of the Center, staff felt it no longer captured the breadth of the work. The name “Division for Surveillance, Research, and Promotion of Perinatal Health” is currently being considered. The final strategic plan will include an implementation plan, as well as a monitoring and evaluation plan; the plan is anticipated to be ready in July of 2023.
Division of Children and Youth with Special Health Needs (DCYSHN) Care Coordination Training and Technical Assistance Center
The DCYSHN is creating a care coordination center to provide training and technical assistance to providers regarding comprehensive, enhanced care coordination including training around the social determinants of health, racial equity, family engagement and trauma informed and healing centered care. Throughout this process, family engagement has been at the forefront. The center is being developed based on previous population health work done as part of the MCH population health learning journey with three other states and facilitators from MCH Workforce Development Center at UNC and Population Health Improvement Partners. The DCYSHN had a team of professionals creating a workplan together for this center. The team was comprised of DCYSHN staff and representatives from MassHealth, DPH Office of Health Equity and The Federation for Children with Special Needs and their Family Voices program. As a result of these efforts, the DCYSHN performed need assessments of families of CYSHN and providers, in order to create training that serves the needs of families and is tailored to providers. The DCYSHN held two focus groups in November 2022 with families of different races, ethnicities, and cultures with live translation. Twelve parents participated in total, seven spoke English, four spoke Spanish, one spoke Portuguese and one spoke Vietnamese. Of these parents, five identified as Latina, one as Haitian Creole, one as Vietnamese, and two as African American. The parents were asked about their understanding and experience with care coordination and their wants and needs around improved care coordination. These original focus groups contributed to the strategic planning for the care coordination center and curriculum. In March 2023, the DCYSHN expanded our core team to a full Steering Committee, made up of parents of CYSHN, providers and DCYSHN staff. This committee meets monthly and provides insights and feedback on the vision, plans and goals for the care coordination center. Their input ensures that the DCYSHN is creating comprehensive curriculum for providers to increase their knowledge and skills around serving and working with CYSHN and that the model and structure of the center will be effective in expanding care coordination in Massachusetts. The future will include further needs assessments working with the provider organizations that the center will serve and partnering with families to provide continued insights into the center’s development efforts.
Pediatric Mental Health Access Grant Early Identification and Diagnosis of Autism Project
The Division of Pregnancy, Infancy and Early Childhood received supplemental funding from HRSA for the Pediatric Mental Health Care Access Project to expand pathways to early diagnosis and support for children with ASD. The project conducted a needs assessment to better understand the barriers to getting an ASD diagnosis for children 0-5 that included interviews with over two dozen key stakeholders and three focus groups with parents (n = 33). Emerging themes included: 1) effective communication, and accurate message transmission are severely hampered when a shared language is absent; 2) the potential presence of bias among assessors in ASD diagnosis is an important and sensitive issue to be addressed; and 3) coming to terms with an autism diagnosis can be incredibly challenging for families, regardless of their cultural background. The focus groups provided valuable insights into the experiences and perspectives of parents navigating the diagnosis process for their children with autism and prioritized culturally sensitive support throughout the diagnosis process, recognizing the influence of cultural beliefs on families' perceptions and approach to autism.
Family Engagement and Leadership
One of the strategies in the MA Family Engagement Priority State Action Plan is to understand and better coordinate efforts across MDPH bureaus and offices to partner with and engage communities, families, fathers, and youth at the system (i.e., internal/state-level) and program level (i.e., external or direct service delivery level). The Title V Family Engagement Implementation Team worked with a CDC Public Health Associate to develop a Title V Family engagement survey, administered during spring 2023, to assess progress on this priority. The Title V Family Engagement Survey was a two-part survey comprised of: 1) an adapted version of the Family Engagement in Systems Assessment Tool (FESAT); a self-assessment tool to help programs reflect upon how families are engaged in program-level initiatives (including commitment to family engagement practices, transparency with families, representation of populations served, and impact of family engagement practices), and to share opportunities for improvement; and 2) a questionnaire collecting information on the various family engagement activities (including compensation) in Title V affiliated programs during FY22 for the Annual Report. Results are currently being analyzed and will be used by the Family Engagement Implementation Team to design training, and tools to support programs, highlighting internal best practices and peer learning opportunities.
