Needs Assessment Update

The South Dakota MCH and CYSHCN Programs completed their statewide five-year needs assessment in May 2020 but continue to carry out ongoing needs assessment activities.

Ongoing Data Collection and Needs Assessment Activities

The MCH epidemiologist sent out a survey to stakeholders in 2021 to determine the data needs of our partners and the primary reasons they use data. Overall, partners wanted more data at a county and local level, and wanted data shared through dashboards. Partners indicated that evaluation of a program was the most common reason they used SDDOH data, followed closely by applying for grants and supporting a new program. This and other information from the survey will be used to inform data collection work for the next year.

As part of the ongoing needs assessment, the Office of Child and Family Services data team led by the MCH epidemiologist and the MCH Director assessed and compiled the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children needs assessments. This WIC needs assessment is completed yearly in the community health offices statewide, but results were never looked at collectively to identify statewide needs, assets, and weaknesses. MCH intern Rachel Greiner, an undergraduate honors student in public health, completed her thesis, Qualitative Analysis of South Dakota Community Health Needs Assessments, with direction from the WIC data analyst and the MCH Director. Rachel identified strengths and weaknesses, but more importantly, she recognized the need to improve the process and utilization of these needs assessments. This process led to the development of the Strategic Community Outreach and Outcomes Plan (SCOOP), being implemented in the community health offices statewide.

The Sanford Patient Navigation Program surveys families of children with special healthcare needs as well as their affiliated professionals to gain ongoing perspective of the needs faced by this population and the professionals that provide services to them. This information is used by the CYSHCN Program to continue shaping the Patient Navigation Program to fill gaps in services and improve outcomes for these children and their families. In 2022, the program began to evaluate the impact of adding a nurse practitioner to the program on health outcomes for patients as well as the mental health of their caregivers.

The South Dakota Newborn Screening Advisory Committee provides support and recommendations to the South Dakota Department of Health (SDDOH) Newborn Screening Program regarding programmatic decisions. The group convenes on an annual basis to receive updates on the status of the newborn screen program and to discuss the addition of new disorders to the South Dakota panel of disorders. The advisory committee consists of newborn screening stakeholders and partners, including pediatric specialists, laboratory personnel, nurses, pediatricians, and family and community members interested in learning about newborn screening.

South Dakota has begun reviewing all child deaths from infant up to age 13. Two multidisciplinary teams located on the east and west side of the state use a common data collection tool, Child Death Review Case Reporting System to report findings for the state-wide Preventable Death advisory committee to review. The state-wide Preventable Death advisory committee is comprised of volunteers from law enforcement, Child Protection Services, hospital staff, fire departments, emergency medical services, public health, behavioral health, forensic pathology, the Bureau of Indian Affairs, Indian Health Services, the Great Plains Tribal Leader’s Health Board, and the States Attorney’s and U.S. Attorney’s offices and meets bi-annually to review the data and make data-driven recommendations for programming and prevention efforts.

The SD DOH formed a Maternal Mortality Review Committee (MMRC) in 2021 to review maternal death cases and determine leading causes of maternal mortality in South Dakota. A maternal mortality abstractor was hired and has access to the necessary medical records from the three major health systems in the state. In addition, the abstractor can analyze data collected from the health information exchange, vital records, WIC, and Medicaid. The first case review meeting was held in October 2021. The SD MMRC is also participating in the Texas DASH pilot study to assess discrimination and social determinants of health as a factor in maternal deaths.

The SDDOH launched a new electronic health record (EHR) in January 2022. The record hosts data from family planning, community health, and nurse home visiting. Additional data linkages with WIC data, the Health Information Exchange, and the SD Immunization Registry will also be possible through this EHR. The MCH epi has been involved with the creation of questions for the EHR that address social determinants of health.

Noted Changes in Health Status

The SDDOH continues to respond to changes in health status and emerging needs of the state’s MCH population, including efforts to combat the COVID-19 pandemic. Contact tracing activities continue and are carried out primarily through electronic means.  Vaccinations are available at community health offices, pharmacies, and the state’s health systems. Free ride sharing services are available to get to vaccination appointments. Currently, over 70% of the state’s population has received at least one dose of a COVID-19 vaccination. The DOH has been utilizing data dashboards, press releases, and social media to communicate case updates and stress the importance of vaccinations and efforts that prevent the spread. The DOH also provides resources for children and adults for coping with the effects the pandemic has had on mental health. 

