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FY 2021 Application/FY 2019 Annual Report Update

Ongoing Needs Assessment Activities

Mississippi’s MCH population needs are continuously assessed by MSDH MCH programs through ongoing monitoring and surveillance. Ongoing monitoring and surveillance efforts assist in informing the direction of activities to address the MCH population resource needs. 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 the existing and emerging issues associated with Title V MCH programmatic efforts, accomplishments, and next steps of existing and upcoming projects. As a result, programs are able to align their efforts to support Mississippi’s MCH population needs.

In 2020, the required comprehensive needs assessment was completed to identify the priority issues for MS’s MCH population. MSDH entered into an agreement with the University of Alabama at Birmingham (UAB), School of Public Health, Department of Health Care Organization and Policy, Applied Evaluation and Assessment Collaborative (AEAC) to develop, analyze, and report on data collected from Mississippi families, practitioners, and other stakeholders. All data collection instruments were designed through a joint effort between the AEAC and MSDH. MSDH was responsible for efforts related to marketing the needs assessment, recruitment of survey participants, identification of key informants and populations for focus groups, and provided final approval for all activities. The AEAC fielded surveys, facilitated focus groups and key informant interviews, performed all analyses, and developed final reports. The AEAC entered into agreements with three community partner organizations to support the needs assessment: The University of Southern Mississippi Institute for Disability Studies, Mississippi Community Education Center, and the Family Resource Center of North Mississippi. These organizations worked with the AEAC to raise awareness of surveys, recruit focus group participants, handle logistics, and provide locations to host focus groups.to assist with the needs assessment.

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 around mental health issues
Improving health equity
Decreasing discrimination based on race, class, or gender
Improve provider shortages
Improve access to care

Mental Health

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, 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 MCH program also facilitated a partnership with MomMe 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

Health Equity

The need to promote health equity was also evident from the needs assessment findings. Health equity is a shared vision of the MSDH MCH Title V Program. 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 focused on the structural and social dynamics working within health care institutions and communities that prevent optimal births for every woman, particularly 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.

Provider Shortages

The impact of provider shortages is inevitably felt throughout the state. Provider shortages impact the health system by lower quality of care and an increase of poor health outcomes. The Mississippi Primary Care Needs Assessment revealed:

Dental Health Provider Shortages

According to 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 in order 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.

Mental Health Providers Shortages

The need for mental health providers across the State is dire. Appendix E indicates the mental health provider to population ratio as greater than 200,000 to 1 in the Delta region. It is important to note that the HRSA designation process counts psychiatrists only and there is a nationwide shortage of psychiatrists and other mental health professionals. A regionalized approach, also 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) will be adding a Psychiatric Residency Program with the first residents starting in July 2021. MSH provides a rich learning environment where psychiatry residents will have a unique opportunity to care for patients with both common and rare psychiatric disorders.

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 (p. 30-31, Mississippi Primary Care Needs Assessment Plan)

Changes in Health Status and Needs

The information below is based on the findings for MS’s 2020 Title V MCH Needs Assessment. Of note, the data findings included NPMs and NOMs reported for Mississippi. Additional state-level data from surveys and reports supplemented FAD for some domains. Both quantitative and qualitative data led to the development of the need statements that were presented to stakeholders and leadership to choose as the state’s priority needs for the upcoming five-year cycle. The need statements are further described within the full domain report for each population of interest. Furthermore, in keeping with the processes’ guiding principle of promoting health equity and reducing disparities, several themes were noted across all domains.

Indicator data show differences in outcomes based on race, ethnicity, socioeconomic status, age, insurance status and type, and urban/rural location.
Stakeholders expressed differences in access to services, treatment experiences, and perceptions of quality of care based on race, ethnicity, socioeconomic status, marital status, sexual orientation, age, disability status, substance use, insurance status and type, primary language, and geographic location.
Several areas of disparity were identified across all domains. The full domain reports for each population of interest provide more in-depth discussion of identified disparities and inequities.

Changes in MCH/Title V Program Capacity

Over the past five years, MSDH has worked to recruit and maintain Title V staff. Several Epidemiologists have been added to the MCH team and provide broad support for data analysis and program evaluation and specialized support in program areas such as health promotion, injury prevention and detection, reproductive and women’s health, newborn screening, childhood lead poisoning prevention, and children and youth with special healthcare needs epidemiologists). Mrs. Charity Moody Willis led the five-year MCH/Title V Needs Assessment process and MCH Block Grant coordination activities. MSDH Title V received an MCH Epi Assignee, Laurin Kasehagen, October 2020 to help build surge capacity for MCH epidemiology- related issues.