In addition, BFHN has partnered with the Boston University School of Social Work to conduct an evaluation to understand the impact, reach, and opportunities for improvement and scale of programs such as Family TIES (Together in Enhancing Support) and Early Intervention Parent Leadership Program (EIPLP). The evaluation included key informant interviews with staff and leadership, secondary data analysis of Family TIES program data, and focus groups with parents who have participated in the programs. A final report will be available in July 2023 and include logic models for each program to support planning, implementation and quality improvement activities, a description of the Family TIES participants for Family TIES to better align resources and identify gaps and opportunities, and recommendations for improvement, innovation and future evaluation.
MDPH has identified the following emerging public health issues and Title V capacity and resources to address them.
Workforce Challenges
Like many industries across the country, state and local MCH programs and organizations are experiencing tremendous challenges in hiring and retaining staff. At the local level, programs such as WIC and home visiting struggle to appropriately staff client-facing services, limiting their ability to meet the needs of families. The Direct Service Provider Crisis has particularly impacted caregivers of children and youth with special health needs on multiple fronts, including lack of access to desperately needed respite. Workforce challenges is experienced at MDPH as well, where many staff have left the Department or state service over the past few years, leading to a loss of institutional knowledge and necessitating additional staff time and resources to fill vacancies. BFHN is leveraging this as an opportunity to recruit and hire new staff with a racial equity lens and using a healing-centered approach. More information about these hiring efforts can be found in the discussion of the racial equity priority in the Crosscutting domain. In addition, see MCH Workforce Development for information about efforts to strengthen the MCH workforce.
Inflation and Cost of Living
The rising inflation and cost of gas, food, and other goods in Massachusetts and across the country are adversely affecting families served by Title V. As result of the COVID-19 pandemic, many people in Massachusetts were already struggling with important basic needs, like housing, food, medicine, technology, and childcare. Title V programs will support families in accessing concrete supports to meet these needs and assess the impact of public benefits and programs that promote economic stability, including Paid Family and Medical Leave, the Earned Income Tax Credit, and Supplemental Security Income benefits. The WIC program will continue to play a critical role maximizing the number of families with young children who have access to food resources for which they are eligible. WIC caseload has grown more than 20% since the beginning of the pandemic; this growth combined with significant food cost inflation across most of the WIC food categories raises concerns about the sufficiency of federal WIC funding to serve all families that wish to enroll in the program.
Housing Crisis for Migrant Families
Massachusetts is welcoming many new immigrant families with significant health and social needs. Significant numbers of families are currently in emergency shelter, and needs are amplified by challenges associated with transportation, health care access, developmentally appropriate play space for children and food storage and preparation facilities. Programs are working with community partners to ensure that families enroll in and have access to services for which they are eligible.
Constrained funding for MCH legislative priorities and emerging issues
Maternal and child health covers a wide breadth of programs and services that requires a multi-generational, life course approach to optimize the health and well-being of 860,000 people across Massachusetts. The challenge is that funds to support nearly 50 Title V programs are siloed and primarily dependent on federal grants, that are time limited, constrained, and restricted. With nearly 70%The Title V MCH Block Grant supporting salaries, funding is significantly constrained by growing salaries and fringe costs. Additional resources are needed to support potential legislatively driven initiatives in Massachusetts like building out a doula workforce, expanding universal home visiting to all pregnant and postpartum people, and eliminating disparities in maternal and infant outcomes. State resources are essential to more effectively promote maternal and child health with initiatives such as strengthening outreach, coordination of care, a statewide breastfeeding strategy that supports all nursing people, ensuring robust data systems, and addressing emerging needs and crisis to name a few.
