The Title V Maternal and Child Health (MCH) Block Grant is a Federal-State partnership program geared toward improving the health of mothers and children, including children and youth with special health care needs. Led by the State Health Officer, the Mississippi State Department of Health, Office of Health Services has the responsibility of preparing and administering the state Title V plan and allocating Title V funds based on Mississippi’s maternal, infant and child health priorities.
Mississippi’s Title V Block Grant Funds
Title V MCH Block Grant funds are awarded to each state based on the needs of the state’s MCH population. States are required to provide a three-dollar match for every four dollars in federal funding received. Mississippi’s award for federal fiscal year 2020 (FY20) is approximately $9M, with a $6M of matching state funds. Per federal requirements, at least thirty percent of Title V funding should support services and programs for children and thirty percent for children and youth with special health care needs (CYSHCN). Mississippi Block Grant funds support state, regional and local programs, as well as staff. The funds are managed by the Mississippi State Department of Health, Office of Health Services.
Needs Assessment
Every five years an assessment of maternal and child health (MCH) needs, and needs for children and youth with special health care needs (CYSHCN), is conducted. Mississippi’s MCH needs assessment is conducted to inform selection of priorities for the state Title V action plan at the beginning of each five year block grant cycle.
DOMAIN: Women/Maternal Health
Identified State MCH Priority Need: Increase access to prenatal care.
High rates of obesity, chronic health conditions, and infant mortality are serious concerns for the state’s MCH population. These chronic health conditons, contribute to the high rates of maternal and infant morbidity and mortality among women of child-bearing age in MS. Of added concern, Zika is an emerging issue. To combat its prevalence, MSDH has received funding through Title X to improve clinic capacity and increase coastal area clinic staff, expand access to effective and affordable contraceptive methods, and raise awareness of family planning services.
MSDH is involved in several initiatives focused on increasing contraceptive access which include: Office of Population Affair’s Contraceptive Access Learning Community regarding unintended pregnancies and contraceptive access; ASTHO Contraceptive Learning Community to develop and leverage partnerships and collaborative efforts to expand contraceptive access along with facilitating training in birthing hospitals and clinical settings; and the Infant Mortality COIIN which addresses birth spacing, preconception and inter-conception care.
DOMAIN: Perinatal/Infant Health
Identified State MCH Priority Need: Decrease infant mortality & reduce low birth weight and premature birth.
Mississippi has persistently had one of the highest infant mortality rates in the nation. he Infant mortality is defined as the death of a child within the first year of life. The infant mortality rate (IMR) in 2017 was 8.72 per 1000 live births. This was not a statistically significant change from 2016. Significant disparities ecist in infant mortality between racial groups in MS. The black infant mortality rate was 11.9 deaths per 1,000 live births compared to the white rate of 6.2 deaths per 1,000 live births. The white infant mortality rate declined from 6.7 deaths per 1,000 live births to 6.2 deaths per 1,000 live births while the black infant mortality rate increased from 11.4 deaths per 1,000 live births to 11.9 deaths per 1,000 live births. Racial disparities in infant mortality are strongly influenced by the differences in preterm birth rates between black and white infants, with 16% of black babies being born before 37 weeks compared to 11.3% of white infants.
When the multiple complications of prematurity are grouped together, preterm birth (delivery before 37 weeks of pregnancy) is the leading causes of infant mortality in Mississippi. Infants born preterm are at an increased risk of breathing complications, infections and brain injury. In 2017, 13.6% of infants were born preterm in Mississippi compared to 9.9% for the United States.
The Mississippi Perinatal Quality Collaborative (MSPQC) and Infant Health programs lead initiatives to promote quality improvement and evidence‐based activities at the hospital and community level to improve birth outcomes across Mississippi. Activities include the “Golden Hour” project which focuses on improving resuscitation practices for very preterm and very low birth weight infants; in addition to multiple safe‐sleep initiatives. One of these initiatives involves the Mississippi Sisters United Project graduate sorority chapters. The Mississippi Sisters United Project receives training on safe sleep environments, breastfeeding, folic acid intake and women health in order to provide this information to communities through outreach activities.