To recruit and retain qualified MCH staff, MS 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 servant positions through established MCH listservs, using additional advertisement and targeted postings, and determining innovative and creative ways to attract and retain a diversified workforce. MS MCH works with colleges throughout the state to initiate critical conversations to draw student talent.

While MSDH has made 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.

According to the editorial Moving From Data to Action: Necessary Next Steps to a Better Governmental Public Health Workforce (Castrucci, B. C., & Fraser, M. (2019), the necessary steps to a better governmental public health workforce are to develop national governmental public health agency workforce goals, define and align the resources, prioritize governmental public health agency workforce development, and iteratively assess, evaluate, and course correct. MSDH cannot expect to achieve health improvement in communities state-wide without a well-trained and innovative public health foundation. Building this foundation requires deliberate and thoughtful leadership, robust strategic thinking and implementation, and the resources needed to carry out public health’s comprehensive mission (Castrucci, B. C., & Fraser, M. (2019).

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. The Office of Health Services’ Maternal and Child Health Program initiated a joint collaboration with the Office of Preventive Health to address the MCH social determinants of health that affect our state. The Office of Health Services is working with the Office of Preventive Health to provide MCH-related objectives around issues such as maternal and infant mortality, developmental screenings, well-visits amongst adolescents, and cross-cutting issues like mental health, health equity, and smoking cessation. Prevention team will be responsible for updating their progress for each objective in the department's TRAPS database which is monitored by the Health Services MCH Engagement coordinator. On the other hand, the MCH staff will be responsible for providing all materials and trainings needed for the prevention team to sufficiently execute the deliverables associated with each objective. Mississippi’s Title V MCH Program continues to partner with numerous entities of the federal, state, and local level to expand its capacity and reach for its MCH population.

Operationalization of Five-Year Needs Assessment Process and Findings

Mississippi’s Title V MCH program operationalizes both the five-year and ongoing needs assessment by choosing and monitoring priorities. These priorities are influenced by the review of quantitative, qualitative and program capacity data. Through the ongoing needs assessment, changes in health needs and the effectiveness of action plan activities on improving health are monitored. Because of ongoing monitoring, programs are able to identify the effectiveness and ineffectiveness of activities. The five-year and ongoing needs assessment is vital to the success of MCH programs.

Organizational Structure and Leadership Changes

The Office of Health Services welcomed a new director of Health Services, Dr. Beryl Polk. Dr. Polk brings decades of experience. Dr. Polk has served as the Director of Child and Adolescent Health which includes the Children and Youth with Special Healthcare Needs (CYSHCN) for the last 8 years.

Emerging Issues and MCH Program Response

MSDH MCH team possesses the flexibility to adjust program goals and activities to address new and emerging issues.

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. (p.18, Mississippi Primary Care Needs Assessment)

Impact of Police Brutality

Police brutality, specifically for Black Americans, is a stark reminder of the deep systemic realities underlying the everyday lives of Black Americans. For years Black Americans have been plagued with racial inequalities and injustices. These inequalities and injustices have translated over to health systems as well through lower quality of care for Black Americans. This issue must be addressed to ensure health equity across all systems. MSDH MCH Program plans to have more equity and implicit bias trainings to address this ongoing problem.

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 in order 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. The Maternal Mortality Review Committee works tirelessly to address maternal mortality in our state formulating activities based on the objectives listed below:

Have the necessary staff and training in place to manage the ongoing functions of the Maternal Mortality Review Committee
Ensure timely, accurate, and standardized information available about deaths to women during pregnancy and the year after the end of pregnancy, including documented opportunities for prevention
Increase awareness of the existence and recommendations of the MMRC among the public, clinicians and policy makers
Implement data driven recommendations to prevent maternal mortality
Increase and complete adoption maternal safety bundles and practices that reflect the highest standards of care.
Increase access to community-based supports for pregnant and postpartum women
Reduce severe morbidity and complication of pregnancy

Unsafe Borders

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. With this in mind, it is evident that MSDH MCH Program must consider these determinants in ensuring that 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 MSDH Health Equity Program. Through these efforts, masks and PPE was 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 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 MS 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 over 100,000 bottles of hand sanitizer have been distributed to over 400 organizations.

The Adolescent Health 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, MS distributing over 8,000 masks at the event.

Furthermore, the COVID-19 Youth Engagement Team was created. The COVID-19 Youth Engagement Team is a collaboration between the AH program, Jackson Heart Study and 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, 6 youth councils have participated in youth lead 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.

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

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.

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.

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

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.