Agency and Program Capacity
Organizational Structure, Leadership, and Staffing
MDPH is part of the Executive Office of Health and Human Services (EOHHS), where legal, human resources, and information technology are centralized. The EOHHS Secretary reports to the Governor. The Bureau of Family Health and Nutrition (BFHN) within MDPH is the Title V Agency, with overall responsibility for the Title V program and funding. The BFHN Director is also the Title V Director, a senior manager who reports to the Deputy Commissioner of MDPH. A sister Bureau, the Bureau of Community Health and Prevention (BCHAP) also includes MCH-related programs. BFHN and BCHAP work closely on many initiatives, including the Needs Assessment and annual Title V reporting. The Childhood Lead Poisoning Prevention Program and Office of Health Equity are also significant components of Title V and reside in the Bureau of Environmental Health and the Office of Population Health, respectively.
Over the past year, MDPH and BFHN experienced significant leadership changes. In January 2023, Governor Maura Healy took office, appointing Kate Walsh and Dr. Robbie Goldstein as EOHHS Secretary and MDPH Commissioner respectively. Scott Geer joined BFHN as Deputy Director of Finance and Operation to further strengthen BFHN’s infrastructure and play an important leadership role managing Title V’s fiscal processes. After Karin Downes’ retirement, Dr. Ann Peralta was hired as the Director of the Division of Pregnancy, Infancy and Early Childhood and the MCH Director. Finally, Suzanne Gottleib, Director of the Office of Family Initiatives and Title V Parent Representative retired in February 2023 after nearly three decades of service. As BFHN expands parent engagement and leadership in Title V, several options are being considered for backfilling Suzanne’s position, including expanding partnerships with family-led organizations, dedicating a leadership position to family engagement in the Early Intervention System and designing a new role to meet the Bureau’s needs for developing capacity in family engagement as one of our Title V priorities. Further information about the Title V Partnership senior management team and their qualifications is provided in Attachment 2.
The organizational charts for BFHN and BCHAP are below and show the divisions and programs within each bureau. A MDPH organizational chart is attached, which shows the location of BFHN and BCHAP within the Department.
As of June 2023, approximately 220 full-time equivalent (FTEs) employees throughout MDPH work on Title V Partnership programs, with 136 FTEs paid from Title V Partnership funds. There are approximately 84 FTEs working on MCH programs but paid through other federal grants. In addition, BFHN employs (directly or via a contract) 12 parents of children and youth with special health needs for the EI Parent Leadership Project, Family TIES, and Universal Newborn Hearing Screening Program. Additional details about how parents, families, and youth are involved in Title V programming are provided in the State Action Plan, Family Partnerships, and Attachment 3.
The share of total 220BFHN staffing supported by Title V is slightly lower (48% versus 54% last year) due to successful efforts to cost-share staff with other federal discretionary grants. These totals and percentage distributions may continue to change during FY24 as efforts continue to bring the Title V budget into a more secure long-term equilibrium. The staff support may also be affected by the loss or reduction of federal discretionary grants, including ARPA funding.
Partnerships, Collaboration, and Coordination
MDPH builds, strengthens, and sustains partnerships with other organizations to better serve the MCH population and expand the capacity and reach of the Title V program. MDPH collaborates with families, public and private sector entities, federal, state and local government programs, clinical providers, academia, and public health organizations. The Family Partnerships section and Attachment 3 describe Title V’s partnership with families. Attachment 4 describes partnerships with external organizations and MCH programs within MDPH. These partnerships, collaboration, and coordination give depth and effectiveness to the MA Title V program and are integral to daily operations.
MCH Population Needs
MDPH conducts a comprehensive statewide needs assessment every five years and in interim years engages in activities to ensure that needs assessment is an ongoing process. Below are examples of efforts to monitor and assess the continuing needs of the MCH population in Massachusetts.
Governor’s Maternal Health Services Report
Massachusetts new administration has identified maternal health and the elimination of racial disparities as top priorities. To inform strategy development and implementation towards these goals, MDPH conducted a review of prenatal, postpartum, and birthing services across the state, through a lens of health equity and health outcomes, with a focus on availability of quality services in rural and other underserved communities. This report synthesized information and data gathered by MDPH and other agencies under the Executive Office of Health and Human Services, including through listening sessions, legislative Commissions and ongoing data analysis.
