Nevada’s Title V Maternal and Child Health (MCH) Program is dedicated to working with diverse public and private partners statewide to improve the health of families. Funded partners implement activities serving women of childbearing age, pregnant persons, infants, adolescents, and children, including children and youth with special health care needs (CYSHCN). Nevada utilizes Title V MCH funding to collaborate with partners and strengthen community engagement and activities ensuring all MCH populations can access quality health education and preventive services.
Nevada’s Title V MCH Program is housed in the Maternal, Child and Adolescent Health (MCAH) Section; Bureau of Child, Family and Community Wellness (CFCW); Division of Public and Behavioral Health (DPBH); Nevada Department of Health and Human Services (DHHS). The Nevada Title V MCH Program website can be accessed at: http://dpbh.nv.gov/Programs/TitleV/TitleV-Home/. The Title V MCH Program is committed to funding evidence-based or informed activities and programming to improve the health and wellbeing of the MCH population in Nevada.
Accomplishments and Priorities by Population Domain
Domain: Women/Maternal Health
According to 2020 Behavioral Risk Factor Surveillance System (BRFSS) data, 61.3% of Nevada women ages 18-44 years received a preventive visit in the past year compared to 71.2% of women nationally. Furthermore, according to 2020 National Vital Statistics System (NVSS) data, 78.2% of pregnant women in Nevada received prenatal care beginning in the first trimester, compared to 77.7% in the US during the same year. This percentage is lower for uninsured women in Nevada, with only 59.3% receiving early prenatal care. The Title V MCH Program partners with statewide and regional MCH coalitions, community-based programs, and public and private partners to increase insurance coverage rates and receipt of timely prenatal care among this population.
Nevada’s Title V MCH Program collaborates with partners to identify and reduce modifiable risk factors for improving birth outcomes, including racial and ethnic health disparities. Participation continued in the Association of Maternal Child Health Programs (AMCHP) “Infant Mortality Collaborative Improvement and Innovation Network (IM-CoIIN) 2.0.” Partners include Local Health Authorities (LHAs), March of Dimes, Division of Health Care Financing and Policy (DHCFP or NV Medicaid), DPBH Office of Public Health Investigations and Epidemiology (OPHIE), DPBH Office of Analytics, Nevada Healthy Start, Washoe County Fetal Infant Mortality Review (FIMR) Committee, Nevada Maternal Mortality Review Committee (MMRC), and the Nevada Home Visiting (NHV) Program.
Title V MCH partnered with AMCHP from November 2020 through April 2021 to implement an obstetric telehealth pilot as part of AMCHP’s CARES Act funded project, Maternal and Child Health Telehealth Capacity for Public Health Systems. Tablets, data plans, glucometers, fetal heart rate, and blood pressure monitoring devices were sent to the University of Nevada, Las Vegas (UNLV), School of Medicine, Department of Obstetrics. The goal was to provide prenatal services to underserved populations in rural and urban southern Nevada, specifically Clark and Nye counties, who would not be able to access prenatal care due to geographic, economic, maternal desert, or residency status barriers. Title V MCH linked UNLV SOM to community-based organizations serving pregnant women, including Nurse-Family Partnership home visiting services at Southern Nevada Health District. Efforts aimed to decrease severe maternal morbidity and poor birth outcomes, and support early and adequate prenatal care in underserved populations. Twenty-five women received a Chromebook and glucometer with testing supplies, and ten women were given blood pressure cuff monitors. This increased their compliance with treatment and monitoring. UNLV SOM will continue this pilot utilizing the same equipment. The pilot project was accepted as a Cutting-Edge Practice in the AMCHP Innovation Database. Additional partners on the CARES funding included home visiting local implementing agencies statewide and CYSHCN partners, including one Early Intervention site, the Family Voices site, and the Children’s Cabinet, leveraged tablets and data plans to access health care and services.
Twelve partner organizations in eight counties provide critical screenings to women of childbearing age, especially women living in rural and frontier areas and living with increased risk. Screenings included postpartum depression; Screening, Brief Intervention, and Referral to Treatment (SBIRT); One Key Question campaign; and others. Collaboration with NHV promotes relevant maternal and infant screenings to MCH populations with higher risk. MCAH staff led state-funded statewide reproductive health efforts through the state’s Account for Family Planning (AFP) Program and state funding. AFP provides family planning, STI, and immunization services to those who would not otherwise be able to access these services.
Title V MCH staff facilitate a COVID-19 and MCH data presentation in collaboration with the DHHS Office of Analytics during Maternal and Child Health Advisory Board (MCHAB) meetings. MCAH staff discussed Nevada Office of Minority Health and Equity (NOMHE)-planned equity and COVID-19 toolkit distribution opportunities and shared materials from NOMHE and other quality organizations about racism and public health, health equity, health disparities, and racism and pregnancy outcomes.