Needs Assessment Process

Mississippi’s MCH population needs are continuously assessed by MCH programs through ongoing monitoring and surveillance to evaluate progress and trends, track implementation of work plans, and identify and address emerging issues. The MCH personnel meet monthly to discuss programmatic efforts, accomplishments, existing and emerging issues, and next steps of ongoing and upcoming projects. This ensures MCH programs can align their efforts and encourages collaboration across MCH programs to support Mississippi’s MCH population needs.

Needs Assessment Findings

Needs assessment findings revealed several recurring themes across domains highlighting the need for MSDH to align strategies and use resources for the following:

Improving access to patient- and family-centered care
Improving health equity for underserved populations
Decreasing discrimination based on race, class, or gender
Providing education on mental health issues and improving access to mental health services
Decreasing provider shortages

Access to Patient- and Family-Centered Care

Mississippians are significantly impacted by inequitable access to care. Most health care resources are concentrated in a few areas of the state. Given the dearth of resources in some areas of the state, barriers, such as transportation, impede the quality and effectiveness of care received. Even when providers are geographically close, residents may still lack the financial resources, insurance, or time to utilize services, resulting in inadequate care. Furthermore, as health is largely driven by behaviors and experiences outside of healthcare services, healthcare providers need to acknowledge the importance of the patient in achieving positive outcomes and view themselves as partners, rather than directors, of health. New strategies are needed to ensure all Mississippians have access to quality and equitable healthcare that is responsive and respectful of them.

The MCH/Title V Block Grant supports Mississippi’s efforts to increase access to patient- and family-centered care. For example, the CYSHCN program partners with specialty clinics, federally qualified healthcare centers (FQHC), and private clinics within communities to provide easier access to care and coordination of services to establish mental and dental homes for under-served citizens. The ability to provide access support via tele-medicine has also improved conditions for those in under-resourced areas.

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

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.

Mental Health Services and Education on Mental Health Issues

To begin to build capacity to address the mental health needs in our state in MCH populations, MCH program personnel have participated in mental health first aid training. In 2021, Adolescent Health Program personnel became certified in mental health first aid. Certified personnel provided statewide training to address mental health needs. In 2022, the CYSHCN personnel also attended Mental Health First Aid training to gain skills and knowledge in recognizing and addressing mental health concerns in CYSHCN youth.

In addition to training, 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

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. All social workers and service/care coordinators in all MCH programs, including CYSHCN, EI, HMHB 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.

Provider Shortages

Newborn Screening and Diagnostic Provider Shortages.

Dental Health Provider Shortages.

Mental Health Providers Shortages.

Changes in MCH/Title V Program Capacity

Over the past 3 years, MSDH has experienced numerous events that have had a serious impact on staff and services, many of which remain challenging: 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. The Title V Block Grant team is mostly comprised of personnel who have been in their roles for two or fewer years and have recently assumed responsibilities for preparing the Title V application and report.

To build MCH Program capacity, some leadership staff have been supported to participate in coaching and leadership training programs such as the certified public manager program through the Mississippi Personnel Board and the Advanced Applied Leadership Program through the Else School of Management at Millsaps College.

Partnerships and Collaborations

The Title V/MCH program also supports the Maternal & Infant Health Bureau (MIHB). Through this support, the MIHB partnered with 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.

The Child and Adolescent Health Office partners with Teen Health Mississippi to develop and implement training and technical assistance for youth and youth-serving organizations in Mississippi, guiding providers on how to best support expectant and parenting youth, educate adolescents on sexual and mental health practices, and best practices for implementing youth friendly healthcare, particularly focused on teen populations with health disparities, such as teens of color, teens with English as a second language, teens with disabilities, LGBTQ youth, etc.

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 its most challenging times, the COVID-19 pandemic. In 2022, Dr. Dobbs announced his departure and successor Daniel Edney, MD, FACP, FASAM. Dr. Edney brought years of experience in private practice when he joined MSDH in 2021 as the Deputy State Health Officer and Chief Medical Officer. Dr. Edney was officially announced as the State Health Officer in August 2022. Dr. Edney is a former president of the Mississippi State Medical Association and currently serves as a board member on the Mississippi State Board of Medical Licensure. He has also served as a fellow and laureate for the Mississippi Chapter of the American College of Physicians and a fellow of the American Society of Addiction Medicine.

