Introduction: Every five years the Minnesota Department of Health (MDH) is asked to complete a comprehensive assessment of the health needs of children, mothers, and families in Minnesota, in order to fulfill a requirement of the Title V MCH Block Grant. Although Minnesota consistently ranks in the top ten for overall health according to America’s Health Rankings (United health Foundation, 2015), and ranked 1st in 2015 for overall child well-being by the Annie E. Casey Foundation (2015), these rankings do not tell the whole story. For many populations, the opportunity to be healthy is not accessible leading to significant and persistent disparities in health outcomes such as: MN’s African American and American Indian babies die at twice the rate of White babies and women of color are two to three times more likely and American Indian women seven times more likely to receive inadequate or no prenatal care. (Center for Health Statistics, 2014, 2016)

Experience: The primary objective of the MCH needs assessment was to review and determine the top 7 to 10 health need priorities for the following populations in Minnesota: pregnant women, mothers and infants; children and adolescents; and children and youth with special health needs (CYSHN). My role was to

Led by a leadership team of stakeholders, the assessment included a planning stage, data gathering, data assessment, stakeholder engagement, and selection of the top priority MCH needs. Existing reports, health assessments and secondary data sources from state, local public health, community organizations and others were used to identify current MCH priority health needs in Minnesota. Additionally, an 11-question stakeholder inquiry survey was developed to further assess the health needs of the MCH populations. Using the survey, inquiry sessions were conducted throughout the state to gather greater stakeholder input.

The qualitative data from the inquiry survey were compared to secondary survey data sources, such as the National Survey for Children’s Health (NSCH), National Survey for Children with Special Health Care Needs (NS-CSHCN), Pregnancy Risk Assessment Monitoring System (PRAMS), and Minnesota Student Survey to develop a comprehensive picture of the general health needs of our target population. After review of the health status and needs from our assessment, the MCH Assessment Leadership Team selected the final top priority health needs for Minnesota’s MCH population.

Organization: My field experience took place within the Maternal and Child Health Section of the Community and Family Health Division at MDH. With a focus on the health of children, youth, women and their families, the MCH Section’s mission is to, “gather and manage data regarding the health of women and children in Minnesota, create and manage the evaluation process for the needs assessment, and support the MCH Assessment Leadership Team by maintaining an engaging process. My learning objectives were to: 1) Develop and strengthen my skills in conducting needs assessments and evaluations; 2) Apply and strengthen methods in working effectively with community members and public health professionals; and 3) Strengthen my skills in writing and developing professional documents. and public health information essential for promoting, improving or maintaining the health and Provide statewide leadership well-being of women, children and families throughout Minnesota.” (MDH, 2016)

This field experience aligned with the MCH Section’s overall role of assessing the health needs of children, mothers and families in Minnesota and, in doing so, utilizing the information to advocate for programs, policies and funding to improve the health of the MCH population.

Results: The assessment culminated in the selection of nine health priorities, highlighting the top health needs for Minnesota’s MCH and CYSHN populations. The selected priorities included: Adolescent Health (ages 10-25), Basic Needs, Community Connectedness, Healthy and Planned Pregnancy, Healthy Babies, Nurturing and Stable Families, Positive Mental Health, Preventive Health Care, and Adequate and Accessible Care. With input from stakeholders, priority information sheets were developed for each of the nine priorities, including the following information: data points, possible strategies to address the issues, and examples of evidence- based/promising practices.

Lessons Learned: The most important lesson I learned from my field experience is that stakeholder engagement is challenging, but very important in our role as public health professionals. During the assessment process, my colleagues and I were intentional about including voices beyond health professionals—the people who are most affected by health inequities—but the reality is that these individuals and families have more important things to worry about, such as feeding their children, overcoming financial hardships and finding transportation to and from work. Although it’s challenging, if we want to be successful in working with communities that are most at need, it is important for us to continue working towards greater community engagement in our work.

I also learned that although the state Commissioner of Health has set health equity as an essential goal of MDH work, health equity is not an issue being recognized all throughout Minnesota. The needs assessment process was conducted with the intent of using a health equity lens. We discovered that there are some Community Health Board members who do not believe health equity is a priority issue in this state. It is critical that to successfully address health inequity in Minnesota, solidarity among state leaders in progressing these efforts are necessary for achieving Minnesota’s health goals, such as those outlined in Healthy Minnesota 2020 and the Advancing Health Equity Report.

Recommendations:

1. Increase engagement of representatives from rural Minnesota.

   Only three representatives from rural Minnesota were involved in the MCH Leadership Team. Although there was an effort to allow for greater engagement by using Skype and mileage reimbursement, the distance made it difficult for us to have meaningful conversations. We saw through the Public Town Hall Webinar that there was much interest in the assessment process from rural Minnesota. I recommend hosting team meetings located both in the Twin Cities area and rural Minnesota to improve the quality of stakeholder engagement in the future.

2. Implement a process evaluation within the needs assessment.
   Given the length of the assessment process (one year), I would recommend developing surveys to assess the Leadership Team’s progress and suggestions for improvement at least twice during the assessment. This would allow us to create a process that is more meaningful and useful to the Leadership Team.

Conclusion: Year after year, Minnesota continues to rank high nationally among other states regarding health and wellness. However, as shown through data, major health disparities continue to exist among our most vulnerable populations. Through the MCH needs assessment, nine maternal and child health priority areas were identified to guide the work of MCH leaders in eliminating these troubling disparities by providing strategies and resources for state and local efforts.