The Maternal and Child Health Services Block Grant, Title V of the Social Security Act, is the only federal program devoted to improving the health of all women, children, and families. Title V provides funding to state maternal and child health (MCH) programs, which serve an estimated 56 million women and children in the U.S. Since 1935, federal and state funds have supported state activities that improve the health of pregnant women, mothers and infants, children, and children with special health needs. These groups are often referred to as the "MCH population."

Title V funds are used to address the state’s maternal and child health priorities. In 2019, Oklahoma benefited approximately 1.3 million women, infants, and children with Title V programs. In Oklahoma, Title V is administered by the Oklahoma State Department of Health (OSDH) and the Oklahoma Department of Human Services (DHS), in close partnership with the Oklahoma Family Network (OFN). This assures families have a voice in the services they receive.

Population Needs and Title V Priorities:
In December 2018, MCH analysts began data collection of MCH health indicators relevant to the populations of women, infants, and children, including those with special health care needs. Health-related data were reviewed from a variety of sources, including birth and death certificates, population-based surveillance systems, school-based surveys, and focus groups. A public input survey was released in March to identify emergent needs for the state of Oklahoma’s MCH population. Tribal listening sessions were conducted with nine of the largest tribal nations in the state and their health care providers. MCH conducted two non-tribal listening sessions - one with a family-youth center in Tulsa, Oklahoma, focused on serving an African American community, the second was held in conjunction with the Joining Forces Conference convened by the Oklahoma Family Network. The Joining Forces sessions included families and caregivers of children and youth with special health care needs (CYSHCN).

MCH, CSHCN, and OFN synthesized and discussed the information received from the public input survey, listening sessions, and the data analysis to establish the following Title V priorities for 2021-2025, See Table 1.
 

Oklahoma’s Progress on National and State Performance Measures:

In Oklahoma, the Title V program utilizes a lifecourse framework for needs assessment, program planning and performance reporting at the state and local levels. Trainings, data, and activities are structured to emphasize the importance and effectiveness of reducing risk factors and increasing protective factors early in life to reduce poor health and social outcomes later in adolescence and adulthood. The most prominent examples of this are the Preparing for a Lifetime, Its Everyone’s Responsibility infant mortality reduction initiative led by MCH and the lifecourse work accomplished with families through OFN.

Both MCH and CSHCN Title V, in partnership with OFN, support and assure comprehensive, coordinated and family-centered services via a system of trainings, partnerships, contracts, and direct services. The provision of services for MCH populations are accomplished through county health departments, professional service agreements, vendor and state agency contracts, requests for proposals, and invitations to bid. Although administratively separate, the Oklahoma City-County Health Department and the Tulsa Health Department are essential MCH partners, providing services and administering projects via direct contracts. MCH continues to be integrally involved with the work of the Oklahoma Perinatal Quality Improvement Collaborative (OPQIC), which aims to improve the care of women and infants throughout the state and the Oklahoma Health Improvement Plan (OHIP) Child Health Group, which brings together multi-disciplinary professionals focused on improving health for children and youth in the state. CSHCN Title V has contracts in place with the Comprehensive Pediatric Sickle Cell Clinic, Family Support 360°, the Oklahoma Infant Transition Program, Family Partners, Sooner SUCCESS, and the JD McCarty Center to provide high quality, family-centered services to Oklahoma’s CYSHCN.

Programs administered in some part with Title V funds include: Preparing for a Lifetime, It’s Everyone’s Responsibility; the Collaborative Improvement and Innovation Network (CoIIN) on Preconception/Interconception Health; Maternal Mortality Review Committee; Period of PURPLE Crying program; Pregnancy Risk Assessment Monitoring System (PRAMS), The Oklahoma Toddler Survey(TOTS) and Youth Risk Behavior Surveillance (YRBS) surveillance programs; Teen Pregnancy Prevention and Positive Youth Development Projects throughout the state; State Systems Development Initiative; Fetal Infant Mortality Review (FIMR) projects; Infant Safe Sleep Cribs and Sleep Sacks Projects; Personal Responsibility Education Program (PREP) projects; school health programs in the two major metropolitan areas; Becoming Baby Friendly Oklahoma; Every Mother Counts Initiative and other-related programs and initiatives.

Maternal/Women:

Accomplishments:
 

• Continued work on a Collaborative Improvement and Innovation Network (CoIIN) team focused on preconception health with various partners: two family planning clinics and four Healthy Start organizations. The team developed and piloted a woman-centered patient engagement tool for a well woman visit to improve the preconception health status of women of reproductive age, particularly low-income women and women of color.
• Continued to staff Maternal Mortality Review (MMR) and promote postpartum hemorrhage and hypertension bundles published by the Patient Safety Council for birthing hospitals in Oklahoma.

Plans:

• Continue to work with the Oklahoma Health Care Authority (OHCA) to provide family planning services to low-income females and males of reproductive age not eligible for Medicaid-covered services, and facilitate enrollment in Medicaid for those eligible.
• Expand use of the patient engagement tool to all county health departments whose clients receive preventive health check-ups and pregnancy tests.
• Continue work with the MMR Committee and create an annual report comparable to other states.
• Coordinate maternal health activities with county health departments and the State Maternal Health Innovation Program grant to improve prenatal and postpartum care in areas of need.