DOMAIN: Child Health
Identified State MCH Priority Need: Increase access to comprehensive health care
According to the 2017 National Survey of Children’ Health (NSCH), MS parents report that 90% of children are in excellent or very good health and 78.9% report excellent or very good oral health. More than 1/3 (41%) aged 10‐17 years were reported to be overweight or obese (85th percentile or above). Nearly all (97.4%) of participants reported current health insurance coverage at the time of the interview. However, 96% were consistently insured throughout past year and 4% reported uninsured or periods without coverage. About 82% of MS children reported with a preventive medical visit in the previous year. In addition, 79.9% of MS children reported a preventive dental visit in the previous year (US 80.2%).
The Mississippi First Steps Early Intervention Program is responsible for coordinating a state-wide comprehensive interagency system of early intervention supports and services (EISS) for infants and toddlers under three years of age with a developmental delay or condition likely to lead to a developmental delay and their families. MS First Steps coordinates with providers and families across the state to ensure children receive developmental screening and/or monitoring for appropriate referrals. The Mississippi First Steps Early Intervention Program in collaboration with intra-agency programs including Perinatal High Risk Management (PHRM) , Early Intervention, and Early Hearing, is working on developing joint procedures for developmental screenings and referrals. The program has also held quarterly meeting with Medicaid to discuss early intervention referrals and service coordination roles and responsibilities that better enable coordination of services provided to child and families.
DOMAIN: Adolescent Health
Identified State MCH Priority Need: Decrease teen pregnancy and teen birth rate
The U.S. Department of Health & Human Services reports that MS had the second highest teen birth rate in 2016 at 32.6 live births per 1,000 girls age 15‐19 (20.3 births per 1,000 females ages 15-19 in the U.S.). Strategies aimed to decrease teenage pregnancies and improve the overall health of MS’s adolescents include sexual health education for teens and young adults, contraceptive counseling, and uptake of annual adolescent and young adult preventive health visits. The MS Adolescent Health Program was able to aid a local school‐based health center in applying a rapid cycle quality improvement process to convert the majority of sports physicals into comprehensive well visits. The program also piloted a learning seminar for high school seniors related to transitioning into adulthood that included topics such as Healthcare Insurance Coverage, Healthy Relationships, Preventive Health, and Adult Life 101. Eighty‐six percent of participating students reported that they would be able to apply information learned in the next few months as they transition out of high school.
DOMAIN: Children with Special Health Care Needs
Identified State MCH Priority Need: Increase access to health care and medical homes
The 2017 National Survey of Children's Health estimates that MS has approximately 169,815 (23.5%) CYSHCN. Nearly 27.5% of MS CYSHCN live below 200% of the Federal Poverty Level, more than the US 20.5%). The National Survey indicated that 14.2% of MS CSHCN have conditions that consistently affect their activities, often a great deal.
MS’s CYSHCN Program has provided quality care coordination to meet client needs and preferences in the delivery of high‐value, high‐ quality care. The care coordinators work within many settings to assist families and connect them to a medical home. These include primary care, specialty care (often more than one specialty), inpatient care, mental health services, long‐term care, and home care settings. It also includes community resources, pharmacies, client and family education, and informal caregivers. The CYSHCN staff is working with two clinical practices, UMMC Children’s Complex Medical Clinic and UMMC Adolescent Health Clinic to serve as a model for CYSHCN as a medical home, utilizer of shared plans of care, and documentation of care coordination activities.
Key Mississippi Characteristics
The following represents a snapshot of key Mississippi characteristics and health indicators.
