Needs Assessment Process

 

Mississippi’s MCH population needs are continuously assessed by MSDH MCH programs through ongoing monitoring and surveillance. These efforts include evaluating progress and trends, implementing, and executing work plans, and addressing emerging issues. This process ensures an annual follow-up to the required comprehensive needs assessment.

 

The ongoing mechanisms that provide data and information that inform MCH Title V efforts are:

• Collaboration across all MSDH programs
• Staff participation on regional, state, and national boards
• Development of data briefs and data fact sheets
• Data sharing
• Surveys

 

In addition to these ongoing mechanisms, one of the main mechanisms that inform MCH Title V efforts is conducted through monthly Title V MCH meetings with staff. These meetings provide an opportunity to discuss existing and emerging issues associated with Title V MCH programmatic efforts, accomplishments, and next steps of existing and upcoming projects. As a result, programs can align their efforts to support Mississippi’s MCH population needs.

 

Needs Assessment Findings

 

Needs assessment findings revealed several re-occurring themes across domains that will be addressed through some of the ongoing needs assessment efforts. These re-occurring themes reveal the need for MSDH to align strategies and use resources for the following:

• Improving access to Mental Health Services
• Providing education on mental health issues
• Improving health equity
• Decreasing discrimination based on race, class, or gender
• Improving provider shortages
• Improving access to care

 

Mental Health Services and Education on Mental Health Issues

 

According to the Mississippi Primary Care Needs Assessment that was conducted by the Office of Rural Health, “Mental and behavioral health (MBH) comprise a range of conditions, the majority of which are responsive to treatment, and many of which are exacerbated by poverty. Of the 3 million residents of Mississippi, 4.7% (close to 150,000) of adults are reported to have a serious mental health condition, such as schizophrenia, bi-polar disorder and/or major depression, which are difficult to manage and often require hospitalizations. Other less acute mental health conditions, such as mild depression and anxiety, post-traumatic stress, etc., are preventable and respond well to treatment” (p.18).

 

To address the mental health needs in our state across the lifespan, many of our MCH programs have participated in mental health first aid training. The Adolescent Health Program became certified in mental health first aid. This certification will allow statewide staff trainings to combat the need for mental health efforts. The CYSHCN staff also attended Mental Health First Aid training in March 2022 to gain skills and knowledge in recognizing and addressing mental health concerns in CYSHCN youth.

 

In addition to trainings, MCH programs have also coordinated workshops and mental services to families. The Maternal and Infant Health Bureau program also facilitated a partnership with MOM.Me to address the mental health needs in the state. The goal of this collaboration is to:

• Establish a Maternal Mental Health Network
• Conduct health education and outreach
• Provide training to community stakeholders to increase provider knowledge of maternal mental health disorders
• Link women and children to support services

 

During this collaboration, the Maternal and Infant Health Bureau and MOM.Me hosted a coordinated care program designed to provide the care mothers need. Participants of the program received (1) a one-hour individual session with a therapist; (2) a one-hour weekly group session led by a peer or therapist; (3) a weekly mood assessment conducted by a Care Coordinator via Zoom; and (4) post-program follow-ups for up to six months. The program also hosted a series of virtual workshops on mental health and baby safety.

 

MOM.Me also offers the same content for fathers to bring awareness to the importance of fathers on maternal mental health and the developmental milestones of their child. Fathers are also educated on postpartum in fathers, infant care, and infant first aid. 

 

In 2020, the CYSHCN Program collaborated with Adolescent Health and the University of Southern Mississippi to conduct a Family Engagement Summit series where they focused on adolescent health and wellness, which included both adolescents with and without special health care needs. The series consisted of “Teen Talk” sessions that allowed adolescents to participate in a more engaging dialogue without the presence of parents to allow adolescents to have a space to express their needs and concerns. The “Teen Talk” sessions were led by the CYSHCN youth advisor, Kaitlyn Hawkins. The program also connected with USM-IDS, who had a young CYSHCN adult who connected with youth on YouTube through a series called “Chit Chat Thursday with Taylor,” where he provides resources and advice to YSHCN.

 

More activities related to addressing the mental health needs across the MCH lifespan for MCH populations are being undertaken in the current year and are being planned for the application year, including assisting MCH personnel who work with infants and toddlers to earn the Infant Family Specialist Endorsement recognized by the Alliance for the Advancement of Infant Mental Health.