The report found that Massachusetts has no maternity care deserts, however, the closure of a number of maternity wards and out-of-hospital birth settings has left several communities with limited access to quality perinatal health services. Comparing distances traveled in 2011 to distances traveled in 2021, birthing people in 29 towns have increased their distance traveled by at least 5 miles, and 14 towns have increased their distance traveled by at least 10 miles; only two towns have residents whose average travel distance to birthing facilities decreased in the past decade.
MDPH identified 25 recommendations to address the current state of maternal health services in MA ranging from improving access to birth center care by updating the licensure regulations for birth centers to building capacity for remote blood pressure monitoring programs for postpartum patients. More information on the report can be found here.
Title V Evaluation
The Title V program was evaluated in the fall of 2023 by a group of MPH students from Boston University's School of Public Health. The evaluation focused on organizational structure improvements that could drive further coordination, engagement, and equity across Title V. The evaluation team conducted a site visit, interviews with Title V stakeholder internal and external to MDPH, and a literature review. The Evaluation team found a lack of staff bandwidth due to staff turnover and funding constraints. There is an understanding that these constraints impact participation on and effectiveness of Implementation Teams. The evaluation team developed recommendations and deliverables to utilize institutional knowledge to ensure sustainability, increase staff ownership and responsibility for Implementation Team activities, and improve progress reporting. MDPH is in the process of developing an implementation plan for these recommendations.
PNQIN Family Engagement Survey
PNQIN developed a Hospital Family Engagement Collaborative Practice Survey for NICU/Special Care Nursery and Obstetrics and Gynecology teams to assess hospital and patient family engagement definitions and practices. This effort was led by the Title V Director who serves as the chair for the PNQIN Family and Community Subcommittee. With support from the Betsy Lehman Center, the Family Voices’ Family Engagement in Systems Assessment Tool (FESAT) was adapted, and survey questions imported into REDCap. The survey was administered to 26 perinatal units from 41 hospitals. Results from this survey demonstrate that there is considerable variation in family and community engagement across Massachusetts obstetric and neonatal hospital units. Findings from this baseline assessment will inform supports, technical assistance, and resources PNQIN can offer to help hospitals strengthen and deepen their engagement activities. PNQIN will begin this process by convening a patient and family advisory council to co-develop PNQIN projects and initiatives, including supports related to patient, family, and community engagement. PNQIN will support and integrate family members from diverse backgrounds into PNQIN committees and workgroups so that the perspectives of pregnant and postpartum people with lived experiences inform PNQIN’s strategy and projects. Following the creation of this advisory body, and the integration of family members into PNQIN activities, PNQIN will co-develop a new initiative to support hospitals as they strengthen their family engagement efforts.
WIC & Breastfeeding Needs Assessments
An annual needs assessment identifies WIC-eligible populations in all 351 cities and towns and guides the statewide distribution of funds. In 2023, 193,501 adults, infants, and children were eligible for WIC, compared to 197,444 in 2020. Among those eligible in 2023, 48.2% of women, 78.9% of infants, and 62.8% of children participated in WIC. These coverage rates represent small decreases in coverage for women and infants but significant improvement for the coverage of children. Local WIC agencies use needs assessment results for outreach plans to engage and enroll eligible families.
The Nutrition Division is also completing a needs assessment in 2024 to strengthen breastfeeding services in the state, including the unique challenges families faced during the COVID-19 pandemic and opportunities to improve or expand services. The needs assessment process has been developed in partnership with the Internal MDPH Breastfeeding Workgroup and has included key informant interviews with internal and external partners, data review, a health care provider survey, and the development of a family-facing survey. The findings will be used to prepare statewide recommendations to better meet the needs of families and improve breastfeeding outcomes in the Commonwealth.
