Episode #1: A Conversation with AMCHP Presidents

In this inaugural episode of MCH Bridges, we sit down with AMCHP’s President, Dr. Manda Hall, and AMCHP’s Past President, Dr. Shirley Payne, to talk about their MCH journeys, their wishes and hopes for the MCH field, and more!
 
Please complete this short survey to share input on the first episode and let us know who or what you’d like to hear about on future episodes: https://bit.ly/MCHBridgesPilot.

Transcript

Maura Leahy:  Hello and thank you for joining us for this episode of MCH Bridges. I'm your host Maura Leahy Program Analyst in Child and Adolescent Health, and this is MCH Bridges, the official podcast of the Association of Maternal and Child Health Programs, also known as AMCHP. AMCHP hopes that MCH Bridges will help our listeners create new connections to maternal and child health leaders, organizations, and ideas, as well as inspire and guide listeners towards actions that will improve the systems that impact MCH populations. MCH Bridges aims to lift up stories and people from the MCH field by centering the voices of the public health workforce, people and communities most impacted by inequities, and individuals and families with lived experiences.

We want to thank everyone tuning in for our inaugural episode of MCH Bridges. For this first MCH Bridges episodes, we thought we would spend some time getting to know more about two people who play a huge role in AMCHP’s leadership and who were in these roles as voted by AMCHP’s members. You guessed it. We're sitting down today to talk with AMCHP’s board of directors outgoing president Dr. Shirley Payne and AMCHP’s current president Dr. Manda Hall. Thank you both so much for joining me today. Let's get started with introductions, although I'm sure many of our listeners probably already know who you both are. Could you please tell us your name, title, and what organization you work for? Dr. Hall, let's start with you.

Dr. Manda Hall: Thank you, Maura. My name is Dr. Manda Hall. I am the Associate Commissioner for the Community Health Improvement Division at the Texas Department of State Health Services. I have the opportunity to align the work we do in MCH with other key programs within our agency, including health promotion and chronic disease prevention and environmental health.

Dr. Shirley Payne: Hello, I'm Shirley Payne. I work for the Indiana Department of Health. My current role is that I am the Assistant Commissioner for our Public Health Protection Commission. What does that mean? It means that I get to help guide and lead our immunization, emergency preparedness, food protection, environmental public health, vital records, and lead and healthy homes division, which is super exciting work. I just transferred into this role in November of 2020. So prior to that, I came from my position in our children's special healthcare services division, where I was in that division for nine years and I was director for seven. 

Maura Leahy: Thank you both for those introductions. Now let's go ahead and just jump right into our next question. Could you share a little about what brought you to the maternal and child health field?

Dr. Manda Hall: So Maura, I am an internal medicine and pediatrics trained physician and I've always enjoyed my work with children, families, and really thinking about health impacts across the life course. My journey in public health began back in 2012 as a Title V children and youth with special healthcare needs director here in Texas. Since that time I have taken on other roles within my public health career with maternal and child health, continuing to be a key component of my work. I really enjoy my time in clinical medicine and being able to care for individuals and at times entire families. However, over the years, what I've found to be most fulfilling in my career is being able to improve outcomes for large groups of people across not only the state of Texas, but our nation. And I've been able to do that through my work in public and population health.

Maura Leahy: Thank you Dr. Hall and Dr. Payne, how about you? 

Dr. Shirley Payne: It has certainly been an interesting journey. I've always had this passion for helping people in general, and I always wanted to find something in the short-term and long-term that could help me do just that. As I started learning more in grad school, just more about the maternal and child health population, it was one of the very first classes that I took, it was an elective that I signed up for. I really got drawn to that. And for me I saw that as a way to really get to my passion, especially around children and children's health. And at the same time, while in my first year of grad school, I actually got a job at an organization that was focused on individuals with intellectual and developmental disabilities. I certainly thought it was something that I would just do to get me through grad school, but it actually led me to the career path that I spent a lot of time on for maternal and child health. And I certainly get to do a lot of that still in my current role, but it was really that initial introduction to exactly what maternal child health was and exploring all things related to that. But then also being able to work directly with individuals with special healthcare needs that really got me excited and really got me on this path. 

Maura Leahy: Thank you both for sharing. It's always interesting to hear the different paths or experiences that bring us to the maternal and child health field. Could you each talk a little about what your experience working in maternal and child health has been like? What role has AMCHP played in your MCH journey?

Dr. Manda Hall: My experience in MCH has been unique in that I have had the opportunity to serve many roles within our programs. In addition to serving as the children and youth with special healthcare needs director here in Texas, I've worked as our Title V MCH director, as well as the medical director for our programs. I've been a part of AMCHP throughout my MCH journey. From my first conference, I've been so impressed with the organization, the staff and the members that I have met over the years. I have served on multiple committees and have been honored to be a part of the AMCHP board since 2017. 