Ms. Krista Guynes, MSW, LCSW, is the Director of the Office of Women’s Health, which includes the Breast and Cervical Cancer Program, Maternal and Infant Health Bureau, Healthy Moms/Healthy Babies Perinatal Case Management Program, and the Family Planning/Comprehensive Reproductive Health Program. She began serving in this role in 2022.
Ms. Stacy Callender, SCSP, is the Director of the Office of Child and Adolescent Health, which includes Newborn Screening, the Birth Defects Registry, Early Hearing Detection and Intervention, Early Intervention (Part C), Lead Prevention and Healthy Homes (LPPHH), Maternal Infant and Early Childhood Home Visiting (MIECHV), Adolescent Health, and Children and Youth with Special Healthcare Needs (CYSHCN) Programs. She began serving in this role in 2021.
Ms. Valecia Davis, MS, is the Director of the Children with Special Healthcare Needs Program and interim Adolescent Health Director. She has been serving in this role since summer 2022.
Dr. Jameshyia Ballard was appointed Director of WIC in July 2022, when the previous WIC Director retired after more than 30 years of service. Dr. Ballard previously served as State Breastfeeding Coordinator and State Vendor Management Director with the WIC program.
Dr. Angela Filzen, DDS, is State Dental Director and oversees the Oral Health Office. She has been serving in this capacity since 2017 and works with community-based organizations to increase dental and medical homes for women and children across the state.
Ms. Danielle Seale, MSW, LCSW, was tasked to lead the MCH Workforce Development Office in 2021, bringing her experiences from more than a decade in public health. In 2022 she was assigned a cadre of Health Services Social Workers to supervise in their social service support of Health Service programs.

New Brand, New Program

Beginning in August 2021, the Perinatal High-Risk Management/Infant Support Services (PHRM/ISS) program that has been in existence at the health department for over 30 years changed to the Healthy Moms/Healthy Babies (HM/HB) of MS program, a nurse case management and home visiting program. To complete the transformation, the program began by developing provider-specific training and orientation for new and existing staff and revamping protocols to implement evidence-based strategies. The HM/HB program developed a recruitment strategy to address the shortage of nurses within the program. The overall goal of the program is to increase capacity, training, and accountability to better serve pregnant women and infants in the state of Mississippi.

Emerging Issues and MCH Program Response

Dobbs Decision

On June 24, 2022, the U.S. Supreme Court officially issued a ruling in the Thomas E. Dobbs, State Health Officer of the Mississippi State Department of Health, et al. v. Jackson Women’s Health Organization. In doing so, the Court overturned its 1973 decision of Roe v. Wade. Given the existing challenges Mississippi already experiences with high maternal and infant mortality and morbidity, these rates are predicted to increase as a result of this recent Supreme Court decision and subsequent enforcement of state laws making abortions illegal. As a result, the state’s only abortion clinic has closed and restrictions for medication abortions are in effect. Additional pregnancies and births, which would have previously been terminated during pregnancy, are most likely to occur for younger women, single women, women of color, women in under-resourced areas without local family planning services, and women with economic hardships who lack the resources to receive reproductive services out of state.

The MSDH currently estimates the elimination of elective abortions will result in as many as an additional 5,000 births annually, many of which will be unplanned, and for which many women will receive little or no prenatal care. Research has shown repeatedly the negative consequences of inadequate prenatal care for mothers, including three to four times the risk of dying from pregnancy-related complications than those who do receive care, and for infants, including increased rates of prematurity, low birthweight, and infections after birth. As these conditions place infants at increased risk of requiring more advanced neonatal care after delivery, Mississippi expects an increased need for NICU admissions in the coming years.

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.

In early 2021, MSDH and health systems partners statewide prioritized vaccine distribution. In October and November 2021, during this reporting period, Mississippi saw its highest rates of COVID and COVID-variant transmissions, infections, hospitalizations, and deaths. In response, the MSDH engaged in targeted campaigns with specific communities, such as engaging with the Hispanic Community to address COVID in October 2021, and began issuing vaccines for children in County Health Departments in November 2021. To improve access to records, Mississippi began participation in MyIR providing online access to immunization records.

As the COVID-19 pandemic began winding down in 2022, MSDH and other health systems stabilized and returned to routine operations. For example, BCCP focused on engaging providers and partners in efforts to return women to breast and cervical cancer screening. This was done by maximizing carryover CDC funding for subgrants with health settings that employed community health workers (CHWs) and patient navigators to provide rapid patient navigation.

Jackson Water Crisis and Lead Lawsuits

As reported under MCH success stories, in mid-August 2022, the capitol city of Jackson experienced heavy rains and flooding which damaged the O.B. Curtis water treatment plant located near the Ross Barnett Reservoir in the Pearl River basin. With the crippling of this major water treatment plant and malfunction of pumps at the J.H. Fewell water treatment plant, the city was unable to produce sufficient water pressure to serve its residents. For weeks, many residents were unable to access clean, safe water for drinking, cleaning, and bathing in their homes. Even as the pressure was slowly being restored across the system, residents remained under a boil water notice for several more weeks and continued to experience waves of rolling boil water notices until the end of the emergency in November 2022.