The SD Department of Health continues to monitor the state’s severe rise in syphilis cases. As of spring 2022, syphilis cases have increased over 1800% above the five-year median. Congenital syphilis cases are also on the rise in South Dakota, increasing 700% over the five-year median.  Due to the sharp rise, the MCH Program is partnering with the DOH Office of Disease Prevention to launch a media campaign to raise awareness of congenital syphilis and direct the public to available resources.

South Dakota has also seen a sharp rise in suicide cases. Provisional data from South Dakota Suicide Prevention (SDSP) shows suicides in the state have been on the rise since 2011, with 2021 showing the highest recorded number of suicides since tracking has been in place. SDSP data shows suicide is the leading cause of death in SD among ages 10 to 19. The data also shows the SD American Indian suicide rate is 2.5 times higher than the SD White suicide rate for 2011-2020. The MCH adolescent domain has made mental health and suicide prevention one of their top priorities. The adolescent domain leader leads a workgroup comprised of stakeholders in the areas of medical consultation, Helpline Center, Department of Social Services, DOH Injury Prevention, University of South Dakota, and Lutheran Social Services. The group promotes evidence-based programs and practices that increase protection from suicide risk, promote positive youth development, and develop and disseminate equitable and accessible Suicide Prevention education material, resources, and messaging. The women’s domain is also focused on mental health and substance misuse and provides depression screening in the community health offices.

The 2022 infant formula shortage brought leadership from WIC, MCH, and Community Health together weekly to discuss changes and updates to the situation. The WIC team also created an emergency channel on Microsoft Teams to communicate updates in real time. The community health staff was integral in keeping leadership updated on what they were hearing from the families in the clinic and communicated the needs expressed by families as well as locations where families were able to locate formula throughout the shortage. They also communicated misinformation they were hearing in the clinic, prompting the DOH to create social media posts to address misunderstandings and provide accurate information.

Title V Program Capacity

The MCH Title V Program has made recent efforts to expand internal staffing, so each domain leader can focus on one domain population. The goal of this change is to expand the capacity of each domain leader to address MCH priorities and emerging health issues for their domain through strategic partnerships, networking, and oversight. In 2022 the maternal mortality case abstractor began leading the MCH women’s domain. This change allows the previous women and infant domain leader to focus on the infant domain priorities. In addition, after data collection began with Child Death Review the DOH Injury Prevention Coordinator was brought in to lead the MCH Child domain and focus on development of injury prevention education for parents in addition to monitoring developmental screening efforts. This change allows the CYSHCN Director, who was previously overseeing the Child domain, to focus on CYSHCN priorities. The Injury Prevention Coordinator position has recently become vacant, and recruitment is underway to fill that position. 

A noted change in SD’s MCH service delivery began in November of 2019, when the Office of Child and Family Services (OCFS) embarked on a process to assess its structure and staffing to identify opportunities to better meet client needs and deliver services more efficiently across the state. This includes gaining a better understanding of the public health services and supports most needed in communities across South Dakota and identifying and evaluating the viability of current service delivery models.

To guide this project, OCFS has been working with several consultants from Health Management Associates (HMA), and a project team comprised of OCFS and division leadership, central office staff members, and regional manager representatives.  The assessment team efforts included the following areas of focus:

• Data Collection – reviewed OCFS services, incorporating information about other service providers, and researching best practices in other states for public health programs and for WIC
• Fiscal and Business Review – looked at current revenue and cost streams, examining financial tools and tracking, and studying service delivery contracts
• Structure Assessment – reviewed organizational charts, FTE, and job descriptions, evaluating current service delivery models, studying WIC operations, making a site visit to the Rapid City/Pine Ridge/Kyle offices, and talking with regional managers and central office teams
• OCFS Vision and Theory of Change – developed a vision statement for OCFS, and a theory of change (TOC) model.  The OCFS assessment team will use these tools to serve as “guardrails” for all future work, to ensure the programs and services focus on the outcomes identified as most important. 

The vision of the OCFS moving forward is: Build equitable systems and leverage partnerships to serve South Dakotans where they are and provide resources for them to make healthy decisions for themselves and their families.