Dr. Shirley Payne: God, I'm sitting here like thinking like how to best describe this in just such few words, but it has really been an amazing, absolutely amazing experience working in the MCH field. I think that, we see, especially from a public health perspective, this idea of where we want to be able to impact communities. You certainly get to impact individuals within that but being able to really do work that truly benefits communities, truly benefits families is one of the most rewarding things that you could ever be a part of. And it's always been this, this piece of me that, every time I get to do something, no matter how hard it could get, no matter how exciting it is, I know that the end result is always going to lead to some improvement and make a community better, be able to make a family better.And that for me, keeps the drive going every single day. 

Being a part of AMCHP while doing this work, not only though you get to do that at your state. Well, certainly in my very first job and experience with maternal and child health, you're at a more of a local level, a community-based level. And then coming to the state, you are certainly more at that broader level where you can see change more on a community basis. But then being a part of AMCHP, that national experience of getting to learn what all the other states and territories are doing, how you are not alone in some of your challenges, there are a lot of people that are already doing what it is that you're trying to do. Then just setting that national agenda of where it is that we want to be. And AMCHP is leader in that, especially when it comes to us on the state level. And as we think about Title V and all the work that comes along with that, and the successes that we're seeing with that, AMCHP truly is the leader in that. So being able to have that exposure at a higher level and really being able to feel like my voice is being heard, whether it's with our strategic plan that we're doing, or even when we're at conferences and even just being able to network with everyone. AMCHP truly as a leader in all of that. And it certainly has made me grow as a person it's made me grow professionally, and then just being able to expand my knowledge in ways that I don't think I would have been able to, if I was not a part of AMCHP.

Maura Leahy: Thank you both for sharing your MCH journeys. Now, shifting gears a little bit. I'm hoping that many of our listeners are familiar with AMCHP’s joint organizational commitment to anti-racism and racial equity. For those that aren’t, AMCHP has united with three other national MCH organizations in a bold public commitment to undoing racism as a key driver to improve maternal and infant health outcomes, highlighting irrefutable disparities in the morbidity and mortality rates across racial and ethnic groups in the United States. By signing the joint organizational commitment to anti-racism and racial equity, AMCHP, CityMatCH, the National Healthy Start Association, and the National Institute for Children’s Health Quality devote their combined organizational strength and influence to educate respective constituencies, jointly advocate for change, hold one another accountable and create tangible steps to root out racism, wherever it exists. If you'd like to read more about the commitment, please visit the AMCHP website. Could I ask you each to talk about how you see your work aligning with AMCHP’s joint commitment to anti-racism.

Dr. Shirley Payne: Absolutely. I think that this past year in itself, I'd say year and a half in itself, has been a difficult place as we think about being in a pandemic, but yet understanding that all of the challenges, and the issues that we are still experiencing in all things and even in our work and what we do has really has not gone away. And so how do we balance between the two of those things? And so AMCHP coming out with this statement is very bold and it is a place that really pushes people to not only be thinking about where you are in the process of beginning to address some of these things, because that's important because doing this work, doing the anti-racism work. The racial equity work is on a spectrum and different people are going to be in a different place, but this really pushes us to action.

And the one key piece that for those folks that may be on the end of the spectrum of where do I even start, where do I even begin with this? It is a matter of, okay, let's just recognize what role we play into that and then move from there. And so I say this context to say, I very much believe that here in Indiana, we are there but also moving forward. We're figuring out the solutions to where we need to be. And so I think with our work, especially in the maternal and child health, you certainly think about infant mortality, maternal mortality. Those are the two big ones that come to mind. 

Again, it's every issue; I would never want to take away from that. But even as I think about that work, when we're at a place for a hundred years and us tracking infant mortality and it just was not going down, or it was really staying the same or the gap was getting wider for our women, our infants of color, really specifically our black infants, that's a challenge. And so you have to be, what else is there? So yes, social determinants of health make up some of that and health equity makes up some of that. But where does racism, where does institutionalized racism, where does implicit bias, where do all of those things fall? Where do all of those things also fit to achieve this? Because we've seen the research, we've seen the documentaries, we've seen all the things that shows that for a black woman, regardless of your education, regardless of where your age is on the childbearing spectrum, you still have worse health outcomes than your white counterparts. 

And so I would say that just, in complete transparency, we're figuring out what that looks like. We certainly have some training to get people's thoughts into this, their buy-in of anti-racism, some implicit bias trainings, but more so an education. And I certainly would never want anyone to think that it's and you have this anti-racism training, now you are anti-racist. It does not work like that. It’s just like we talk about with our culture competency trainings, it's not something to be arrived at or something to be achieved. It is an ongoing process. And so for us, really truly understanding what that works looks like. We've established a health equity council for our agency that specifically tackles anti-racism. One of our subcommittees is our John Lewis committee. And so these are issues that they tackle within that as well, and really be able to give guidance to the agency now that we are an accredited agency for public health. And it's one thing that you continue to have to look at. So what is, what are the measurements that we are using to that? And so we actually currently have a whole data transformation plan happening and going on that not only focuses on those measurable pieces from a racial equity, health, equity standpoint, certainly a full agency piece, but this is a part of that. 