 

Improving Health Equity and Decreasing Discrimination Based on Race, Class, or Gender

 

The need to promote health equity was also evident from the needs assessment findings. Health equity will increase community capacity to shape outcomes and foster multi-sector collaboration, in turn creating the foundation for a healthy and vibrant community. The Perinatal/Infant Health program has made efforts to address this need through racial equity trainings, focusing on the structural and social dynamics working within health care institutions and communities that prevent optimal births for every woman, particularly Black and indigenous women of color. With trainings on racial equity, social determinants of health inequities, collective impact and advocacy, participants will begin to realize their role within the transformation of those systems.

 

The MCH Program hosted an implicit bias workshop training for staff. Its purpose was to help staff understand the biases in our everyday life, to discuss how to manage biases, and to understand how biases can affect the level of care for MSDH clients and staff. The workshop provided tools to begin discussions on how to adjust automatic patterns of thinking and to eliminate discriminatory behaviors. It equipped staff the necessary tools to maintain and promote an inclusive and respectful work environment. The workshop training also focused on the topic of patient-centered care and how implicit bias can lead clinicians/and service providers to use personal biases that affect the use of family planning in specific situations or populations (e.g., unmarried adolescents). Since integration of family planning into maternal and child health services is a vast area with many intersections, considering how to address bias is an important element for family planning success.

 

In addition to trainings, some programs have developed plans and policies addressing health equity within their program. The Early Hearing and Detection Intervention (EHDI) program received a grant through HRSA to establish an Inclusion and Diversity Plan. The purpose of this plan is to promote and foster a culture that values diversity, equity, and inclusion throughout the EHDI program and the diverse communities that the program serves.

 

The Office of Preventive Health and Health Equity was asked to lead the efforts in addressing the impact of COVID-19 on minority and vulnerable populations such as rural communities, African Americans, Hispanics/LatinX, Vietnamese, and immigrants through education on protective and social distancing measures, access to COVID-19 testing, access to vaccines, and access to resources. The Office of Health Equity has worked to increase access to the COVID-19 vaccine for the state’s minority and vulnerable populations through the Community Vaccination Program and by addressing vaccine misinformation and hesitancy through health promotion campaigns via multiple media platforms. The Office of Health Equity serves as a link and liaison between community-based organizations and community health centers and the community to provide timely and effective response to needs and issues surrounding the COVID-19 pandemic and distribution of vaccinations in minority and vulnerable populations in the state. The Office recruits community health centers and community partners to work together to identify sites in communities that will improve access to the vaccine for minority and vulnerable populations. To date more than 380 vaccination events have taken place across the state, and more than 8,600 vaccines have been administered through the Community Vaccination Program.

 

Provider Shortages

 

The impact of provider shortages is inevitably felt throughout the state. Provider shortages impact the health system by lowering the quality of care provided and increasing the number of poor health outcomes. Although Mississippi experiences provider shortages in every medical and health field, the following highlights some particularly challenging shortages.

 

Newborn Screening and Diagnostic Provider Shortages.

The United States, and Mississippi in particular, is facing a shortage of pediatric audiologists and lacks the genetic specialists to work with families of infants who are found to have conditions identified during newborn screening. This shortage will be difficult to address as training programs are costly, lengthy, and insufficient to address the need. Particularly with pediatric audiologist, reimbursement for working with pediatric populations disincentivizes providers, encouraging them to focus on older, geriatric populations.

 

Dental Health Provider Shortages.

According to the HRSA Bureau of Health Workforce, 248 dentists are needed to eliminate the dental shortage designations. This shortage will be difficult to address and presents a strong rationale to expand the scope of practice of support dental staff, such as hygienists and other midlevel personnel, to address the unmet primary dental health needs in the short term. In addition, consideration should be given to expanding teledentistry. Longer-term solutions point towards expanding dental education to build a pipeline to increase dental providers.

