Program Overview

The foundation for the District of Columbia’s (DC) Title V Maternal and Child Health Program aligns with nationally recognized best practices and reflects core principles identified to improve MCH outcomes. The driving principles of our approach include: using a life course perspective, recognizing that a person’s health is determined by factors present prior to conception; addressing social determinants of health, recognizing that poverty and racism profoundly affect psychosocial well-being and are major contributors to disparities in birth outcomes and lifelong health; implementing systems-level interventions, recognizing that addressing underlying social policies have broad impacts on improving health; and building collective impact, recognizing that sectors beyond public health and medicine must have a role in realizing long lasting equitable outcomes for all of our families.

Our framework to improve MCH outcomes is based on the overarching goal to ensure every community understands its health risks and role in improving perinatal/MCH health outcomes. The DC Department of Health (DC Health) has identified seven core priorities that drive our programmatic efforts:

• Every teenage girl and woman in DC is in control of her reproductive health.
• Every pregnant woman receives patient-centered, high quality prenatal care beginning in the 1st trimester.
• Every healthcare provider has the tools and resources they need to provide quality care and manage complex social needs of women and infants.
• Every healthcare facility providing maternal and infant care has the tools and resources to practice evidence-based healthcare and to document Quality Improvement and Quality Assurance (QA) activities.
• Every newborn receives high-quality neonatal care in the hospital and outpatient setting.
• Every parent has the life skills and resources needed to nurture and provide for their family.
• Every infant and parent has a safe and healthy environment to thrive and receive the support they need to promote early childhood development and learning.

DC Health relied on findings from the Five Year Needs Assessment and gathered input from external MCH professionals to identify priority needs. In FY18, DC Health had six Title V grantees and three intra-district partnerships. Title V strategies build upon the District’s strengths (high insurance coverage, a small geographic area, limited number of health systems and political will to improve MCH outcomes), while addressing our weaknesses (persistent disparate health outcomes and inequitable distribution of resources for our low-income and minority residents).  

Women/Maternal Health NPM 1 Well Woman Visit

• Priority: Improving women’s reproductive health
  • Goal: Increase use of preventive care services among reproductive age women
  • Goal: Decrease unplanned pregnancies
  • Goal: Reduce chronic disease burden (including tobacco use) among reproductive age women

Infant Mortality Rates (IMR) in the District have been on a stable downward trend from 2007 (13.1) through 2016 (7.1). Despite this progress, DC’s IMR exceeds the DC Healthy People 2020 Target of 6.0 per 1,000 live births and significant racial and ethnic disparities persist. In 2016, Black infants were five times more likely to die before their first birthday than white infants. The majority of infant deaths are attributable to maternal complications. Improving the care of women before, during and after pregnancy will improve the livelihood of DC women and infants.

In FY18 Title V funded La Clínica del Pueblo’s, Mujeres Saludables Program to ensure 90% of their reproductive age women had an annual well-woman visit and to decrease no-shows for appointments. La Clínica engaged in capacity building to enhance population level monitoring and follow-up for services (well-women visits and prenatal care). La Clínica reached 332 Latina women through its charlas, small group discussions through the clinic’s team of health promoters (promotores) who implement La Clínica’s Círculos de Salud (or Health Circle) curriculum that focuses on well-women’s care and information regarding culturally and linguistically appropriate resources.

Title V funded staff in the Health Care Access Bureau to oversee the locally funded Diffusions of Care Grant. Four DC health centers serving many Medicaid-insured residents received grants to increase access to care by: expanding clinic hours and/ primary medical, dental and mental health services staff. In FY18, the program served 84,146 patients a nearly 300% increase from FY15.

DC Health aims to improve pregnancy planning and thereby preconception health through emphasizing reproductive life planning (RLP). In FY18, One Key Question® (OKQ), which encourages providers who support women to routinely ask: “Would you like to become pregnant in the next year? was implemented in all school-based health centers, resulting in 1,252 student RLPs. OKQ was also integrated into DC Healthy Start (HS) program, with 86% of eligible DCHS participants having a documented (RLP), increased from 74% in FY17. Title V continued to fund Breathe DC East River Tobacco Free Project (EOR) to provide tobacco cessation support to pregnant women and smokers in households with children under the age of 12. Breathe DC collaborated with managed care organizations and health systems to implement cessation support services to members and train staff on Ask, Advise, Refer model.

