MCH Student:
Elizabeth Stein
Date of Defense:
April 20, 2018
Abstract:
Introduction
Pregnant women and children are among the most vulnerable populations in regards to overall health and well-being. Working at both the Minnesota Department of Health and March of Dimes-Minnesota provided a broad range of experiences to work with these populations in using data and evidence to inform practice and policy. The two main issues addressed by these experiences surrounded screening practices for children and adolescents and access to prenatal care.
Screening measures in this population are used to quickly identify children who may be at risk for various health, developmental, or socioemotional problems.1 They are vital in detecting concerns early so better resources and services are available to the family and healthy behaviors can be established. In Minnesota, providers and educators are encouraged to use validated screening measures for well-child checkups or Early Childhood Screenings and turn to the Department of Health when looking for appropriate instruments. Determining validation criteria and evaluating screening instruments is therefore essential in adhering to Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) standards.
Prenatal care is crucial for monitoring, preventing, or treating potential health risks or complications throughout pregnancy.2 Inadequate prenatal care can lead to outcomes such as premature birth and low-birthweight infants, which are more likely to result in infant death.2 While Minnesota has generally high rates of prenatal care, with 79.2% of women having early and adequate care in 2014, there are significant disparities for young women and women of color.3 These disparities particularly impact African American and Native American women who are more than three times as likely to receive inadequate or no prenatal care.2
Experience
During my public health training, I have had the opportunity to gain experience at state level health organizations through my field experience and various internships. While learning objectives were met throughout my field experience at the Minnesota Department of Health, an internship through the March of Dimes strengthened these objectives and further explored the core functions of public health-assessment, policy development, and assurance. This internship also supported my Public Health Interdisciplinary Policy Concentration by providing real-world experience in policy research and development.
Overall, I sought to gain knowledge of public health initiatives being implemented in child and adolescent populations throughout the state of Minnesota. I wanted to develop skills in data collection and analysis in a public health agency setting. Finally, I hoped to participate in the coordinating and planning of projects related to maternal and child health populations.
At the Minnesota Department of Health, I worked as part of the EPSDT program called Child and Teen Check Ups (C&TC) and the Minnesota Interagency Developmental Screening Task Force to assist in making screening instrument recommendations for use in primary health care, Head Start, and educational settings. This consisted of reviewing reliability and validity data for various socioemotional and developmental screening instruments and working with the task force to determine if they should be included in the Department of Health’s official recommendations. Programs that conduct screenings for children in Minnesota rely on these recommendations for accurate and coordinated screenings.4 Health care settings are also required to use C&TC approved screening instruments for billing, coding, and reimbursement purposes.5
At the March of Dimes, I worked as part of the Advocacy and Government Affairs team during the 2018 legislative session. In this capacity, I conducted issue-specific research on prenatal care disparities to inform evidence-based decision making and to look for potential policy solutions. I helped to organize March of Dimes’ annual “Day on the Hill,” where advocates met with legislators and encouraged them to support increased access to prenatal care, particularly for women of color and those experiencing substance or opioid use disorders. Data on prenatal care disparities were used to inform bills introduced in the House and Senate which would require the Commissioner of Health to conduct research and distribute grants addressing disparities in prenatal care access and utilization, as part of the Eliminating Health Disparities Initiative.6
Organization
The Minnesota Department of Health is the state public health agency whose mission is “to protect, maintain, and improve the health of all Minnesotans.”7 MDH has around 1,500 employees and provides a vast range of services and programs throughout Minnesota. My work within the Child and Adolescent Health Unit on screening instrument recommendations coincides with the organizations focus on population health and state-wide health improvement, as well as using data to identify public health concerns.7
The March of Dimes is a non-profit organization that has divisions throughout the United States, whose mission is to fight for the health of all moms and babies. There is a core team of staff in Minnesota which mainly focuses on fundraising and marketing. During my internship, I worked with the Director of Advocacy and Government Affairs for Minnesota and Wisconsin as well as with their registered lobbyist in Minnesota. My experience at this agency aligned with the organization’s goals of supporting healthy pregnancy and reducing disparities in pregnancy outcomes such as low birthweight and preterm birth.8
Lessons Learned
1. Both the Department of Health and March of Dimes invested in committees, coalitions, and task forces to create multi-disciplinary panels when addressing problems and seeking solutions. These partnerships are vital to the programming at each organization, and reinforced how important relationship building and cooperative, dynamic solutions are to problem solving.
2. Financial security is essential for the implementation of core functions and services in public health. A lack of funding can result in central aspects to organizations to be compromised.
3. These experiences opened my eyes to how politics inevitably influence public health through funding and agenda setting. While it can be incredibly frustrating to feel like politics get in the way of change, I was consistently surrounded by hardworking, creative individuals whose passion for maternal and child health principles carried them forward.
Recommendations
Working in a large state-level organization and a smaller non-profit setting encouraged me to look at ways of supporting maternal and child health populations outside of traditional health settings. Additionally, activities, programs, and policies which promote upstream solutions to health, such as better access to quality education, healthcare, and nutrition should be continued and bolstered.
Conclusion
Through these experiences at the March of Dimes and the Department of Health, I developed skills in looking at evidence or data, and using it to influence programs and policy. Furthermore, I was shown ways to navigate through bureaucracy and competing agendas to find common ground and practical solutions to complex problems. While there is work to be done, these experiences showed me Minnesota is a great place to be working in public health as it invests in dynamic solutions to erase inequity and reduce disparities.
References
1. Minnesota Department of Health. (2018). Developmental and social-emotional screening of young children (0-5 years of age) in Minnesota. Retrieved from: http://www.health.state.mn.us/divs/cfh/topic/devscreening/
2. Minnesota Department of Health. (2009, July). Early and Adequate Prenatal Care. Received from: http://www.health.state.mn.us/divs/cfh/na/documents/prenatalcare2010.pdf
3. (2018). Adequate/adequate plus prenatal care: Minnesota, 2003-2014. Retrieved from: www.marchofdimes.org/Peristats
4. Wilder Research (2009). Babies in Minnesota: The well-being and vulnerabilities of our youngest children. Retrieved from: https://www.wilder.org/Wilder-Research/Publications/Studies/Babies%20in%20Minnesota/Babies%20in%20Minnesota%20-%20The%20Well-Being%20and%20Vulnerabilities%20of%20Our%20Youngest%20Children.pdf
5. Department of Human Services. (2018). Child and Teen Checkups (C&TC). http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_150092
7. House Bill 3574, 90th (2018). Retrieved from: http://www.health.state.mn.us/divs/opa/MDHoverview20120401.pdf
8. March of Dimes. (2018). About us. Retrieved from: https://www.marchofdimes.org/mission/about-us.aspx