 

Mississippi’s Office of Oral Health developed a Mississippi State Oral Health Plan, 2016-2021. The Plan called for surveillance and assessment of oral health status, which was subsequently addressed by the development of the Mississippi Oral Health Surveillance Plan, 2018-2022. The data collection for the surveillance plan is currently underway, and the results will establish a baseline for oral diseases and resulting health outcomes in Mississippi. The surveillance activities include dental caries, periodontal disease, cancers of the oral cavity and pharynx and access to care issues occurring over one’s lifespan. This information will assist in the placement of new dental providers and public education programs in the areas of the state with the greatest needs. Other benefits of the surveillance process will be an improvement in actionable oral health data for the state and local health providers, more accurate data to report to policy makers, and baseline data to evaluate success.

 

Mental Health Providers Shortages.

The need for mental health providers across the state is dire. The ratio of mental health providers to population as greater than 1 to 200,000 in the Delta region. It is important to note that the HRSA designation process counts psychiatrists only, and there is a nationwide shortage of psychologists and other mental health professionals. Employing a regionalized approach and counting psychologists and licensed clinical social workers would provide a better assessment of capacity. In partial response to the need for psychiatrists, the Mississippi State Hospital (MSH) added a Psychiatric Residency Program with the first residents having started in July 2021.

 

Access to Care

 

Mississippians are affected by inequitable access to care. Barriers such as transportation impede the quality and effectiveness of care received. Although these barriers are acknowledged, strategies should be put in place to ensure all Mississippians have access to quality and equitable healthcare access. The MCH/Title V block grant supports the CYSHCN program’s ability to partner with clinics within communities to provide easier access to care and aid in establishing a mental and/or dental home for some of the most under-served citizens. The ability to provide access support via tele-medicine has also improved conditions for those in under-resourced areas.

 

Changes in MCH/Title V Program Capacity

 

Over the past 2-1/2 years, MSDH has experienced numerous events that have had a serious impact on staff and services, many of which remain unresolved: the impact of COVID-19, including critical staffing shortages; a statewide reassessment and realignment of job classifications; and a continuing drain of skilled public health professionals. These events have made it challenging to recruit and maintain knowledgeable and skilled Title V staff. This year’s Title V Block Grant team is composed solely of staff who are new to the Title V application and report.

 

To recruit and retain qualified MCH staff, MCH works closely with Human Resources to increase efficiencies within the hiring process. Standardized hiring procedures are now in place and additional technical assistance has been provided throughout the hiring process. Proactive strategies have also been employed to publicize vacant positions. Strategies include broadly circulating state vacant positions through established MCH listservs, using additional advertisement and targeted postings, and determining innovative and creative ways to attract and retain a diversified workforce. MCH works with colleges throughout the state to initiate critical conversations to draw student talent.

 

While MSDH has made limited progress, there is a need for improved recruitment strategies, core competency training, competitive salaries that provide a livable wage, and leadership coaching. From previous workforce development surveys, MSDH has been viewed as bureaucratic, lacking innovation, and under resourced. Job attributes should offer fulfilling, meaningful work, a position that is mission-driven and provides the opportunity to make an impact on their community. MSDH realizes a qualified and competent public health workforce is essential in addressing existing and emerging public health issues. The growing variability of these challenges emphasize the need for adequate core competency training and education of public health professionals. Competitive salaries are needed to attract potential employees, provide a livable wage, encourage low employee turnover, and increase the work environment morale. Leadership coaching provides an inclusive workplace that fosters the development of others and the ability to lead staff toward meeting MSDH’s vision, mission, and goals.

 

Partnerships and Collaborations

 

The Title V/MCH program acknowledges the power of prevention in improving the health and well-being of across the life course. Health Services initiated a collaboration with the Office of Preventive Health and Health Equity to address the social determinants of health that affect not only Title V/MCH programs but also the health of all Mississippians. Programs in Preventive Health and Health Equity will assist MCH-related strategies around issues such as maternal and infant mortality, developmental screenings, well visits among adolescents, and cross-cutting issues such as mental health, health equity, and disparities. Mississippi’s Title V MCH Program continues to partner with numerous entities at the federal, state, and local level to expand its capacity and reach for its MCH population.

 

The Title V/MCH program also collaborates with the Title X Family Planning Program Through this collaboration, the Family Planning Program partnered with MSDH Maternal and Infant Health Bureau and a local community-based organization Mom.ME (https://www.momme.rocks/) to establish a community-based collaboration and support to expand community knowledge of available services. Mom.ME works to promote maternal mental health literacy to improve the health of women across the life course and create a continuum of care and integrated system of community-based services in women’s health. To build on this collaboration, the Family Planning Program partners with Teen Health Mississippi to provide training and technical assistance for youth and youth-serving organizations in Mississippi. Trainings provide recommendations on how to best support expectant and parenting youth, adolescents on sexual and mental health practices, and best practices for implementing youth friendly healthcare.

