Title V Block Grant and the Maternal and Child Environmental Health Network
Alfred N. Romeo, R.N., Ph.D.
Utah Department of Health
Title V Maternal and Child Health (MCH) Block Grants support improved health care and public health services for women, infants, children, children and youth with special health care needs, and families. Other grants and cooperative agreements focus on specific issues for women and children. Building collaborations across funding streams can result in improved outcomes for projects and improve the effectiveness of services for women and children.
The Title V Block Grants provide states and territories with funding based on their population. States have the flexibility to choose activities that support women, children, and families under 15 National Performance Measures (NPM)s such as:
Preventive dental visit during pregnancy
Smoking during pregnancy
The states and territories develop plans under each of the NPMs that they have selected and report on the progress of those plans. The data from the NPMs can be used to track improvements across years and make comparisons to the national average.
A complementary funding stream is the Maternal and Child Environmental Health Network (MCEHN) cooperative agreement. Funding for the MCEHN is from the Maternal and Child Health Bureau (MCHB) through the Division of Children with Special Health Care Needs and the Genetic Services Branch. While it provides much less funding and is more narrow in its focus, it also seeks to improve the health of women and infants related to the effects of environmental exposures.
The MCEHN aims to disseminate information to women and their health care providers, as they prepare for pregnancy, while they are pregnant, and while they are breastfeeding. MCHEN disseminates information on environmental exposures that women and their babies may have had to the following:
Prescriptions and over-the-counter medications
Herbal products and supplements
Chronic and acute health conditions, including infections (e.g., Zika)
Substances of abuse.
The goal is to reduce functional and structural birth defects, morbidity and mortality rates, and other adverse outcomes for mothers and their children. The MCEHN provides limited, supplemental funding to an existing network of “teratogen information services.” A teratogen information service is an organization with experts trained in recognizing teratogenic exposures and interpreting the research to provide information to the public and professionals about the risks of exposure to those teratogens. Alcohol, Accutane, and thalidomide are examples of well-known teratogenic exposures. Individuals in these organizations joined together to form a professional society, the Organization of Teratology Information Specialists (OTIS).
OTIS and its service arm, MotherToBaby, were awarded the MCEHN funding to supplement 14 local MotherToBaby affiliates/services in the United States. Although MotherToBaby affiliates are not physically located in every state, they do cover and provide information to all states and territories in the 10 Health Resources and Services Administration (HRSA) regions. Most of the local MotherToBaby affiliates exist within universities and hospitals but one is located in a Title V agency in a state department of health.
MotherToBaby Utah, a local affiliate, is located within a Title V agency. This affiliate started more than 35 years ago, with support from Dr. Peter Van Dyck, and is located in Utah’s Maternal and Child Health Bureau. It is a joint project with the University of Utah’s Department of Pediatrics. MotherToBaby Utah receives about 7,000 inquiries a year, by phone, text, chat, and email.
Accessing MCHEN Services on a Practical Level
When a woman is either planning a pregnancy, is pregnant, or is breastfeeding and has a question about an exposure she may have had, or may have in the future, she can contact her MotherToBaby affiliate and contact an expert directly to ask questions. Here are a couple of scenarios:
- Mothers may be worried about taking medications during pregnancy and breastfeeding, and they want to protect their babies. They may not realize that many conditions—such as a fever, depression, and infections—are more problematic for themselves and their babies than the medications used to treat those conditions.
- Mothers also commonly ask about the risks of medications for colds, pain relievers, antibiotics, antihistamines, herbal products, and medications for mood disorders, such as anxiety and depression. Because of the plethora of information available —which is often confusing and conflicting— mothers and their providers may need help interpreting the research.
MotherToBaby experts will provide information, to women or their healthcare providers, about any risks from an exposure, including potential birth defects, developmental delays, or other complications.
Note, however, that MotherToBaby does not provide medical advice for women and their providers. Rather, medical and mental health providers determine which medications are effective and best suited to treat a condition, and then call MotherToBaby to ask about potential risks for the baby. Once the MotherToBaby expert provides information on risks, the medical and mental health providers and mother then decide together the best medication for the situation. Similarly, a pharmacist may call MotherToBaby to ask questions about the risks of a medication before dispensing it to a woman because some resources (package inserts, Physicians’ Desk Reference, etc.) will not provide much detail about the pregnancy and breastfeeding warnings associated with a medication.
Communications and Outreach
MotherToBaby also provides written communications and outreach in other ways. More than 350 fact sheets may be accessed here on a variety of exposures, including the new COVID-19 infection. To help women and healthcare providers find the different exposures, the fact sheets are grouped into the categories of medications; herbal products; infections and vaccines; maternal medical conditions; substances of abuse; other common exposures; and occupational exposures. All fact sheets serve as official statements from MotherToBaby; all information has been carefully researched, reviewed, and then approved.
In addition, MotherToBaby consults with other organizations and projects. Recently, MotherToBaby served on the steering committee for AMCHP’s Maternal and Child Environmental Health (MCEH) Collaborative Improvement & Innovation Network (CoIIN). This CoIIN helps states improve their capacity to address lead exposures in mothers, infants, and children. For more details on the CoIIN, access this website. Participating states in the CoIIN asked AMCHP and MotherToBaby to partner with them to develop guidelines to help providers and primary care doctors prevent and/or manage maternal and child exposures to lead.
Opportunities for Collaboration
As previously mentioned, states and territories can choose the NPMs and activities that will best serve their state’s women, children, and families. States can collaborate with their regional MotherToBaby affiliate to conduct activities that support several NPMs.
For example, NPM 1 is well-woman visit. MotherToBaby encourages women to visit their providers for their well woman check-up, before pregnancy, in order to stay up to date on immunizations, continue their prenatal vitamins, and control any conditions that might increase the risk of birth defects, such as uncontrolled diabetes..
NPM 4 is breastfeeding. Women and their healthcare providers can ask MotherToBaby experts about medications that a woman may need to use as she starts or continues breastfeeding such as antianxiety or antidepressant medications. States and local MotherToBaby affiliates can work together to develop and implement activities that support the improvement of NPMs.
To find the local affiliate for any state or territory, and to explore ways to collaborate on NPMs, visit www.mothertobaby.org, or call the national routing number at (866) 626-6847.