By Michael D. Warren, MD, MPH, FAAP, Associate Administrator, Maternal and Child Health Bureau, Health Resources and Services Administration
As 2022 comes to a close, we here at the Health Resources and Services Administration’s Maternal and Child Health Bureau (MCHB) are reflecting on the work of Title V, a federal-state partnership now in its 87th year.
Staff in MCHB’s Division of State and Community Health have been spending the past few months conducting the annual Block Grant reviews, the culmination of the annual process of submitting the Block Grant application and report. In partnership with reviewers, including a growing cadre of family reviewers, MCHB staff hear firsthand from state partners about the innovative strategies and partnerships to advance health and well-being in their states. Title V continues to have broad population reach. In FY2021, Title V programs collectively served 92% of pregnant women, 98% of infants, and 58% of all children (including children and youth with special health care needs) across the 59 states and jurisdictions.
The past few years have highlighted the importance of Title V’s role in assuring the health and well-being of MCH populations. During the COVID-19 pandemic, states deployed strategies to ensure the continued provision of direct services, like home visiting, care coordination, and family planning through a switch to virtual or telehealth services. MCH and Children and Youth with Special Health Care Needs (CYSHCN) Directors advised state and local leaders on policies to keep children and families safe, and pivoted to respond to emerging issues, like declines in pediatric well-visits and immunizations.
While the response to the pandemic alone could have been all-consuming, states also had to navigate the continued pediatric behavioral health crisis. According to the National Survey of Children’s Health, the prevalence of depression and anxiety among children ages 3-17 increased by 27% and 29% respectively, from 2016-2020. Title V programs have been instrumental in expanding access to behavioral health services, including through establishment of teleconsultation programs through MCHB’s Pediatric Mental Health Care Access Program.
Title V programs also have an increasing focus on advancing equity for MCH populations. In the most recent 5-year needs assessments, 27 states noted a priority on equity or reducing health disparities. In addition, 54 states and jurisdictions acknowledged health equity and/or social determinants of health as important considerations in their work to address needs of the MCH populations. Equity is one of the four goals of MCHB’s Strategic Plan, released in 2021. Over the past year, MCHB supported five state Title V programs to advance their equity work through the National MCH Workforce Development Center. MCHB is now supporting AMCHP to assess barriers and opportunities related to advancing equity through state Title V programs; this work will result in the convening of a national meeting and development of a compendium that we hope will be a valuable resource as states work to eliminate unacceptable disparities in maternal and child health outcomes.
MCHB recently released two resources to help states eliminate health inequities. In the latest release of the Title V Information System (TVIS), states can stratify various performance measures by health insurance status, household income/poverty level, race/ethnicity, and rural/urban residence. Another helpful resource is the Maternal and Infant Health Mapping Tool. This tool allows states to map maternal and infant health outcomes and overlay various HRSA-funded assets (such as health centers and National Health Service Corps sites), with information available down to the county level. States can map excess black infant deaths, those deaths that we must prevent to achieve equity in infant mortality rates. The mapping tool also allows users to upload their own data, creating customizable maps for program planning.
As we look ahead to 2023, MCHB is excited to continue the longstanding federal-state partnership through Title V. Indeed, much work remains to be done to achieve our vision of an America where all mothers, children, and families thrive and reach their full potential. We must continue to accelerate the pace of change, with a particular focus on reducing and eliminating centuries-old inequities. To do so, we have to look upstream—focusing on prevention where possible, and addressing root causes of inequities, including social and structural determinants of health like access to care, housing, transportation, racism, and bias. And we must partner together with communities, engaging organizations that are rooted in the community’s values and individuals with lived experience. Together, we can accomplish great things for America’s mothers, children, and families!