Perinatal:

Accomplishments:
 

• Provided funding and support for the Oklahoma Mothers' Milk Bank (OMMB) and the Oklahoma Breastfeeding Hotline (OBH). Promoted breastfeeding duration and the establishment of Baby-Friendly Hospitals through funding and support of the Oklahoma Hospital Breastfeeding Education (HBEP) and Becoming Baby-Friendly in Oklahoma (BBFOK) Projects.
• Distributed 290 cribs to families in need via the crib project for safe sleep and continued the sleep sack hospital program in 27 birthing facilities. 
• Increased the number of Breastfeeding Friendly Worksites to 242. Oklahoma currently has 10 Baby-Friendly Hospitals.
• Screened 100% of all newborns in Oklahoma through Newborn Screening Program and 100% of affected newborns received short-term follow-up and were referred to long-term follow-up care coordination.

Plans:

• Continue to partner with and support newborn screening activities in the state.
• Promote breastfeeding initiation and duration through various initiatives.
• Recruit additional delivery hospitals to participate in the Infant Safe Sleep Hospital Sleep Sack and Cribs Projects.
• Continue work with the Oklahoma Perinatal Quality Improvement Collaborative and partners to address opioid use/abuse in pregnant women and increasing rates of newborns diagnosed and treated for neonatal abstinence syndrome.

Child:

Accomplishments:
 

• Participated in the Child Safety Learning Collaborative, to focus on reducing motor vehicle injuries and fatalities among children and adolescents in Oklahoma.
• Continued support for Child Passenger Safety (CPS) activities, including staff time for the installation of car seats to families in need and providing staff to train new CPS technicians.
• Provided funding for the Oklahoma Poison Control Hotline for training and technical assistance to families, students, health care providers and child care programs.

Plans:

• Provide leadership on the Infant Injury Prevention Work Group, as part of the statewide infant mortality initiative, Preparing for a Lifetime, It's Everyone's Responsibility. 
• Maintain a collaborative relationship with Injury Prevention Service (IPS) and Safe Kids Oklahoma, through MCH staff assistance with car seat safety events, CPS training, and seat installations.
• Continue work with MCH-funded school nurses to assure evidence-based practices and communicable disease guidelines are being followed.
• Continue funding Poison Control Center education and outreach activities.
• Begin the provision of well child health visits in county health department clinics in areas of high need.

Adolescent:

Accomplishments:
 

• Maintained three state-funded adolescent pregnancy prevention projects in local county health departments, and administered the Personal Responsibility Education Program (PREP) grant for Oklahoma City and Tulsa County Health Departments.
• Implemented bullying prevention programs in the two largest school districts in the state, as well as in schools served by the MCH-funded school nurses.
• Provided family planning clinical services to adolescents in county health departments and contract clinics.

Plans:

• Collaborate with local county health departments to establish and support local Public Health Youth Councils which identify issues within their communities affecting adolescents and work with public health professionals to implement solutions.
• Conduct trainings with others who work with youth using evidence-based methods such as Question Persuade Refer (QPR), Positive Youth Development (PYD), and Life Course Perspective.
• Ensure MCH-funded school health education and promotion programs will continue to provide age and grade appropriate health and wellness information, integrating education and health via the Whole School, Whole Community, Whole Child (WSCC) model.
• Continue to provide family planning services to adolescents in county health departments and contract clinics.
   

CYSHCN:

Accomplishments:
 

• Funded Sooner SUCCESS activities, including a provider survey to assess transition processes and policies for primary care and specialty clinics.
• Funded parent-to-parent support, sibling support, training, and opportunities for family leadership via OFN.
• Continued funding the Oklahoma Infant Transition Program (OITP), Family Partners, the OU Pediatric Sickle Cell Clinic, and the Oklahoma Family Support 360⁰ Center.
• Provided formula, adaptive equipment, and medical care to CYSHCN with financial need that was not otherwise covered by Title XIX Medicaid funds.
• Provided funding to J.D. McCarty and the Supplemental Security Income-Disabled Children’s Program for respite vouchers to families with CYSHCN.

Plans:

• Continue to provide formula, adaptive equipment, and medical care to CYSHCN with financial need.
• Continue contracts with Sooner SUCCESS, OFN, Family Partners, J.D. McCarty, OITP, Family Support 360°, and the Sickle Cell Clinic to further work in the state for the families of children and youth with special health care needs.
• Disseminate the transition toolkit for primary care providers.
• Work with partners to identify ways to connect families with services to meet behavioral health needs.

Comments and Suggestions:

MCH, CSHCN, and OFN welcome comments and suggestions for needs and issues not discussed in this Block Grant Application and Annual Report. Oklahoma Title V is committed to an ongoing review of health needs and capacity issues across the state. It is recognized that collaboration and partnership are necessary to truly impact the health of the state’s MCH population.

For more information about this document, the process, to provide comments, or to partner with Title V please contact:  Joyce Marshall, MCH Title V Director, OSDH at 405-271-4480 or joycem@health.ok.gov or Carla McCarrell-Williams, CSHCN Title V Director, DHS at 405-521-4092 or Carla.McCarrell-Williams@okdhs.org.