In late 2020, the assessment team focused on synthesizing all of the information captured, and generated ideas about what would the “future OCFS” look like across several categories of work that embody the general domains of programs, services, and functions in OCFS:

• Organizational Structure – which incorporates Program Alignment, Staffing, and Internal Partnerships
• External Partnerships – including Contracts (formal agreements) and Other Types of Collaboration (informal efforts or those without structured agreements)
• Data for Administration and Cross-Office Functions – comprised of Financial Data (revenue and cost), Program Management Data (staff time, contracts, grants, etc.), Reporting and Data Transparency, and Consolidating/Aligning Data Systems
• Continuous Quality Improvement and Evaluation – which includes Staff, Programs, and Disparities Among Populations
• Digital Services Delivery – comprised of Capability and Capacity to deliver services virtually
• Communications – including Key Partners, Clients, and Crisis Communications

In 2021, these categories were used to develop five implementation teams focused on external partnerships, communications, digital services delivery, program data/CQI evaluation, and school projects. Each of the implementation teams have begun meeting regularly to work on the prioritized strategies in their implementation plan.

Implementation of the proposed changes to the organization and structure of the OCFS began in 2021. These changes include moving from a seven-region structure for local services to a four-region structure. Within each region, a leadership team has been assembled including nurse, dietitian and billing/operations leads who work collaboratively with the Public Health Manager to implement both OCFS and region wide strategies.

The goal of this reorganization is to:

• Deliver the right care at the right time - staff each working at highest scope of practice
• Build capacity and autonomy for regional and local responsiveness
• Prioritize and lean into the “gap-filling” function of OCFS
• Reduce overall costs of service delivery model
• Develop and commit to an OCFS-wide long-term strategy with the tribes, and other specific populations, to address health inequities

Regional leadership teams will:

• Position regions for growth and ability to be dynamic vs. static
• Focus on outcomes to measure achievement, progress, and success
• Center on equity for both clients and staff
• Allow for flexibility to match staffing and services to different needs of each region
• Continue with a standardized statewide framework for regions to function with a centralized support system

The five implementation teams that were developed in 2021 will continue to meet regularly over the next couple years to carry out the identified priorities and monitor progress toward reaching the identified goals.

Title V Partnerships and Collaborations
 

Title V programs have built strong partnerships both within and outside the DOH to collaborate on key programs and initiatives that impact priority populations. The physical presence of the OCFS 74 community health offices serves as a major asset throughout the state. These offices carry out coordinated programs, services, and outreach that are funded through a variety of federal, state, and local public health funding streams. These offices serve as the “local” health department and in many rural and underserved communities this “staying” power builds trust and partnerships.

Opportunities to strengthen partnerships lie with three groups: community-based and faith-based organizations that are directly supporting priority populations; nine American Indian tribes within the borders of SD; and family engagement organizations to expand the reach of Title V investments which aim to improve health and wellbeing of SD families. Strategies will be developed and prioritized in the action plans for the coming year to sustain or cultivate engagement. Specific health equity partnership development strategies will be assessed on utility and feasibility.

Throughout the needs assessment process, 27 long standing partners were identified representing all sectors including tribal health systems and programs. Most of these partnerships are defined as “formal” meaning they have a contract, MOU or historical working relationship with the DOH. The MCH team also identified 17 emerging partners, the vast majority of whom were informal (meaning non-typical) partners that represent emerging needs. These partners tended to represent the infants, children, and adolescent domains.

Maternal Child Health Bureau Investments: Bright Start Home Visitation Program includes OCFS as both grantee and implementing agency for the MIECHV program. Bright Start uses the Nurse Family Partnership (NFP) model in eight sites covering over 14 counties in SD. The Bright Start Home Visitation Project Director will be actively engaged with the workgroup implementing strategies under NPM 1 and NPM 5.

The State Systems Development Initiative (SSDI) grant was awarded to SD in 2020 that coordinates with and directly supports the work of the MCH Title V Block Grant. SD’s SSDI grant supports an epidemiologist focused on maternal and child health, the South Dakota PRAMS, and facilitation of the identified SPM to better coordinate and disseminate data.