 

Organizational Structure and Leadership Changes

 

Thomas Dobbs, MD, MPH, served in various capacities since 2007 in Public Health as State Epidemiologist, Deputy State Health Officer, and State Health Officer until July 29, 2022. Dr. Dobbs led the state through one of the most challenging epidemics of our lifetime—COVID-19—and will be remembered for his work. Daniel Edney, MD, FACP, FASAM is the incoming State Health Officer; he serves as a medical provider and previously served as Deputy State Health Officer and Chief Medical Officer since 2020.

 

Dr. Beryl Polk serves as Director of Health Services/Title V under the leadership of the State Health Officer, Dr. Edney. She brings decades of experience in program development, management, and evaluation. Dr. Polk is a Certified Case Manager (CCM), Certified Public Manager (CPM), Licensed Social Worker (LSW), has a MS in Counseling and a PhD in Leadership and Management with an emphasis in program development and evaluation. She has served for 23 years in various roles with MSDH. Dr. Polk provides leadership to more than 300 employees, both directly and indirectly, and across the state through the various offices listed below.

 

The Division of Health Services houses several programs: Women’s Health, Child & Adolescent Health, including Children and Youth with Special Healthcare Needs (CYSHCN), Women Infant and Children (WIC), Oral Health, and MCH Workforce Development.

• The Office of Women’s Health includes the Breast and Cervical Cancer Prevention Program, Maternal and Infant Health Bureau, Healthy Moms/Healthy Babies, a home visiting program, and the Family Planning/Title X Program. The Women’s Health Director position is currently vacant.
• Ms. Stacy Callender is the Director of Child & Adolescent Health, which includes Newborn Screening, the Birth Defects Registry, Early Hearing Detection and Intervention, Early Intervention Program (Part C), and Lead Prevention and Healthy Homes Program, Adolescent Health, and Children and Youth with Special Healthcare Needs (CYSHCN).
• MS. Valecia Davis is the Director of the Children with Special Healthcare Needs Program and has been serving in this role since summer 2022.
• Dr. Jameshyia Ballard was appointed Director of WIC on July 15, 2022, when the previous WIC Director retired after more than 30 years of service. Dr. Ballard has been with the WIC program for the last eight years.
• Angela Filzen, DDS, is the Oral Health Director and works with community-based organization on dental and medical homes for women and children across the state.
• The MCH Workforce Development Director is Ms. Danielle Seale; she has served in public health for more than a decade.

 

As always, the Health Services Offices collaborates with both internal and external stakeholders to carry out the mission of the agency.

 

Emerging Issues and MCH Program Response

 

COVID-19

The COVID-19 pandemic has again laid bare the influence of poverty, race, and ethnicity on the vulnerability to disease and the resulting health disparities. Death rates among Blacks are being disproportionately experienced by younger Blacks and death rates are higher among Native Americans. Since the pandemic began, death rates among Blacks aged 55-64 years are higher than for Blacks aged 65-74, and for whites aged 75-84. Mortality rates per 100,000 among Blacks in Mississippi was 253.8 (2,050 deaths), twice the rate of white Mississippians (126.4). The mortality rate from COVID-19 among Native Americans in Mississippi was 1,235 / 100,000 (94 deaths), almost 10 times the rate of white mortality. Despite the low number of deaths, the mortality rate from COVID-19 among Native American Mississippians was the highest among the indigenous residents nationwide.

 

Racism

Racism is a serious threat to the public’s health and overall quality of life. According to the CDC, “A growing body of research shows that centuries of racism in this country has had a profound and negative impact on communities of color. The impact is pervasive and deeply embedded in our society—affecting where one lives, learns, works, worships, and plays and creating inequities in access to a range of social and economic benefits—such as housing, education, wealth, and employment. These conditions—often referred to as social determinants of health—are key drivers of health inequities within communities of color, placing those within these populations at greater risk for poor health outcomes.”

 

This indicates the severity of racism in our everyday lives and for all to have a greater quality of life and improved health outcomes, we must address the generational injustices that contribute to these health and racial inequities in our state and nation.

