The Title V Program in North Carolina (NC) is administered by the NC Division of Public Health (DPH). The NC Title V Director serves as Senior Medical Director for Health Promotion in DPH. The NC CYSHCN Director is positioned in the newly created Division of Child and Family Well-Being (DCFW) as the Assistant Director supervising the Whole Child Health Section (DCFW/WCHS). Both the DPH and DCFW are part of the NC Department of Health and Human Services (NCDHHS) team to provide essential services to improve the health, safety, and well-being of all North Carolinians in collaboration with its partners, driven by equity and committed to whole-person care. To ensure coordination and collaboration between DPH and DCFW, the Divisions have jointly created a DPH-DCFW Steering Committee which is in the process of finalizing a charter to codify cross-divisional coordination and an Interagency Memo of Agreement (IMOA) which will include the Title V requirements and expectations. In addition to the Title V Office (formerly the Women’s and Children’s Health Section [WCHS]) staff members, the NC Title V Director supervises the newly reorganized Women, Infant, and Community Wellness Section (WICWS) which is made up of three branches – Maternal Health, Reproductive Health, and Infant and Community Health – and the Chronic Disease and Injury Section (CDIS). The DCFW/WCHS is made up of six units – Child Behavioral Health, Schools and Health, Best Practices, Childhood Supports, Genetics and Newborn, and Operations. Also located in the DCFW are the Early Intervention Section and Community Nutrition Services Section which also impact the maternal and child health population.

One overarching goal of the 2020 NC Title V Needs Assessment was to ensure that the process worked in alignment with Section, Division, and Department strategic planning efforts so that Title V resources could be leveraged as much as possible. These plans include, but are not limited to, the NC Perinatal Health Strategic Plan (PHSP), the CYSCHN Strategic Plan, the NC Early Childhood Action Plan, and the NC DPH Strategic Plan. The needs assessment process afforded the DPH an opportunity to reexamine the 2015 priority needs which were intentionally written broadly and had not changed much since they were selected back in 2005. A 2020 NC Title V Needs Assessment Leadership Team was created in February 2019 which consisted of the Title V Director, the CYSHCN Director, the WHB Head, and the State Systems Development Initiative (SSDI) Project Coordinator. This group met monthly to create and implement a needs assessment work plan. The WCHS hosted a Title V MCH Internship Team supported by the National MCH Workforce Development Center during summer 2019 which allowed two MCH students, one in graduate school and the other an undergraduate, to assist in qualitative data collection activities. The needs assessment process included many opportunities for involvement by stakeholders, including families and community representatives, other state agencies, program participants, and programmatic partners and providers including a MCHBG Big Questions Needs Assessment Survey administered in spring 2019 at conferences and meetings of programs supported by Title V; focus group and key informant interviews; and an electronic survey of WCHS partners and stakeholders to identify priorities and guide planning within the five MCHBG population domains. Partners and stakeholders received a personal invitation from the NC MCH Title V Director and/or WCHS Branch Heads to respond to the survey which elicited 934 completed responses from at least 99 counties.

In March 2020, an expanded Section Management Team (SMT) meeting, which, in addition to the Section Chief, Branch Heads, and Operation Manager also included unit supervisors and other critical WCHS members invited by SMT, was held to review the qualitative and quantitative data and determine the 2020 NC Title V Needs Assessment Priority Needs. Prior to the meeting, the Leadership Team developed prioritization criteria which was shared with staff along with an overview of the Title V Performance Measure Framework. A simple dot voting process was then used to determine the top priority needs. The Branch Heads worked with their staff and the SSDI Project Coordinator to draft the strategies, objectives, performance measures, and evidence-based or -informed strategy measures for the State Action Plan which was revised and completed by the Leadership Team in the context of NCDHHS strategic priorities and goals. The following table lists the eight selected priority needs and the accompanying National and State Performance Measures (NPMs & SPMs) by population domain. The COVID-19 pandemic highlighted health inequities across the country and we took this as a call to action for NCDHHS to better support North Carolinians. As part of the realignment to bolster whole person health, encourage transparency and accountability, and promote health equity work across the department to create a healthier North Carolina, the DCFW will promote cross-program initiatives to support North Carolina’s children growing up safe, healthy, developing to their full potential, and thriving in nurturing and resilient families and communities. In addition, effective July 5, 2022, the Immunization Branch will move to the NC DPH Epidemiology Section to allow better coordination with other branches in that section. The Immunization, Communicable Disease, and Public Health Preparedness and Response Branches already work closely together on a range of issues like COVID-19, hepatitis, measles, and other vaccine-preventable illnesses. Bringing them together will allow greater coordination and collaboration. This will also bring together most key COVID-operations into the Epidemiology Section. The NC Title V Program will continue to work across the NCDHHS and partners to promote maternal and child health and well-being as reflected by the priority needs below.

The data and stakeholder feedback supported continued use of most of the NPMs it was using for the past five years, but the Title V Office has chosen new SPMs which align more directly with the objectives and strategies in the State Action Plan as well as the other current strategic plans including the NC Early Childhood Action Plan. While there has been incremental progress in most of the previously used indicators, there is still much room for improvement, particularly in decreasing racial/ethnic disparities and inequities. The Title V Program has moved NPM14.1 (Percent of women who smoke during pregnancy) to a SPM in the Perinatal/Infant Health Domain, and has dropped NPM14.2 (Percent of children, ages 0 through 17, who live in households where someone smokes) and NPM15 (Percent of children who are continuously and adequately insured). Data for NPM15 are actually disconcerting as the percentage of children who were adequately insured continues to decrease in NC. The Title V Program will certainly keep monitoring these data, but will not report on them as NPMs for 2021-25. The State Action Plan is reviewed and revised every year as needed.