Perinatal/Infant Health NPM 4 Breastfeeding

• Priority: Decreasing perinatal disparities
  • Goal: Decrease infant mortality
  • Goal: Increase breastfeeding initiation and duration

Key outcomes affecting the health of newborns and infants are preterm births, low birthweight, and infant deaths. In 2016, 82.8% of DC infants were initially breastfed, decreasing to 57% at six months, and 33% at 12 months. The breastfeeding rate among WIC enrollees was 59.86% in FY18, surpassing our 57% target, however, at some WIC clinics rates can be as low as 28%.

The DC Breastfeeding Coalition (DCBFC) continued funding in FY18 to provide technical assistance (TA) and financial support to maternity facilities to achieve and maintain Baby Friendly (BFHI) designation; and increase community-based support for breastfeeding through expanding access to peer counselors and 24/7 video consultation through a mobile app (Pacify). DCBFC provided a Lactation Consultant Preparatory Course (LCPC) to increase diversity of the lactation profession and improve access to peer and professional breastfeeding support.

In FY18, the Safe Sleep Program (SSP) educated parents with information about safe sleep practices. SSP partnered with community based organizations and District government agencies educating 528 parents and training 1,032 community partners (over three times FY17) and distributing 506 portable cribs, across all Wards. Title V also supported DC’s Universal Newborn Hearing Screening Program also known as Early Hearing Detection and Intervention (EHDI) Program, and the Newborn Metabolic Screening Program.

Lastly, Title V continues to create synergy with other District efforts to improve perinatal and infant health. Title V continues to provide oversight to The DC Community Action Network (CAN) which uses a collective impact model by bringing together health providers, government agencies, and community-based organizations to align their work to achieve equitable birth outcomes. Title V also partnered with the Maternal, Infant, and Early Childhood Home Visiting Program and HS to increase breastfeeding education among program staff, and provide peer lactation support for women in those programs.

Adolescent Health, NPM 9 Bullying, SPM 2 Teen Pregnancy Prevention, SPM 3 Interpersonal Violence

• Priority: Improving adolescent access to and utilization of primary care and behavioral health services
• Priority: Enhancing positive youth development for adolescents to decrease high-risk behaviors (teen pregnancy, STIs, violence)
  • Goal: Decrease youth violence including bullying and partner violence
  • Goal: Reduce sexually transmitted infections and unintended pregnancies
  • Goal: Increase access to and coordination of health systems

Adolescents in the District face a multitude of challenges including engaging in high risk behaviors that result in substance abuse, STI transmission, pregnancy and exposure to injuries. Bullying and other forms of interpersonal violence are also a significant problem.  About 33% of middle school students reported being bullied.  DC’s rate of physical fighting in middle school is one of the nation’s highest. DC’s teen birth rate has been on the decline (24 per 1000 in 2016), but rates in Wards 7 and 8 are twice as high, 57.3 and 56.9, respectively. Title V supports programs that promote positive youth development, assisting youth with achieving optimal health, educational and life outcomes.

In FY18, Title V continued to fund the Office of Human Rights to develop a series of lessons (El Camino Program) to target bullying and help middle school students learn how to use technology and social media in a healthy and supportive way.  Title V funded the Wendt Center’s Resilient Scholars Project which provides high quality, evidence-based mental health services through group or individual therapy to children/adolescents (ages 6-17 years) suffering from affective disorders as a result of trauma and/or traumatic loss.