- Number of Live Births: 37,370a
- Infant mortality rates: 8.7 per 1,000 live birthsa
- Number of children <18 years old: 24% (713,567)b
- % of children <18 years old with special health care needs: 23.5%c
- % of births covered by Medicaid: 64%
- % of children <18 years old without health insurance: 2.6%
Key Women, Maternal and Infant Health Indicators
|
Indicators |
2012 |
2013 |
2014 |
2015 |
2016 |
2017 |
HP 2020 |
|
Increase access to prenatal care |
|
|
|
|
|
|
|
|
Percent of pregnant women receiving prenatal care in the first trimester. (MS Vital Statistics) |
84.7 |
74.3 |
75.5 |
76.2 |
76.0 |
77 |
77.9 |
|
Percent of very low birth weight (VLBW) infants born in a hospital with a Level III+ NICU. (MS Vital Statistics) |
65 |
64 |
74.4 |
79.3 |
79.3 |
--- |
83.7 |
|
Reduce preterm births, low birth weight, and infant mortality. |
|
|
|
|
|
|
|
|
Percent of women with a past year preventive medical visit. (MS BRFSS) |
67.2 |
67.8 |
71.4 |
72.7 |
78.4 |
71.8 |
- |
|
Percent of preterm births (less than 37 weeks of gestation). (MS Vital Statistics) |
16.9 |
13.1 |
12.9 |
13.0 |
13.6 |
13.6 |
11.4 |
|
Percent of low birth weight deliveries (less than 2,500 grams). (MS Vital Statistics) |
11.6 |
11.5 |
11.3 |
11.5 |
11.5 |
11.6 |
7.8 |
|
Percent of Non-Medically Indicated (NMI) early term deliveries. (MS Vital Statistics) |
17.6 |
12.9 |
11.5 |
11.4 |
11.9 |
11.7 |
- |
|
Increase initiation, duration and exclusivity of breastfeeding. |
|
|
|
|
|
|
|
|
Percent of mothers who exclusively breastfed their infants at 6 months of age. (Breastfeeding Report Card) |
10 |
9.3 |
11.1 |
13 |
‐ |
- |
25.5 |
HP2020: Healthy People 2020 Goal
KIDS COUNT Key Indicators Compared to other states,
Mississippi’s overall child well-being rank for 2017 was 50
|
Indicators |
Mississippi |
United States |
|
|
Economic Well-Being |
|
|
|
|
Percent of children in poverty (2016) |
27 |
18 |
|
|
Percent of children whose parents lack secure employment (2016) |
34 |
27 |
|
|
Percent of children living in households with a high housing cost burden (2016) |
26 |
31 |
|
|
Percent of teens (ages 16-19) not attending school and not working (2016) |
8 |
7 |
|
|
Education Indicators |
|
|
|
|
Percent of children (ages 3-4) not attending preschool (2014-16) |
47 |
52 |
|
|
Percent of fourth graders in public school not proficient in reading (2015) |
73 |
65 |
|
|
Percent of eighth graders in public school not proficient in math (2015) |
78 |
67 |
|
|
Percent of high school students not graduating on time (2015-16) |
17 |
15 |
|
|
Health Indicators |
|
|
|
|
Percent low birth weight babies (2016) |
11.6 |
8.3 |
|
|
Percent of children without health insurance (2016) |
5 |
5 |
|
|
Child and teen death rate (per 100,000 children ages 1-19) (2016) |
40 |
26 |
|
|
Percent of teens (ages 12-17) who abuse alcohol or drugs (2015-16) |
3 |
4 |
|
|
Family and Community Indicators |
|
|
|
|
Percent of children in single-parent families (2016) |
44.2 |
35 |
|
|
Percent of children in families where the household head lacks a high school diploma (2016) |
13 |
13 |
|
|
Percent of children living in high-poverty areas (2012-16) |
24 |
12 |
|
|
Teen birth rate (per 1,000 females ages 15-19) (2016) |
31 |
19 |
|
Source: Annie E. Casey Foundation, 2017 KIDS COUNT, https://datacenter.kidscount.org/topics
Sources:
a Vital Statistics Mississippi, 2017
b Mississippi KIDS COUNT Data Book, The Annie E. Casey Foundation, 2017
c National Survey of Children with Special Health Care Needs.
d Kaiser Family Foundation estimates based on the Census Bureau's American Community Survey, 2008-2017
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