Division for Surveillance, Research & Promotion of Perinatal Health
The Division for Surveillance, Research & Promotion of Perinatal Health (DSRPPH) formerly known as the Center for Birth Defects Research and Prevention completed a strategic planning process that was steeped in racial equity principles for engaging families and partners in visioning a path forward. The purpose of the Division’s Strategic Planning process was to: 1) refine the Center’s mission and vision; 2) update its goals and objectives; 3) identify opportunities to: a) add new activities, b) enhance/strengthen current activities; and 4) create and/or strengthen Center collaborations. The Division engaged consultants in the fall of 2022 to lead the Strategic Planning process. An application was distributed to Division staff to identify members for a core working team; simultaneously, an application was distributed to family leaders to identify individuals with lived experience to participate in this process. A kick-off meeting was convened in January of 2023, where staff and family leaders were grounded in the process and oriented family leaders to the work of the Division. The core group drafted content for the strategic plan and brought it to the family leaders and staff through an iterative process to get feedback and revise the plan. Part way through the process, the plan was brought to the Bureau’s Senior Leadership Team and internal and external collaborators for additional input. One of the main changes to arise from the process is an update to the Centers name, given the growth of the Center, staff felt it no longer captured the breadth of the work. The name “Division for Surveillance, Research, and Promotion of Perinatal Health” felt more comprehensive and the transition to the new name happened in September of 2023. The final strategic plan includes an updated mission and vision statement, as well as an implementation evaluation plan.
Division of Children and Youth with Special Health Needs (DCYSHN) Care Coordination Training and Technical Assistance Center
The DCYSHN is creating a care coordination center to provide training and technical assistance to providers regarding comprehensive, enhanced care coordination including training around the social determinants of health, racial equity, family engagement and trauma informed and healing centered care. Throughout this process, family engagement has been at the forefront. The center is being developed based on previous population health work done as part of the MCH population health learning journey with three other states and facilitators from MCH Workforce Development Center at UNC and Population Health Improvement Partners. The DCYSHN had a team of professionals creating a workplan together for this center. The team was comprised of DCYSHN staff and representatives from MassHealth, DPH Office of Health Equity and The Federation for Children with Special Needs and their Family Voices program. As a result of these efforts, the DCYSHN performed need assessments of families of CYSHN and providers, in order to create training that serves the needs of families and is tailored to providers. The DCYSHN held two focus groups in November 2022 with families of different races, ethnicities, and cultures with live translation. Twelve parents participated in total, seven spoke English, four spoke Spanish, one spoke Portuguese and one spoke Vietnamese. Of these parents, five identified as Latina, one as Haitian Creole, one as Vietnamese, and two as African American. The parents were asked about their understanding and experience with care coordination and their wants and needs around improved care coordination. These original focus groups contributed to the strategic planning for the care coordination center and curriculum. In March 2023, the DCYSHN expanded our core team to a full Steering Committee, made up of parents of CYSHN, providers and DCYSHN staff. This committee meets monthly and provides insights and feedback on the vision, plans and goals for the care coordination center. Their input ensures that the DCYSHN is creating comprehensive curriculum for providers to increase their knowledge and skills around serving and working with CYSHN and that the model and structure of the center will be effective in expanding care coordination in Massachusetts. The future will include further needs assessments working with the provider organizations that the center will serve and partnering with families to provide continued insights into the center’s development efforts.
Pediatric Mental Health Access Grant Early Identification and Diagnosis of Autism Project
The Division of Pregnancy, Infancy and Early Childhood received supplemental funding from HRSA for the Pediatric Mental Health Care Access Project to expand pathways to early diagnosis and support for children with ASD. The project conducted a needs assessment to better understand the barriers to getting an ASD diagnosis for children 0-5 that included interviews with over two dozen key stakeholders and three focus groups with parents (n = 33). Emerging themes included: 1) effective communication, and accurate message transmission are severely hampered when a shared language is absent; 2) the potential presence of bias among assessors in ASD diagnosis is an important and sensitive issue to be addressed; and 3) coming to terms with an autism diagnosis can be incredibly challenging for families, regardless of their cultural background. The focus groups provided valuable insights into the experiences and perspectives of parents navigating the diagnosis process for their children with autism and prioritized culturally sensitive support throughout the diagnosis process, recognizing the influence of cultural beliefs on families' perceptions and approach to autism.