Title V also provides oversight of Teen Pregnancy Prevention (TPP) programs and School Based Health Centers (SBHCs). TPP programs use evidenced-based or promising practices (i.e. The One Key Question®) that incorporate reproductive life planning, including increasing the availability of adolescent-friendly health services, creating sustainable community-clinical linkages for adolescent health services, and increasing access to long-acting reversible contraceptives (LARCs). SBHCs operate in seven public high schools and offer a range of services, including primary, behavioral health, oral health services and prenatal care. Title V provided operational support to the Oral Health Program (OHP) to ensure access to and utilization of comprehensive primary dental services. In FY18, OHP finalized a list of indicators for the DC Oral Health Surveillance Program and summarized the findings from several datasets. In collaboration with OSSE, the first oral health question (on dental care utilization) was included in the 2019 YRBS.

Child Health NPM 6 Developmental Screening, NPM 8 Physical Activity, SPM 1 Healthy Food Access

• Priority: Reducing chronic disease burden (including obesity) among children and youth
  • Goal: Increase early identification of developmental delays and linkages to care to mitigate long term sequela.
  • Goal: Increase the number of children and adolescents engaging in recommended daily physical activity.
  • Goal: Increase access to healthful foods for children living in food deserts.
  • Goal: Reduce childhood tobacco exposure.

In 2016, the vast majority (91%) of children in DC reported being in “very good” or “excellent” health. DC boasts one of the highest rates of insured children (98%) in the nation. Despite this, DC faces some significant population health issues among this population. Disparities exist, with Wards 5, 7, and 8 having obesity rates higher than the national average and all U.S. states - these wards also have the highest chronic disease rates, lowest median income, and a large minority population. A high prevalence of tobacco use also affects these areas (30% in Ward 8, 23% in Ward 5, 22% in Ward 7). Food insecurity affects over a quarter of households.

In FY18, Title V worked with the Office of the State Superintendent for Education (OSSE) Division of Early Learning (DEL) to implement Strong Start Early Intervention Program (Strong Start) - a statewide, comprehensive, coordinated, multidisciplinary system that provides early intervention therapeutic and other services for infants and toddlers with disabilities and developmental delays and their families. Title V and OSSEDEL continued to provide staff oversight of the Help Me Grow (HMG) program in FY18. HMG provides services to District residents through a comprehensive and integrated system (launched in FY17) designed to address the need for early identification of children at risk for developmental and/or behavioral problems and to prenatal women.

Title V supported TA and funding to local education agencies (LEAs) to: increase the capacity of food personnel, school staff to promote physical activity and healthy food options ECEs adopted strategies to increase physical activity and 15 state-level multi-component physical education policies for schools were adopted by the state, among other achievements.

Title V continued to provide programmatic oversight of locally funded food access programs geared to serve low-income women and children including Joyful Food Markets (JFMs), Healthy Corner Stores Partnership, Produce Plus Program, and Mobile Farmers’ Markets. JFMs provide up to 23 pounds of healthful foods and targeted health and wellness education for students in 39 Ward 7 and 8 elementary schools. FY18, Joyful Food Markets conducted 336 markets and approximately 4,700 elementary school families participated per month.

Children with Special Health Care Needs (CSHCN), NPM 12 Transition

• Priority: Enhancing use of medical home and transitional services for CYSHCN
  • Goal: Increase the use of transition planning for adolescents with and without special health care needs
  • Goal: Increase number of adolescents with and without special health care needs receiving recommended preventive health services

Persistent gaps in care coordination for many of District’s youth with special health care needs contribute to health issues -34.2% reported receiving comprehensive care with a medical home; and, 34% received services necessary to make transitions to all aspects of adult life. To receive transition services, CSHCN must first establish care with a medical home.

Title V continued to fund the Children's National Health System (Children’s National) Parent Navigator Program in FY18. The Program employs navigators who are parents of CSHCN, including bilingual/Spanish speakers, to work with families of CSHCN to address barriers around access, communication, transition and medical/community resources empowering parents to actively take part in the medical decision making process. In FY18, Parent Navigators worked directly with primary care providers who routinely make the initial referral for services, although referrals may come from different entities. The program successfully provided peer to peer support/navigational services to 381 families, resolved a total of 545 issues, and completed a total of 148 patient satisfaction surveys with 78.46% of families reporting being very satisfied with services they received through the program.