This presented challenges for MCH program participants in the Jackson area as well as MCH program personnel. The MSDH Offices housing the leadership for its MCH programs, located in Jackson less than 2 miles from the malfunctioning J.H. Fewell water treatment plant, was significantly impacted by the water crisis. Not only was the water unsafe for drinking but the pressure was insufficient for functioning facilities, resulting in the temporary closure of the building and the use of portable restrooms after the buildings reopened. Nonetheless, MCH personnel, working remotely as needed, focused on addressing the needs of the women, children, youth, and extended families impacted by this crisis through helping them access bottled water at distribution points, purchasing water faucet filters, and providing information on updates and education on installing and using filters and protecting young children from lead in water.

Though this event was a specific crisis, the Jackson water system presents an ongoing challenge as years of deferred maintenance and lack of investments in upgrades combined with unique soil conditions that increase the likelihood of breaks in underground water pipes. The MCH programs periodically are called to respond to boil water notices, water outages, and occasional facility shutdowns.

Health Disparities

Health disparities threaten the health and quality of life of the overall population. 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.”

The impact of centuries of racism have led to significant inequities in health and wellbeing both directly and through negative impacts on social determinants of health. To improve the health of Mississippi communities overall and for a greater quality of life, the public health system must address generational injustices that contribute to these health 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, as 87.5% of 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.

Needs Assessment Process

MCH Population Health and Wellbeing

Based on results of ongoing monitoring over the past few years, MCH populations in Mississippi continue to experience significant challenges and poorer outcomes for health and wellbeing. Women in Mississippi have had significantly increased rates of severe maternal morbidity and continued high rates for preterm (<37 weeks) and early term (37, 38 weeks) deliveries. Once better controlled, Mississippi has experienced an epidemic of syphilis cases with an 80% increase among adults and a 10+ fold increase in congenital syphilis cases. Likewise, after years of progress, Mississippi is seeing increases in teen pregnancies. Mississippi continues to have high rates of low-birth-weight babies, increasing trends of children identified with Neonatal Abstinence Syndrome (NAS), and increased rates for infant mortality, including those related to Sudden Unexpected Infant Death (SUID). Likewise, the child and adolescent mortality rates and childhood obesity rates have also increased while the percentage of children in good or excellent health has decreased.

Due to strains on the state’s health care system due to financial policies, provider shortages, high-need populations, and the stress of a multi-year pandemic, many hospitals and practices have closed or reduced services, increasing challenges for MCH populations to access care. Over the past few years, Mississippi has seen decreases in the number of children who have been unable to access care and the number of CYSHCN who can access care in a well-functioning system. Further, the percentage of children who have received vaccinations has also decreased, related to a lack of access as well as a lack of trust in health care institutions and guidance.

Mississippi Title V Program Capacity to Address Needs

The Title V Program has increased capacity to address the following identified needs.

Provider Shortages

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 Providers: 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. Further, economic pressures often divert providers away from working with the most need populations; for example, lower reimbursements and higher time commitments for working with pediatric populations disincentivizes audiologists from working with pediatric populations and instead encourages them to focus on older, geriatric populations which are more lucrative.

The Leadership Education in Neurodevelopmental and Related Disabilities (LEND), University Center for Excellence in Developmental Disabilities (UCEDD) programs, and University of Mississippi Medical Center are critical partners for preparing personnel who can help identify and intervene with children with disability and conditions impacting their development. These programs provide advanced training for professionals to improve the health of infants, children, and adolescents with disabilities. MCH Programs have many opportunities to partner with these institutions to increase the capacity to respond to MCH population needs and decrease provider shortages.

Dental Health Providers: 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.

Mental Health Providers: The need for mental health providers across the state is dire; for example, the ratio of mental health providers to residents is greater than 1:200,000 in the Mississippi Delta. These shortages include not only psychiatrists (i.e., HRSA designation of mental health provider) but also psychologists, clinical social workers, 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 Patient- and Family-Centered Care

Health Disparities and Discrimination Based on Age, Race, Class, Gender, and Gender Identity

In partnership among the Office of Child and Adolescent Health and the CYSHCN and Adolescent Health programs and Teen Health Mississippi (THMS), a community-based organization dedicated to attaining equitable health outcomes for adolescents, THMS conducted multiple focus groups with adolescents and providers. Their findings identified the personal values of healthcare providers and their support staff negatively impact the experiences of youth, decrease their likelihood of access services, and contribute to poor health outcomes for youth. Further, participating youth reported experiences of intentional and implicit bias related to race, gender, sex, sexual orientation, age, socioeconomic status, education level, and geographic location that negatively impacted their access to services and contributed to poor health outcomes.