Other Federal Investments Administered in the DOH OCFS: South Dakota MCH populations are also supported, and SD’s MCH Block Grant reach is expanded through additional grants within the broader OCFS.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves participants through 74 community health offices across the state. The program works cooperatively with the Cheyenne River, Rosebud Sioux and Standing Rock tribal reservations to ensure every county in South Dakota has access to WIC services. From October 2020 to September 2021, WIC served an average of 14,474 participants per month.

Rape Prevention Education Grant (RPE) aims to decrease sexual violence by funding community-based organizations who use the public health approach to decrease sexual violence risk factors and increase sexual violence protective factors. The Sexual Violence Project Specialist for the South Dakota Network Against Family Violence and Sexual Assault will engage as an active partner on SPM 1 workgroup.

Office for Victims of Crime Rural Sexual Assault Nurse Examiners (SANE) is utilized statewide to increase the opportunity for victims of sexual assault across rural SD to receive services in their communities and increase awareness of law enforcement services. The project director for both RPE and SANE grants will be actively engaged on the work group implementing strategies under NPM 1 and SPM 1.

State Personal Responsibility Education Program (PREP) is delivered through a partnership with Lutheran Social Services. PREP is being utilized statewide to educate young people on abstinence and use of contraception to prevent pregnancy and sexually transmitted infections, including HIV/AIDS. SD’s program goals are to lower both Chlamydia rates and teen birth rates among young people. The LSS Project Director for PREP will engage as an active partner on the SPM 1 workgroup.

Title V Sexual Risk Avoidance Education (SRAE) is administered through a partnership with LSS and Boys & Girls Club, SRAE is utilized statewide to educate young people on sexual risk avoidance and teaches youth to voluntarily refrain from non-marital sexual activity. The target population is 10 – 13-year-old who are considered vulnerable youth. The goals of this program are to lower both Chlamydia rates and teen birth rates among young people in SD. The LSS Project Director and Boys and Girls Club Program Coordinator will engage as an active partner on the SPM 1 workgroup.

SD Family Planning Program (SDFP) delivers statewide services through a network of 22 sites and provides services to low-income individuals to increase healthy maternal/infant outcomes. The Title X Project Director will be actively engaged with the workgroup implementing strategies under NPM 1.

Major Health Systems: Sanford Health, Avera and Monument Health, partner with MCH program staff to provide a variety of services including coordinated case management services and genetic counseling. Sanford Health provides the one children’s specialty clinic in the state and works closely with the State’s Newborn Screening Coordinator to coordinate newborn screening follow up and case management services. These health systems have representation on workgroup implementing strategies to address NPM 5 and NPM 11.

Other State Government Agencies: South Dakota Department of Social Services DOH has an MOU with SD Medicaid to provide direct healthcare services and modified case management within the 74 community health offices. The DOH and Medicaid have also established an interagency collaborative over the last year. The focus of this partnership is across all MCH domains. DSS Behavioral Health and the DOH began working together to merge resources on suicide prevention and promoting DSS’ youth suicide prevention campaign - BeThe1SD. They will engage as a new active partner on NPM 7.2 workgroup. South Dakota’s Office of Emergency Management partners with DOH’s Office of Public Health Preparedness and Response (PHPR) and OCFS in providing emergency response efforts across the state. OCFS field staff in community health offices are assigned to a Point of Dispensing (POD) site to dispense emergency pharmaceuticals in the event of a public health emergency. 

Other Programs Within the DOH: Child Death Review (CDR), through a (MOU) between DOH and member agencies, volunteer professionals across the state conduct IDR. Two regional teams, East and West River, are made up of members from law enforcement, DSS Child Protection Services and Behavioral Health, DOH, hospital staff, fire departments, Emergency Medical Services (EMS), Forensic Pathology, Division of Criminal Investigation (DCI), Bureau of Indian Affairs (BIA), IHS, Great Plains Tribal Chairman’s Health Board, and the States Attorney’s offices. DOH’s Office of Data, Statistics and Vital Records provides data for the review process. CDR is funded exclusively by MCH dollars.

Tribes, Tribal Organization and Urban Indian Organization: Maternal and child health services are provided in a variety of ways. A few of those include partnerships with DOH; dedicated staff within a tribe; and through a partnership with the Great Plains Tribal Leaders Health Board. Tribal MCH Programs are informal, but long-standing. Partnerships with Rosebud IHS and Tribal MCH and Cheyenne River Sioux Tribal MCH are in place to provide safe sleep environments to American Indian families in need each year. The needs assessment team also noted an emerging partnership with the Sisseton-Wahpeton Oyate MCH staff, who will serve on the workgroup addressing NPM 1.

