III.C. 1. Needs Assessment Update

Ongoing Needs Assessment Activities 

Throughout the 2021-2022 grant year, we have continued to collect data and information to better understand MCHBG priority populations, including changes in disparities, and emerging and future needs. We are making progress toward improving our surveillance systems and data linkage across previously siloed systems, have identified specific research projects to better understand the needs of priority populations, and have initiated ongoing needs assessment activities to collect feedback from priority populations and community leaders over the next four years. We are also continuing to plan and develop dashboards and materials to communicate public health findings to the public better. 

The Surveillance and Evaluation unit continued our Title V activities include analyzing new data available from the Pregnancy Risk Assessment Monitoring System (PRAMS) and the state birth file to assess trends in behavior, access to care, and birth outcomes among the maternal/women’s and perinatal/infant health domains. Data on health outcomes and behaviors among pregnant women and their infants (in prior years referred to as the Perinatal Indicators Report) from 2020 were run and presented to the Washington State Perinatal Collaborative in May of 2022. During the past year, we developed topical fact sheets and materials specific to adolescent pregnancy, breastfeeding, infant mortality, and oral health in children and pregnant women.  

In support of the work being conducted by the Surveillance and Evaluation Unit programs within OFCHI have been conducting their own needs assessment activities and working in support of S&E to complete theirs. Adolescent Health is planning a “mini-NA,” reaching out to youth and providers to inquire about experiences and perceptions around care. In addition, they are planning to partner with local health to create a youth-oriented data platform and engaging School Based Health Centers to further understand their needs and capacities. CYSHCN have employed various information gathering approaches to learn more about CYSHCN and their families, including outreach to multicultural families, outreach to different geographic entities, and engaging in listening sessions for families with CYSHCN. The Women’s/Perinatal program, working with S&E’s Maternal Mortality Epidemiologist, have looked into substance abuse services at the county level and started to compare outcomes with community services available in an analysis of gaps in services.

The 2020 Home Visiting Needs Assessment highlights persistent racial and ethnic disparities among families with young children, particularly among American Indian and Alaskan Native, Black or African American, Native Hawaiian or Pacific Islander, and Hispanic populations. Findings were based on composite scores that included a range of indicators from four categories: socioeconomic status, maternal and child health, behavioral health, and education indicators. American Indian/Alaska Native populations were high risk or very high risk in all four categories, Black or African American populations were high risk or very high risk in all but behavioral health, and Native Hawaiian or Pacific Islander and Hispanic populations were each high risk or very high risk in two of four domains. The report determined that the highest number of children ages 2 and younger in priority populations reside in Yakima, King, Pierce, Spokane, Snohomish, and Benton counties, with Black or African American populations specifically concentrated in urban areas. These findings were similar to those described in the Washington State Maternal Mortality Review Panel Report: 2014-2016. These include higher maternal mortality ratios for American Indian/Alaska Native mothers compared with all other racial/ethnic groups, and higher mortality rates among women covered by Medicaid, often used as a proxy measure of low socioeconomic status. 

Update of Health Status Among MCH Populations  

Overall MCH Population Data Indicators 

Access to care was a concern identified by all populations in the 2020 needs assessment, along with the cost of living, housing, and food security. Concerns about disparities by race and ethnicity, income, and geography were identified throughout the needs assessment. 

 In 2019, an estimated 9.8% of all Washingtonians, and 12.0% of those under 18 years old, lived in poverty (<125 percent federal poverty level [FPL]). Both of these rates were statistically significantly lower than the national rate, ranking 43rd and 41st lowest among states, respectively. Income is unevenly distributed around the state, however. In the 2019 American Community Survey 21 of 35 Washington counties were ranked by median income. Of those with median incomes greater than the national average, only two, Benton County and Clark County, were not in the Puget Sound region. Seven of the eight below the national average were in majority rural counties in both Western and Eastern Washington. There were significant racial and ethnic disparities as well, with an estimated 30% of Black or African American, 27% of American Indian/Alaska Native, 24% of Native Hawaiian or Pacific Islander, 21% of Hispanic, 12% of Asian, and 8% of white residents living in poverty. (American Community Survey, 2019).

