The Title V Program in North Carolina (NC) is administered by the NC Division of Public Health (DPH) and collaborates with programs across the NC Department of Health and Human Services (NCDHHS), other state agencies, statewide partners, local health departments, community-based organizations as well as other stakeholders to improve maternal and child health in North Carolina. 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 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. 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 serve the maternal and child health population.

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 was established to 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, the Immunization Branch moved 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 allowed greater coordination and collaboration.

The NC Title V Program works across the NCDHHS to advance the Title V priorities and improve health, health equity and wellbeing of individuals of reproductive age, mothers, fathers, infants, children, and adolescents in the context of NCDHHS priority goals:

1. Advance health access by increasing opportunity and improving outcomes for people who face greater health and situational challenges within NCDHHS and across the state.
2. Promote child and family well-being by making it easier for children and families to access the healthcare, programs, and supports they need to thrive.
3. Support behavioral health and resilience by prioritizing investments in coordinated systems of care that make services easy to access when and where they are needed and reduce the stigma around accessing these services.
4. Build a strong and inclusive workforce that supports early learning, health, and wellness across North Carolina.
5. Achieve operational excellence by enabling efficient, effective, and innovative processes and services. 

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, the NCDHHS Strategic Plan, and the NC DPH Strategic Plan. The framework for the 2020 NC Title V Needs Assessment focused on a life-course approach driven by whole person integrated approach, health equity, social determinants of health inclusive of racism, family and consumer voice, and ensuring data-driven and evidence-based approach, as shown below:

The following table lists the eight selected priority needs that emerged from the 2020 Needs Assessment with the accompanying National and State Performance Measures (NPMs & SPMs) by population domain. The data and participant feedback supported continued use of most of the previous NPMs, 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. 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 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.

In January 2022, the NCDHHS established the Division of Child and Family Well-Being (DCFW), bringing together staff and programs serving the behavioral health physical health, and social needs of children and families. This reorganization was designed to bring together programs and staff that were operating across the Division of Public Health (DPH), Division of Social Services (DSS), and Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMHDDSAS) with the focus on whole person care. These programs include:

• Community Nutrition Services Section (originating from DPH)
• Early Intervention Section (originating from DPH)
• Food and Nutrition Services Section (originating from DSS)
• Children and Youth (originating from DPH)
• Child Behavioral Health (originating from DMH/DD/SAS)

This reorganization has transitioned in several phases with the final phase being the budget expected to be passed by the General Assembly during the current legislative session. 

The North Carolina State MCH Block Grant Plan is approved on a state fiscal year basis through the Budget Act passed by the NC General Assembly. Funding from the MCHBG supports local programs in women’s and children’s health administered by both DPH and DCFW, as well as DHHS infrastructure to support broader efforts.

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 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 (NCPC), 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, and the Governor’s Council on Sickle Cell Syndrome. The NC Title V Program continues to support a full-time Family Liaison Specialist (FLS) position in the DCFW/WCHS 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 recognizes 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 to improve overall health.