Family Engagement and Leadership
One of the strategies in the MA Family Engagement Priority State Action Plan is to understand and better coordinate efforts across MDPH bureaus and offices to partner with and engage communities, families, fathers, and youth at the system (i.e., internal/state-level) and program level (i.e., external or direct service delivery level). The Title V Family Engagement Implementation Team worked with a CDC Public Health Associate to develop a Title V Family engagement survey, administered during spring 2023, to assess progress on this priority. The Title V Family Engagement Survey was a two-part survey comprised of: 1) an adapted version of the Family Engagement in Systems Assessment Tool (FESAT); a self-assessment tool to help programs reflect upon how families are engaged in program-level initiatives (including commitment to family engagement practices, transparency with families, representation of populations served, and impact of family engagement practices), and to share opportunities for improvement; and 2) a questionnaire collecting information on the various family engagement activities (including compensation) in Title V affiliated programs during FY22 for the Annual Report. Results have been analyzed and being used by the Family Engagement Implementation Team to design training, and tools to support programs, highlighting internal best practices and peer learning opportunities.
In addition, BFHN has partnered with the Boston University School of Social Work to conduct an evaluation to understand the impact, reach, and opportunities for improvement and scale of programs such as Family TIES (Together in Enhancing Support) and Early Intervention Parent Leadership Program (EIPLP). The evaluation included key informant interviews with staff and leadership, secondary data analysis of Family TIES program data, and focus groups with parents who have participated in the programs. A final report was provided in July 2023 and included logic models for each program to support planning, implementation and quality improvement activities, a description of the Family TIES participants for Family TIES to better align resources and identify gaps and opportunities, and recommendations for improvement, innovation and future evaluation.
Emerging Issues
MDPH has identified the following emerging public health issues and Title V capacity and resources to address them.
Workforce Challenges
Like many industries across the country, state and local MCH programs and organizations are experiencing tremendous challenges in hiring and retaining staff. At the local level, programs such as WIC and home visiting struggle to appropriately staff client-facing services, limiting their ability to meet the needs of families. The Direct Service Provider Crisis has particularly impacted caregivers of children and youth with special health needs on multiple fronts, including lack of access to desperately needed respite. Workforce challenges is experienced at MDPH as well, where many staff have left the Department or state service over the past few years, leading to a loss of institutional knowledge and necessitating additional staff time and resources to fill vacancies. BFHN is leveraging this as an opportunity to recruit and hire new staff with a racial equity lens and using a healing-centered approach. More information about these hiring efforts can be found in the discussion of the racial equity priority in the Crosscutting domain. In addition, see MCH Workforce Development for information about efforts to strengthen the MCH workforce.
Inflation and Cost of Living
The rising inflation and cost of gas, food, and other goods in Massachusetts and across the country are adversely affecting families served by Title V. As result of the COVID-19 pandemic, many people in Massachusetts were already struggling with important basic needs, like housing, food, medicine, technology, and childcare. Title V programs will support families in accessing concrete supports to meet these needs and assess the impact of public benefits and programs that promote economic stability, including Paid Family and Medical Leave, the Earned Income Tax Credit, and Supplemental Security Income benefits. The WIC program will continue to play a critical role maximizing the number of families with young children who have access to food resources for which they are eligible. WIC caseload has grown more than 20% since the beginning of the pandemic; this growth combined with significant food cost inflation across most of the WIC food categories raises concerns about the sufficiency of federal WIC funding to serve all families that wish to enroll in the program.
Housing Crisis for Migrant Families
Massachusetts is welcoming many new immigrant families with significant health and social needs. Significant numbers of families are currently in emergency shelter, and needs are amplified by challenges associated with transportation, health care access, developmentally appropriate play space for children and food storage and preparation facilities. Programs are working with community partners to ensure that families enroll in and have access to services for which they are eligible.