Dr. Manda Hall: So here in Texas, our MCH programs work to support our agency's mission of a healthy Texas. We do this through data driven approaches to improve health outcomes throughout our MCH populations. A key part of this work is to understand the role of health disparities and implement programs that work to address these disparities with our partners throughout the state. An example would be our work related to maternal health. Like the rest of the country disparities persist in maternal morbidity and mortality with non-Hispanic black women being disproportionately impacted. To support recommendations to help reduce the incidents of pregnancy related deaths and morbidity here in Texas, DSHS created a subcommittee to focus on maternal health disparities as part of our maternal mortality review committee. This multidisciplinary group has created tools to help facilitate case review and understand the role of contributing factors to maternal deaths for those women who are disproportionately impacted. This information can then be utilized by our MCH team and implementing maternal health and safety initiatives such as Texas AIM, making care safer for Texas mothers, along with maternal health education and awareness campaigns, resources for providers and partnering with our state perinatal quality collaborative.

Maura Leahy: Thank you both for those responses and transparency and for sharing some specific examples of ongoing work in your states. Dr. Payne, I really appreciate your calling out the importance of our recognizing the role that we all play, and that it's an ongoing process and not something to be achieved or a box to be checked off. Now, here at AMCHP, we're big proponents of blue sky thinking, which is a form of creative brainstorming without limits. Imagine there are no budget constraints, no red tape, no barriers to collaboration or creativity holding you back in 10 years. What do you hope to see realized in the maternal and child health field?

Dr. Manda Hall: So at our conference a few years ago, I was on a panel that was asked what our moonshot or monumental goal was. I said it then, and I'm going to say it again today: that our work and chasing zeros around maternal and infant mortality is realized, and that the disparities we see now no longer persist.

Dr. Shirley Payne: Oh goodness, that's a tough one because you have so many things that you would want to see happen. And I always try to think of it in a way how can you get to this realization of all those things happening at once? And sometimes you can't quite get there, but what I feel like in 10 years, if we are at a place, and I would say I want to use from a health equity standpoint, so this equitable level of health and care that everyone has that equal opportunity to achieve a positive health outcome. Whatever that might be within the field that we have and what that looks like. I want us to all have that access that should not be an issue. It should not be an issue because someone is placing a stereotype on you or whatever that looks like.  And so it's coming from a framework from that. I want to ensure that anybody that presents to us with an unmet need, that need is truly getting met. And I think that is where our challenge is. 

And I think we're always going to have a level of that, but I think 10 years from now, and especially as I think about children with special healthcare needs. The biggest thing that I like to push as being a part of this work is that idea around care coordination. And we have been talking about this for so long when it comes to children with special healthcare needs, but we're now talking about it way more as we think about home visiting for parents. Can we still have this hands-on approach in 10 years and not this okay, technology's taken over, I can reach women this way, I'm just going to still do it by the phone? Can we just go back a little bit and think about the role of your public health nurse? Think about the role of your home visitor, think about the role of your social worker, think about the role of your parent as the expert. How is that interaction going to help? Because it's that navigation of these systems that are still fragmented and in 10 years, I would love for them not to be that way. And I would love for people to be able to easily navigate through those things. But where there are the gaps that exist, how are we leaning on and utilizing people to help others navigate through this system? A true care coordination perspective, not case management, because there's two different things, but from a true care coordination to make sure that every need is getting met, to be presented. And the people are properly compensated for that. I think when you think about care coordination and other pieces, I’ll even say from your home visiting perspective, unless it is grant funded, it is a conversation after conversation to be able to go to your Medicaid or go to another insurance carrier or carriers to really get folks to see the value into this and what that looks like.

Maura Leahy: Well, if that's not the daily dose of motivation you need, I'm not sure what is. Is there anything else that you'd like to share with us today on MCH Bridges?

Dr. Manda Hall: Just that I'm truly honored to be the AMCHP president. Please know how much I value the opportunity to work together with our partners across the nation to improve the health of women, children, youth, and families, including those with special healthcare needs.

Dr. Shirley Payne: I'd just like to thank you all for the opportunity just to come on and talk a little bit about the MCH work and the world that we all get to be a part of. Again, I can't reiterate enough just how important and integral AMCHP really is to all of us, but I would certainly be remiss to say that. It certainly has made me a better person and a better professional, and I'm grateful for the opportunity to be a part of AMCHP and then to be here with you all today. 

Maura Leahy: Thank you so much Dr. Hall and Dr. Payne for taking the time out of your very busy schedules to chat with us today and thank you all to tuning in on the very first MCH Bridges.

Maura Leahy: Thank you all for joining us for this episode of MCH Bridges. We kindly ask that you take a few minutes to fill out a quick feedback survey at https://bit.ly/MCHBridgesPilot and let us know what you want to hear more about and who you want to hear from on future episodes. The link to the podcast feedback survey can also be found www.mchbridges.org. Be sure to follow AMCHP on social media. We're on Twitter and Instagram at @DC_AMCHP. We hope this episode created some new connections for you. Stay well and I hope our paths cross on the next MCH Bridges.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,963,039 with 0% financed from non-governmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. government.