The need to promote health equity was 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. Several MCH program have made efforts to address this need through designing and offering racial equity trainings, focusing on the structural and social dynamics working within healthcare institutions and communities that prevent optimal births for every woman, particularly Black and indigenous women of color, and create barriers to integrated health services, including family planning, HIV/STI services, cancer screening, and sexual health counseling. With training 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 MSDH requires training on health equity for all its personnel and offers additional workshops for healthcare providers on related topics, such as implicit bias and social determinants of health. This training helps MCH personnel in the state, including those internal and external to MSDH, to understand experiences of bias and inequities in our everyday life, understand how biases can affect the level of care for MCH populations, and discuss how to manage biases and promote health equity. For example, training participants are provided strategies for adjusting automatic patterns of thinking and eliminating discriminatory behaviors and equipped with tools to maintain and promote inclusive and respectful work environments. Additional training on the principles of patient- and family-centered care further supports health equity by promoting respect for patients’ and families’ values, preferences, and expressed needs.

Child and Adolescent Health programs also partnered with a community-based organization to review their policies, procedures, and practices to develop plans and policies centering health equity within their programs. These programs collaboratively developed a comprehensive plan with strategies to promote health equity broadly across programs as well as some wrote individual diversity and inclusion plans, such as the Early Hearing and Detection Intervention (EHDI) program. Supported by the Office of Health Equity, MCH programs have expanded language access by providing real-time interpreters and translation services to enable non-English speaking populations to access health services equitably.

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.

Mental Health Services and Education on Mental Health Issues

To begin to build capacity to address the mental health needs in our state in MCH populations, MCH program personnel have participated in annual mental health first aid training and supported all personnel who provide care coordination, service coordination, and/or case management to earn a national Infant Family Specialist credential from the Alliance for the Advancement of Infant Mental Health through year-long training and reflective supervision. Furthermore, MSDH partnered with the newly formed Mississippi Association for Infant Mental Health to ensure several MSDH/MCH personnel became certified as trainers to build the state’s capacity both within MSDH and across Mississippi for future personnel to be able to access the training and reflective supervision required for certification/recertification.

MCH programs have also coordinated workshops and mental services for families and other partners. The Maternal and Infant Health Bureau program also facilitated a partnership with MOM.Me to address the mental health needs in the state through:

Establishment of a Maternal Mental Health Network
Conducting health education and outreach
Providing training to community stakeholders to increase provider knowledge of maternal mental health disorders
Linking mothers, fathers, and children to support services

Adjustment after the COVID-19 Pandemic

The COVID-19 pandemic laid bare the influence of poverty, race, and ethnicity on the vulnerability to disease and the resulting health disparities. Disproportionate death rates were noted among African Americans and Native Americans. Mortality rates per 100,000 among Blacks in Mississippi was twice the rate of White Mississippians, and the mortality rate among Native American Mississippians was ten times higher than the rate of White Mississippians and the highest rate nationwide for indigenous residents.

As the COVID-19 pandemic began winding down in 2022, MSDH and other health systems stabilized and returned to routine operations. Even so, new challenges emerged in ensuring access to care due to the unwinding of Medicaid coverage for many who were able to maintain care throughout the pandemic. In June 2023, the Mississippi Division of Medicaid began its first round disenrollments. By February 2024, over 116,705 people had been disenrolled from Mississippi Medicaid.

The MCH programs have partnered with the Division of Medicaid to assist with the dissemination of information about recertification of benefits. The MCH programs supported their enrolled families as well as engaged their extended community connections to ensure consistent messages were offered about changes with Medicaid benefits, the recertification process, and how to access services. Care Coordinators, Service Coordinators, Case Managers, and Health Services Social Workers not only provided education but also assisted families with contacting Medicaid, completing paperwork, and access information from the Division of Medicaid to mitigate any challenges and prevent service interruption.

Impact of the Title V Organizational Structure

Most of the MCH Programs are housed under the Division of Health Services, now under Community Health and Clinical Services. Within Health Services, there are several Offices and Programs, including the Office of Women’s Health, which includes the Maternal and Infant Health Bureau, the Office of Child & Adolescent Health, which includes the Children and Youth with Special Healthcare Needs (CYSHCN) Program, Women Infant and Children (WIC), Office of Oral Health, and the Office of MCH Engagement and Collaboration. Addition Health Services personnel provide guidance and support for field-based clinical nurses who provide direct services, such as Early Periodic Screening, Diagnosis, and Treatment (EPSDT), and for program operations, finances, and grants development. Over the past few years, the organizational structure of the Title V Program has been impacted by expansion of programs and internal collaboration, agency and program reorganization, and staffing challenges.