Constrained funding for MCH legislative priorities and emerging issues
Maternal and child health covers a wide breadth of programs and services that requires a multi-generational, life course approach to optimize the health and well-being of 860,000 people across Massachusetts. The challenge is that funds to support nearly 50 Title V programs are siloed and primarily dependent on federal grants, that are time limited, constrained, and restricted. With nearly 70%The Title V MCH Block Grant supporting salaries, funding is significantly constrained by growing salaries and fringe costs. Additional resources are needed to support potential legislatively driven initiatives in Massachusetts like building out a doula workforce, expanding universal home visiting to all pregnant and postpartum people, and eliminating disparities in maternal and infant outcomes. State resources are essential to more effectively promote maternal and child health with initiatives such as strengthening outreach, coordination of care, a statewide breastfeeding strategy that supports all nursing people, ensuring robust data systems, and addressing emerging needs and crisis to name a few.
Agency and Program Capacity
Organizational Structure, Leadership, and Staffing
MDPH is part of the Executive Office of Health and Human Services (EOHHS), where legal, human resources, and information technology are centralized. The EOHHS Secretary reports to the Governor. The Bureau of Family Health and Nutrition (BFHN) within MDPH is the Title V Agency, with overall responsibility for the Title V program and funding. The BFHN Director is also the Title V Director, a senior manager who reports to the Commissioner of MDPH. A sister Bureau, the Bureau of Community Health and Prevention (BCHAP) also includes MCH-related programs. BFHN and BCHAP work closely on many initiatives, including the Needs Assessment and annual Title V reporting. The Childhood Lead Poisoning Prevention Program and Office of Health Equity are also significant components of Title V and reside in the Bureau of Climate and Environmental Health and the Office of Population Health, respectively.
Over the past year, MDPH and BFHN experienced significant leadership changes. In January 2023, Governor Maura Healy took office, appointing Kate Walsh and Dr. Robbie Goldstein as EOHHS Secretary and MDPH Commissioner respectively. Scott Geer joined BFHN as Deputy Director of Finance and Operation to further strengthen BFHN’s infrastructure and play an important leadership role managing Title V’s fiscal processes. After Karin Downes’ retirement, Dr. Ann Peralta was hired as the Director of the Division of Pregnancy, Infancy and Early Childhood and the MCH Director. Finally, Suzanne Gottleib, Director of the Office of Family Initiatives and Title V Parent Representative retired in February 2023 after nearly three decades of service. As BFHN expands parent engagement and leadership in Title V, several options are being considered for backfilling Suzanne’s position, including expanding partnerships with family-led organizations, dedicating a leadership position to family engagement in the Early Intervention System and designing a new role to meet the Bureau’s needs for developing capacity in family engagement as one of our Title V priorities. Further information about the Title V Partnership senior management team and their qualifications is provided in Attachment 2.
The organizational charts for BFHN and BCHAP are below and show the divisions and programs within each bureau. A MDPH organizational chart is attached, which shows the location of BFHN and BCHAP within the Department.
As of June 2023, approximately 220 full-time equivalent (FTEs) employees throughout MDPH work on Title V Partnership programs, with 136 FTEs paid from Title V Partnership funds. There are approximately 84 FTEs working on MCH programs but paid through other federal grants. In addition, BFHN employs (directly or via a contract) 12 parents of children and youth with special health needs for the EI Parent Leadership Project, Family TIES, and Universal Newborn Hearing Screening Program. Additional details about how parents, families, and youth are involved in Title V programming are provided in the State Action Plan, Family Partnerships, and Attachment 3.
The share of total 220 MDPH staff supported by Title V is slightly lower (48% versus 54% last year) due to successful efforts to cost-share staff with other federal discretionary grants. These totals and percentage distributions may continue to change during FY24 as efforts continue to bring the Title V budget into a more secure long-term equilibrium. The staff support may also be affected by the loss or reduction of federal discretionary grants, including ARPA funding.
Partnerships, Collaboration, and Coordination
MDPH builds, strengthens, and sustains partnerships with other organizations to better serve the MCH population and expand the capacity and reach of the Title V program. MDPH collaborates with families, public and private sector entities, federal, state and local government programs, clinical providers, academia, and public health organizations. The Family Partnerships section and Attachment 3 describe Title V’s partnership with families. Attachment 4 describes partnerships with external organizations and MCH programs within MDPH. These partnerships, collaboration, and coordination give depth and effectiveness to the MA Title V program and are integral to daily operations.
The state did not provide any content for this Narrative Section.
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