The mission of the NC Title V Program, to support and promote the health and well-being of NC individuals including mothers, infants, children, youth, and their families to reduce inequities and improve outcomes, aligns well with the goals of Title V. The NC Title V Program works closely with local, state and national partners and serves as a critical collaborator and convener. From reproductive life planning and preconception health to perinatal and infant health to child/adolescent health including those with special health care needs, the NC Title V Program emphasizes a life course approach to achieving health and health equity in all populations. The NC Title V Program values evidence-based and evidence-informed strategies in promoting health, while following guidelines around best practice. Given the importance of cross-sector work, the NC Title V Program leverages the expertise and experience of our many partners and leaders in the state.

The NC Title V Program currently manages and administers an annual budget of over $765 million and employs 956 people. This is 47% of the DPH staff, along with 47% of the budget. This of course will shift in future years with the creation of the DCFW. The NC Title V Program’s broad scope promotes collaborative efforts while discouraging categorical approaches to the complex challenge of improving maternal and child health. The Program is committed to ensuring that services provided to families are easily accessible, user-friendly, culturally appropriate, and free from systemic barriers that impede utilization. While many staff members work in the central office in Raleigh or on a hybrid schedule, there are a number of regional consultants who work from home and regional offices and a growing number of home-based central office staff members. The EIB has a network of 16 Children's Developmental Service Agencies (CDSAs) serving all 100 counties.

The Title V Block Grant funds 26 NC Title V Program state-level employees, with others funded in part per the cost allocation plan. These positions are primarily nurse consultants, public health genetic counselors, and public health program consultants within the Title V Office, WICWS, and DCFW/WCHS, but also include staff members in the NC State Center for Health Statistics (SCHS), CDIS, and the Oral Health Section to fund collaborative efforts.

The NC Title V Program supports services and programs for underserved and vulnerable populations using state appropriations, grant funding, Title V, Medicaid Federal Financial Participation, and other receipts. The NC Title V Program provides Title V funding to local health department (LHDs) through the Consolidated Agreement, which is a contract between the LHD, DPH, and DCFW that outlines requirements of each agency including funding stipulations, personnel policies, disbursement of funds, etc. Program specific requirements for each state funded activity are provided in Agreement Addenda. The funding that goes directly to LHDs is used to provide services for individuals without another payer source, as well as enabling services and population health education.

The NC Title V Program also collaborates on a number of activities with several professional organizations in the state including but not limited to: NC Medical Society; North Carolina Pediatric Society (NCPS); NC Obstetrical and Gynecological Society; Midwives of North Carolina; NC Friends of Midwives; and the NC Academy of Family Physicians. The NC Title V Program partners with the NC Institute of Medicine, the NC Hospital Association, and the NC Area Health Education Centers and works closely with the NC Partnership for Children, Prevent Child Abuse NC, the NC Chapter of the March of Dimes (MOD), , NC Child, and other organizations. There are many accredited schools of public health and medicine in NC, and the NC Title V Program maintains close working relationships with many of them.

The NC Title V Program is committed to building the capacity of women, children, and youth, including those with special health care needs, and families to partner in decision-making about state Title V activities and programs. There are several NCDHHS advisory councils and commissions that are in place and involve family members including, but not limited to: the Commission on Children with Special Health Care Needs (CSHCN), Newborn Metabolic Committee, Newborn Hearing Advisory Committee, Office on Disability and Health Advisory Group, Association for School Health, MIECHV, Triple P, NC Baby Love Plus Community Advisory Network, Interagency Coordinating Council (for Early Intervention), and the Governor’s Council on Sickle Cell Syndrome. The DCFW/WCHS continues to support a full-time Family Liaison Specialist (FLS) who is a parent of a child with special health care needs to train and support family engagement in DCFW/WCHS programs and partner organizations and maintains an active group of Family Partners. The WICWS has created Village 2 Village, a community and consumer engagement work group whose members provide feedback on the PHSP strategies, publications, and services. Participants are NC residents between 18 to 44 years old from rural and urban counties who must have children no older than one year of age. As with the Family Partners, participants are compensated for time, travel, meals, and lodging according to NC state government reimbursement guidelines.

The NC Title V Program focuses on ensuring access while also facilitating a strategic approach utilizing needs assessments and convening partners and leaders in the development of strategic plans. Despite substantial successes, the NC Title V Program remains challenged by a variety of systemic barriers and recognize that there is still much work to be done to fully integrate a systems approach in NC. While there is a strong commitment to addressing social determinants of health and systemic racism to achieve health and health equity, this work will take time. The NC Title V Program continues to advocate for NC residents and is central to the three NCDHHS priority areas of focus:  Behavioral Health & Resilience, Child & Family Wellbeing, and Strong & Inclusive Workforce. The NC Title V Program continues to work with the many partners to help achieve our goals and create a more strategic vision for NC, while maintaining the safety net, public health infrastructure at our LHDs, and a focus on evidence-based programs for maternal and child health. Promoting health and wellbeing and supporting North Carolinians, including our children and families, is especially critical as we move forward in our ongoing response to the COVID-19 pandemic and recovery.