The MCH Programs have continued to expand their ability to serve vulnerable populations through the establishment of new grant-funded programs, including the Maternal Infant and Early Childhood Home Visiting (MIECHV) under Child & Adolescent Health and the Wisewoman, Time4 Mom, and Healthy Start Programs under Women’s Health. Existing MCH programs mainly offer universal health surveillance and referral services which address all or most children in the state or intensive tertiary prevention and/or intervention for children and adolescents with significant needs, such as Early Intervention for children with disabilities or developmental delays or CYSHCN services for those with special health care needs. The MSDH and Mississippi in general has fewer secondary prevention programs for selected populations of children and families to prevent rather than treat poor health and wellbeing. Under the Preventive Health Pyramid Model (see graphic below), these expanded programs provide Tier II: Secondary Prevention services, expanding the capacity of MSDH to reach beyond its existing Tier I: Primary/Universal Prevention and Tier III: Tertiary Prevention and Intervention programs.

Recognizing the power of prevention in improving the health and well-being of across the life course, Health Services and the MCH program has expanded its collaboration with the Office of Preventive Health and Health Equity to address the social determinants of health impacting the health of MCH populations and all Mississippians. Programs in Preventive Health and Health Equity 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 also continues to partner with numerous entities at the federal, state, and local level to expand its capacity and reach for its MCH population. (See the Family Partnerships and Public and Private Partnerships sections below for more detailed information.)

Over the past three years, MSDH has undergone reorganization of regions, divisions, office, programs, and personnel, increasingly so as the MSDH adjusted after the winding down after the COVID-19 pandemic. During this time, the Public Health Pharmacy was moved out of Health Services into its own Division, the Tobacco Program was moved under Preventive Health, and the Early Hearing Detection and Intervention Program was integrated with the Newborn Screening Program. In 2022, the MSDH established an Office of Workforce Development, leading the MCH Workforce Development Office under Health Services to be reorganized as the MCH Engagement and Coordination Office. In addition, Health Services established the Office of Financial Management and Operations for overseeing and supporting all programs budgeting and expending MCH funds. More recently, the state’s three Health Regions were reorganized into four Health Regions, the Office of Health Data and Research was moved under Health Services to embed epidemiologist directly into the MCH programs, and the Early Intervention Program was moved out of Child & Adolescent Health. The MSDH is continuing to explore additional structural changes to improve alignment, coordination, and efficiency.

Over the past few years, the MSDH has experienced increased challenges with recruiting and retaining knowledgeable and skilled Title V staff. Over the past three years, the MSDH has experienced challenges seriously impact staffing and services, including the aging and exiting of the state’s skilled public health professionals—with the COVID-19 pandemic further exacerbating critical personnel shortages. After the worst challenges of the pandemic, the MSDH was left with a 47% vacancy rate. Rebuilding and filling vacancies has been a very slow process. As a result, the majority of the Title V Block Grant leadership team is mostly comprised of personnel who have been in their roles for less than three years.

Since 2022, new key personnel have assumed MCH leadership due to personnel leaving the agency or retiring:

In 2022, Thomas Dobbs, the State Health Officer who led the agency during the pandemic, announced he was leaving. In August 2022, Daniel Edney, MD, FACP, FASAM, became State Health Officer for the MSDH, after serving as the Deputy State Health Officer and Chief Medical Officer in 2021. Dr. Edney was in private practice in Vicksburg for more than 30 years and formerly served as president of the Mississippi State Medical Association and as a board member on the Mississippi State Board of Medical Licensure. He received his M.D. from the University of Mississippi School of Medicine with residency in the University of Virginia's internal medicine program. He holds board certifications in Internal Medicine and Addiction Medicine and is a Fellow of the American College of Physicians.
In June 2024, Dr. Beryl Polk, the former Title V Director, retired after 24 years of service. In May 2024, Dr. AnnaLyn Whitt joined the MSDH as the new Director of Health Services/Title V Director. Dr. Whitt has 25 years of experience in program and grant management, health, and social work. She oversees more than 300 employees, directly and indirectly, and across the state.
In February 2024, Praise Tangbe left her role as the MCH Block Grant Coordinator. In June 2024, Stacy Callender, who previously served as the Director of Child & Adolescent Health and led the MCH Block Grant writing team for the past two years, officially assumed this title under her new role for Grants Development and Management to support all grant funded Health Services programs.