Great Plains Tribal Leaders Health Board (GPTLHB) advocates for its constituents to have access to health resources available in the areas of research, education, assistance, prevention, and outreach. This organization will be part of the workgroup addressing SPM 2.

Public Health and Health Professional Education Programs/Universities: SDSU Population Health Center is a formal, long-standing partner that provides technical assistance to the MCH team to develop, monitor and evaluate the program’s overall objectives. They assisted with the development, execution, and evaluation of the Needs Assessment and will continue to provide technical expertise but will also serve on the workgroup that will direct State Performance Measure 2.

USD Sanford School of Medicine (SSOM) and the MCH program have fostered a partnership as a formal and emerging partner who now leads the state’s Early Hearing Detection and Intervention collaborative. Previously the DOH led this grant. USD also houses the state’s medical school and along with SDSU jointly houses the state’s only public health program.

Community-Based Organizations: The HelpLine Center is a nonprofit organization that offers youth suicide prevention education and activities throughout the state. With this partnership the following activities are offered: 24/7 statewide crisis line – updating the database of mental health providers and emergency services in order to provide quality referrals. They will engage as an active partner on the NPM 7.2 workgroup.

Operationalization of Needs Assessment Findings

The state’s MCH leaders have taken steps to operationalize its five-year needs assessment process and findings. The seven priority needs identified in the five-year needs assessment and their corresponding NPMs and SPMs are listed in the table below.

The MCH domain leaders have formed diverse workgroups that meet quarterly to inform and help carry out the activities in the domain action plans. Domain leaders also track their collaboration efforts utilizing the Wilder Collaboration Index and carry out ongoing evaluations of their programs. They continue to evaluate the needs of the populations they serve through surveys and data analysis.

Organizational Structure and Leadership

The OCFS provides leadership and technical assistance to assure systems are promoting the health and well-being of women of reproductive age, infants, children, and youth, including those with special health care needs and their families. OCFS provides oversite to state-employed nurses, nutrition educators and dietitians for the provision of public health services in the state.  The OCFS moved from a 7-region structure to a 4-region structure in June 2021.  With this change, the leadership of each region is expanding to include a regional manager, dietitian lead, nurse lead, and billing/operations lead.

Linda Ahrendt, M.Ed is the OCFS and Title V Administrator and has been with the DOH for 22 years. Jennifer Folliard, MPH RDN is the OCFS Assistant Administrator and MCH Director and has been with the DOH for 2 years. Whitney Brunner serves as the CYSHCN Director and has been with the DOH for 2 years. Other OCFS team members that work with MCH include the following:

• Rhonda Buntrock, OCFS Assistant Administrator- WIC Program Administrator
• Peggy Seurer, OCFS Assistant Administrator- Public Health/Clinical Services
• Carrie Churchill, Bright Start Home Visiting Program Manager
• Bernadette Boes, Newborn Screening Coordinator
• Timaree Axlund, South Dakota Family Planning (SDFP) Program Nurse Manager
• Hope Kleine, SDFP Nurse Consultant
• Jill Munger, MCH Nurse Consultant/ Child Death Review Coordinator, Infant domain lead
• Sarah Barclay, MCH Adolescent Coordinator
• Christine Catts, Maternal Mortality Case Abstractor, MCH Women’s domain lead
• Amy Mattke, Case Management
• Tim Heath, Immunization Program
• Mark Gildemaster, Manager, Data and Statistics
• Katelyn Strasser, MCH Epidemiologist
• Isaac Snaza, OCFS Epidemiologist
• Caleb Van Wagoner, OCFS Health Informatics Analyst
• Joel Arriolacolmenares, OCFS Business Operations Coordinator
• EA Martin, SDSU contractor, MCH and home visiting epidemiology

The DOH contracts with an epidemiology team and has a designated MCH epidemiologist to continually analyze our available data and develop fact sheets/articles based on their findings. The MCH program also continues to improve its website content and works with a media contractor to grow and shape maternal and child health communications and marketing efforts across the state.