A PLACE FOR SHARING

Competency 12: Policy

Stephanie Garcia received her Master’s in Public Health in Community Health Sciences from the University of Illinois Chicago Center of Excellence in Maternal and Child Health. Prior to her research role at PolicyLab at Children’s Hospital of Philadelphia, she worked at the Women’s and Children’s Health Policy Center at the Johns Hopkins Bloomberg School of Public Health on an initiative supporting state Title V programs in implementing evidence-based maternal and child health programs and policies. She is passionate about translating research to programmatic recommendations for state and local audiences.

Deanna Marshall received her Master’s in Public Health in Health Management and Policy from Drexel University Dornsife School of Public Health’s Maternal and Child Health Catalyst Program. She served as a Health Resources and Services Administration Title V Maternal and Child Health intern at the Vermont Department of Health. Prior to entering the field of public health research at PolicyLab, Deanna was a public school educator.

Stephanie and Deanna are excited for the opportunity to share their experience working with government partners on a statewide needs assessment to fulfill the Maternal, Infant, and Early Childhood (MIECHV) program requirement in Pennsylvania.

Needs assessments are a foundational public health tool used to understand the needs and assets of a local population, identify trends over time, and inform resource allocation. Data from community needs assessments can help policymakers base public policy decisions on local needs and priorities. Our respective maternal and child (MCH) training programs equipped us with the knowledge and skills to conduct data-driven, stakeholder-informed needs assessments. Now, as public health researchers at PolicyLab at Children’s Hospital of Philadelphia, we have had the opportunity to apply these tools in practice.  

2020 Family Support Needs Assessment: An Academic-Government Partnership

The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program requires states/grantees to complete a needs assessment every four years to identify the communities most in need of services and to assess home visiting programs’ capacity to inform strategic allocation of resources for these community-based public health services. In Pennsylvania, the Office of Child Development and Early Learning (OCDEL) is the appointed administering agency for MIECHV funds. Over the past year and a half, our team at PolicyLab has partnered with OCDEL to conduct the 2020 Family Support Needs Assessment. The goals for the statewide needs assessment are:

1.  Document Pennsylvania’s MCH landscape

2.  Assess capacity and scope of early childhood home visiting services

3.  Identify opportunities for community-level systems improvement and local practice

4.  Provide information to inform state policy and procurement of early childhood services

To accomplish this, we took a multi-method approach that leveraged several data sources and incorporated end-user feedback throughout the process. We wanted to first gain an understanding of how needs assessments are used in practice before moving forward with our work plan. To that end, we initiated a “pre-work” phase, intended to be the first step in a thoughtful approach to creating a meaningful needs assessment. We facilitated conversations among state and local early childhood stakeholders to understand the utility of past needs assessments and to solicit feedback on our proposed approach.

Assessing the Health of Communities: Identifying Risk and Highlighting Strengths

A core component of the statewide needs assessment is to identify communities across the state with concentrations of risk. Historically, these measures of risk have included a combination of traditional MCH indicators, such as premature birth and infant mortality, and socioeconomic measures such as population in poverty and high school dropout rate. We chose to additionally incorporate measures of social determinants of health across the lifecourse including substance use, environmental quality, rent burden, intimate partner violence, and food access.

We are assessing risk in six domains composed of 59 indicators from a mix of publically available datasets and state child care and Medicaid data. The domains are as follows: 

  • Perinatal Outcomes
  • Socioeconomic Status
  • Substance Use
  • Community and Environment
  • Child Care
  • Child Maltreatment

For each domain, we calculated risk scores by weighting each indicator for data quality, recency, and representativeness of the home visiting client population. For example, we weighted indicators that pertain specifically to Medicaid-enrolled mothers who had given birth in the past 2 years higher than general population measures. Counties in the highest quartile of weighted risk within each domain are considered “high risk” for that domain, while those in the lowest quartile are considered “low risk.” 

In addition to measuring risk quantitatively, we wanted to capture community needs and strengths as perceived by those who live and work in each county. We broadly distributed a survey to maternal and child health stakeholders on their perspectives of county-level health and social service access and quality. More than 2,100 Pennsylvanians, representing all 67 counties, responded to our survey. The results of this survey will help us better understand the local-level perceptions of strengths and needs. 

As public health researchers, we understand the value of using multiple data sources to paint a more comprehensive picture of a population. Therefore, to complement the significant quantitative element of the needs assessment around identifying risk, we decided to use qualitative methods to highlight community strengths, in the form of stakeholder-identified innovations. We used our community survey to ask respondents to identify promising practices in their areas that were helping children and families. This section, titled “Community Spotlights,” will profile 6 of the almost 900 identified practices with a descriptive write-up on program history, components, lessons learned, and impacts on MCH outcomes.

We are nearing the last phase in the needs assessment process: dissemination planning. Through our pre-work, we heard consistent feedback from state and local providers, policymakers, and advocates, among others, that the needs assessment supports grant writing, decision making and education on critical issues facing local communities and the state. In coordination with our state partners, we plan to disseminate results to local implementing agencies, policymakers, advocates, and other stakeholders. This includes a final report with county-level data, risk scores across the six domains, narratives on promising practices and capacity, and one-page county profiles with summaries and interpretations for better utilization of this information.

We look forward to sharing our results once the 2020 assessment is complete, and hope it can be a useful tool for public health policymakers and local home visiting agencies to best serve families and children across Pennsylvania.

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