 

Maternal Mortality

Maternal mortality has continually plagued the black community in our state. According to the CDC, Black women are three times more likely to die from a pregnancy-related cause than white women. This profound difference is appalling and must be addressed because pregnancy-related deaths are preventable. Addressing the variation in quality healthcare, underlying chronic conditions, structural racism, and implicit bias will help reduce the black maternal mortality rate.

 

Undocumented Residents

Immigrant mothers and children are a vulnerable group that faces dangers to their physical and mental health. This stems from immigration policies that include the right to asylum, detention and deportation protocols, regulation of health coverage, and access to both physical and mental health care. These factors can be seen as social determinants for immigrants. As such, the MSDH MCH Program must consider these determinants in ensuring every mother and child has access to quality care despite their citizenship status.

 

MCH Program Response

 

COVID-19 realigned the MCH team’s scope of work and action plans. It was evident that there was a need for coordinated care, an understanding of available services, and access to care. In response, the Title V MCH Director and MCH staff joined efforts of the COVID-19 Response team that was led by the MSDH Health Equity Program. Through these efforts, masks and PPE were distributed statewide, health information distributed to religious entities, and staff participation at vaccination sites. Below is some of the program’s response to the COVID-19 pandemic.

 

Women’s/Maternal Health

 In response to the COVID-19 pandemic, essential BCCP staff were directed to an alternating onsite/telework schedule. Most BCCP staff returned to primarily onsite work effective June 15, 2020. Due to rapid increases in COVID cases in late November 2020, BCCP implemented the alternating onsite/telework schedule again. While MSDH was the lead agency for vaccination distribution, the BCCP program supported the vaccination process through the reassignment of the nursing staff.

 

The family planning program also assisted in the response to the COVID-19 pandemic by providing thermometers to local community-based and faith-based organizations. Several members of the Family Planning and MCH team worked directly with COVID-19 response by working in the call center, assisting with PPE and supply distribution, facilitating community events for testing, and organizing community and faith-based listservs.

 

Perinatal/Infant Health

In response to the COVID-19 pandemic, the Mississippi Perinatal Quality Collaborative (MSPQC) hosted weekly COVID-19 Maternal and Neonatal Updates to provide guidance to all birthing hospitals on best emerging practices and strategies to mitigate exposures to pregnant women and infants. MSPQC contacted states such as New York, Louisiana, and local Mississippi clinicians to share strategies and to present data and findings on COVID-19 response and care of women and infants.

 

Adolescent Health.

In response to the COVID-19 pandemic, the MSDH Adolescent Health Program staff was reassigned to assist with COVID-19 efforts. The staff, Christopher Russell and Mariesha Eason, joined the Health Equity and Disparities COVID-19 Response Team to assist with resource (adult masks, children’s masks, and hand sanitizer) distribution. The team set up systems for inventory management and was responsible for coordinating pick-ups and deliveries of all resources. Since starting in late April of 2020, approximately 2 million face masks and more than 100,000 bottles of hand sanitizer have been distributed to more than 400 organizations.

 

The Adolescent Health (AH) team also partnered with the University of Mississippi Medical Center School of Nursing and the Woman’s Foundation and Teen Health Mississippi to organize a drive-thru resource giveaway for the Georgetown Community in Jackson, distributing more than 8,000 masks at the event.

 

Additionally, the COVID-19 Youth Engagement Team was created. The COVID-19 Youth Engagement Team is a collaboration between the AH program, the Jackson Heart Study, and the Health Equity and Disparities COVID-19 Response Team. Initially, this project was to reduce the spread of COVID-19 by engaging youth groups (specifically mayoral youth councils) to receive feedback from youth for the development of a strategic plan that would promote youth-led COVID-19 prevention efforts around the state. Youth were engaged through virtual townhalls. From their feedback, an action plan was developed. This action plan has been shared with the youth and youth group advisors. To date, six youth councils have participated in youth-led COVID-19 prevention activities. These groups have participated in creating PSAs, community resource (face mask and hand sanitizer) distribution, creating senior care packages, food drives, and information dissemination.

 

Although COVID-19 was a critical public health issue this year, the Title V MCH program will continue to develop plans, monitor the effectiveness and ineffectiveness of activities, and examine key processes to address emerging public health issues.