In 2022, Ms. Krista Guynes, MSW, LCSW, became the Director of the Office of Women’s Health, which includes the Breast and Cervical Cancer Program (BCCP), Healthy Moms/Healthy Babies (HM/HB) Program, Family Planning/Comprehensive Reproductive Health (FP/CRH) Program and the Maternal and Infant Health Bureau (MIHB). She previously led the BCCP and Perinatal High-Risk Management (PHRM) Programs.
In 2022, Ms. Valecia Davis, MS, became the CYSHCN Director and interim Adolescent Health Director. She previously served in Early Intervention and Health Services Operations.
In 2022, Dr. Jameshyia Ballard was appointed Director of WIC, when the previous WIC Director retired after more than 30 years of service. Dr. Ballard previously served as State Breastfeeding Coordinator and State Vendor Management Director with the WIC program.
In 2021, Ms. Danielle Seale, MSW, LCSW, began the MCH Workforce Development Office, bringing more than a decade of public health experience. In 2022, the Office was renamed/refocused on MCH Engagement and Coordination. The Office was assigned a cadre of Health Services Social Workers to provide supplemental social services to Health Service programs.
In 2022, Johnny Singleton began the Office of Financial Management and Operations from the MSDH F&A Office. The Office supports MCH programs in budgeting and tracking expenditures.
In July 2024, Ashley Wolff was appointed Part C Coordinator for the Early Intervention Program, newly organized directly under Health Services.

Currently several key MCH leadership positions remain vacant, including:

The Director for the Office of Child and Adolescent Health, which includes the Genetics/Newborn Screening, Birth Defects Registry, Early Hearing Detection and Intervention, Lead Prevention and Healthy Homes (LPPHH), Maternal Infant and Early Childhood Home Visiting (MIECHV), Adolescent Health, and Children and Youth with Special Healthcare Needs (CYSHCN) Programs;
The State Dental Director which oversees the Oral Health Office.
The Adolescent Health Director position, filled temporarily by the CYSHCN Director.

To recruit qualified personnel, MCH programs work closely with Human Resources and the Office of Workforce Development. Proactive strategies are used to recruit a diverse workforce, including publicizing vacant positions through targeted social media and working with colleges to provide internship opportunities to draw student talent. With the support of the Mississippi State Personnel Board, all positions have been reclassified with competitive salaries providing a livable wage.

Title V Workforce Capacity and Workforce Development

While MSDH has made some progress with recruitment, the MSDH also needs to improve retention. Previous workforce surveys found MSDH was viewed as bureaucratic, lacking innovation, and under resourced. Jobs should offer fulfilling, meaningful work, and provide mission-driven positions with the opportunity to make an impact on the community. To retain a qualified and competent public health workforce, which is essential to address existing and emerging public health issues, the MSDH and Health Services Division have instituted several efforts to build workforce capacity and commitment. To build MCH leadership capacity, some MCH Program directors have been supported to participate in coaching and leadership training programs such as the certified public manager program through the Mississippi Personnel Board and the Advanced Applied Leadership Program through the Else School of Management at Millsaps College.

In 2021, the Office of Health Services also established a MCH Workforce Development (MCHWD) Office to assess, coordinate, and provide Health Service and Title V staff and interns with applicable knowledge about public health, MCH, and health services.

In 2023, MSDH received a CDC Strengthening U.S. Public Health Infrastructure, Workforce and Data Systems grant. This funding supported the establishment of the MSDH Workforce Office to address public health workforce needs, including recruiting, onboarding, and professional development with continuing education credit. With the agencywide Workforce Office, the MCHWD Office was refocused on MCH Engagement and Coordination (MCH ECO) to:

Improve cross program communication;
Enhance data collection and sharing;
Promote staff development and professional benchmarks;
Expand availability of quality infrastructure for operations; and
Improve alignment of patient service delivery.

The MCH ECO participated with the Title V Learning Journey project from the National Workforce Development Office at University of North Carolina at Chapel Hill (2022-2023) to identify a departmental mission and vision statement, populations of focus, and values:

Mission: To strengthen the MCH Workforce capacity by assessing and improving (providing) exposure to evidence-based or -informed, culturally appropriate trainings and development opportunities for MSDH staff, health students, external partners to build a diverse and culturally sensitive workforce.

Vision: To work in partnership with the MSDH programs and community partners through promoting learning, recruitment, engagement, leadership, and retention for a diverse, knowledgeable, and competent current and future MCH workforce in the state of Mississippi.

Populations: MSDH and Health Service staff, Students in Mississippi Institutions of Higher Learning, Community partners

Values: Culture and Environment Change, Growing Staff with Joy, Communication, Leadership Cheerleading

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