 In 2020, 10% of women 18-44 years of age in Washington reported poor or fair physical health. 31% of women 18-44 years of age reported having been diagnosed with depression. This is higher than the percent of depression reported in the general population of adults in Washington, at 23%. 65% of women of childbearing age had a medical check-up in the past year (compared with 70% for the general adult population. 13% of women of childbearing age did not receive medical care due to cost, compared to 9% for the general adult population. (2020 Behavioral Risk Factor Surveillance System [BRFSS]) 

Maternal and Child Health Populations 

The Overview section at the beginning of each report in the State Action Plan Narrative by Domain includes data and discussion of the health status of each MCH population domains. 

Impacts of COVID-19 Pandemic 

In February 2022 Washington State began its second year of the COVID-19 Pandemic. As in the prior years, its effects continued to be felt in different ways by the MCH population.

In the fall most public schools returned to in-person learning, marking the first time many school-aged children went back into classrooms physically. In March of 2022 the state lifted the indoors mask mandate, allowing individuals to assess their risk and act accordingly.

Statewide there have been 1,984,668 total cases of COVID-19 since the pandemic began with 66,318 cases hospitalized and 13,245 deaths. (WA State COVID-19 Data Dashboard)

As of June 2022, 82.3% of all Washingtonians aged 5 and older have been immunized with at least one dose of vaccine, while 74.8% are fully vaccinated. These totals include data from the Department of Defense and the Veteran’s Administration. Disparities in infection rates by race and ethnicity show that some groups are making up disproportionate numbers. These include Hispanic, Black/African American, American Indian/Alaska Native and Pacific Islander communities. (WA State COVID-19 Data Dashboard).

While DOH has continued to work to better understand the impacts of COVID-19, data collection on some aspects of the pandemic among children and adolescents lags somewhat. Early data indications suggested that access to care decreased during 2020. Among 3- to 4-year-olds covered by Medicaid, preliminary reports show that only 54 % received adequate well-child visits in 2020. This figure is compared with 67% in 2019 and 66% in 2018. For adolescents, among 12- to 21-year-olds covered by Medicaid, only 28% received well visits in 2020. This is compared with 43% in 2019 and 40% in 2018 (MCO). In fall of 2020, Washington administered the COVID-19 Student Survey (CSS) to better understand how the pandemic had affected high school students lives’.  Among the 30,000 students surveyed, 7% had received a positive COVID-19 diagnosis and 16% had at least one diagnosis in their household. Around 30% reported not having received regularly scheduled medical care since the beginning of the 2020 school year. Data from the Healthy Youth Survey from 2018 and 2021 among 10th Graders do not show a difference in percent of students who had seen a doctor or health care provider in each year, however. In 2018 68% reported having seen a provider in the prior year and in 2021 67% reported having seen one. (HYS)

The Community Recovery-Oriented Needs Assessment (CORONA) survey explored the behavioral, economic, social, and emotional impacts of COVID-19 on Washington residents. The survey found that 43% of pregnant respondents and 42% of all women ages 18 to 44 were unable to see a doctor when they wanted to after February 2020 due to COVID-19. Respondents also indicated reduced access to medication, with 13% of pregnant respondents and 13% of women ages 18 to 44 reporting an inability to access medicine due to COVID-19. Among households with children, 57% reported that children experienced more difficulties with emotions, concentration, behavior, or getting along with others.  

Working Toward a Better Understanding of MCH Needs 

We are continuing to develop the Child Health Intake Form (CHIF) data system to better capture and use data related to CYSHCN in the state. We will use this data to influence and improve services. Data from CHIF on percent of CYSHCN with insurance is used as an ESM. We continue to develop a UDS data system. Work on our Birth Defects Surveillance System also continues, including work with an outside vendor.

Our Title V and Office of Family and Community Health Improvement (OFCHI) staff are exploring and developing new methods to bring data and information to our stakeholders in a more accessible and engaging way. As part of its core functions, the MCH Surveillance and Evaluation unit has continued to focus on the development of data dashboards, including dashboards featuring perinatal data and data on CYSHCN, story sheets, and other material that will enable us to communicate public health findings to the various populations we serve. We have and will continue to use, and where possible, collect data to inform ongoing decision-making leading up to the next Five Year Needs Assessment process. We are engaging in trainings and discussions about how to increase awareness and inclusion of voices and opinions from marginalized communities, including communities of color, to influence our work and priorities. 

III.C. 2. Five-Year Needs Assessment Summary 

States will not be required to submit a Five-Year Needs Assessment Summary during the three-year period covered by this Application/Annual Report Guidance.