Title V MCH Program staff post MCH-specific COVID-19 resources on the program website and are engaged in COVID-in-pregnancy surveillance monitoring discussions with CDC as part of an OPHIE-led team. Staff also monitor multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, share COVID-19 resources to partners to support rapid information sharing, and reach out to partners and subawardees to understand how COVID-19 is affecting their efforts. MCH Director garnered a MCH-Immunizations CDC Foundation Assignee who has supported COVID-19 vaccine information sharing for pregnant and breastfeeding people, children, and providers on MCH-related vaccine topics including catch up vaccinations. English and Spanish resources were developed and widely shared, and webinars hosted for providers and for families in English and Spanish, with signing and ADA compliant accessibility enhancements.
Domain: Perinatal/Infant Health
According to the National Immunization Survey, Nevada’s rate for ever breastfeeding increased from 81.8% in 2017 to 83.4% in 2018, similar to the 2018 national average of 83.9%. Nevada’s 2018 rate for exclusive breastfeeding at six months was 28%, an increase from 2017’s rate of 21.7%%, and above the national average of 25.8%. Nevada’s Title V MCH Program partners with the Nevada Women, Infants, and Children (WIC) Program, MCH coalitions, breastfeeding coalitions, community-based programs, LHAs, the public, and private partners to increase breastfeeding rates by improving access to breastfeeding supports for new parents.
Nevada WIC breastfeeding campaigns help increase awareness, promote WIC breastfeeding services, and normalize breastfeeding in public locations. Eighty-nine Nevada businesses have signed the pledge to provide welcoming environments for breastfeeding. Washoe County FIMR reviewed 78 cases in FFY21. Nevada Title V MCH Safe Sleep efforts include funding a statewide Cribs for Kids (C4K) Program, statewide English and Spanish radio and television media campaigns, and statewide distribution of children’s books with safe sleep messages. C4K distributed 853 Safe Sleep Survival Kits with associated education, a 5.3% increase from FFY20. The NHV Program also promotes breastfeeding and safe sleep to participants.
Nevada Title V MCH activities related to decreasing substance use in pregnancy include participation in the AMCHP Promoting Innovation in State MCH Policymaking (PRISM) Learning Community, Association of State and Territorial Health Officials (ASTHO) Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative (OMNI), Nevada Comprehensive Addiction and Recovery Act (CARA), and IM-CoIIN efforts. The MCH Director serves on the Core team as well as numerous subcommittees and contributed to educational guides and resources produced by the OMNI group and updated the Sober Moms Healthy Babies MCH-funded website with CARA family and provider information. The Nevada Title V MCH Program continues Safe Sleep and Injury Prevention education with Indian Health Service clinics. Trainings provided include Infant Safe Sleep, car seat installation, Ages and Stages Questionnaires (ASQs), and Abusive Head Trauma. Pregnancy Risk Assessment Monitoring System (PRAMS) data inform potential evidence-based strategies to improve this domain.
Domain: Child Health
According to the 2019-20 National Survey of Children’s Health (NSCH), Nevada (22.3%) is significantly below the national average (36.9%) for children ages nine through 35 months who received a developmental screening using a parent-completed screening tool in the past year.
Nevada’s Title V MCH Program collaborates with public and private partners to improve the rate of children receiving timely developmental screening and increase the number of applicable entities trained on developmental screening.
Nevada’s Title V MCH CYSHCN Program promotes the Medical Home Portal (MHP), which improves access to healthcare by supporting professionals and families using the Medical Home model to care and advocate for CYSHCN and non-CYSHCN. In FFY 21, the number of unique users remained similar to the number in FFY 20, decreasing slightly from 28,657 to 27,049. The number of website views decreased from 64,132 to 48,497.
Bullying and Suicide Prevention efforts with the Nevada Department of Education (NDE) and the DPBH Office of Suicide Prevention (OSP) also support child health.
Domain: Adolescent Health
One in five births to a teen (15-19 y.o.) in Nevada is a repeat teen birth. To improve teen birth measures, the Nevada Title V MCH Program partners with state and local teen pregnancy prevention programs, NHV, MCH Coalitions, LHAs, community- programs, and private partners to increase access to educational materials, including funding LHAs and rural/frontier Community Health Nurses (CHNs) to provide education and promote Medicaid coverage of Long Acting Reversable Contraceptives (LARCs) post-partum. The "Reproductive Engagement Community Action Plan" report outlines the work of the Community Engagement in Reproductive Health Services Stakeholder group to improve access to reproductive health services on behalf of the Director’s Office of the Department of Health and Human Services.
Domain: Children and Youth with Special Health Care Needs
CYSHCN should have access to a medical home, but according to the 2018-19 NSCH, only 38.4% of CYSHCN in Nevada do. This is slightly below the national average of 42.2%, but an increase from 2018-19 (30.3%). Comparatively, 35.2% of children without special health care needs in Nevada have a medical home, a decrease from 41.8% in 2018-19, and below the national average of 47.9%.
Nevada’s CYSHCN Program provides resources and support to community agencies serving children ages birth to 21 years. The CYSHCN Program funds a variety of community programs to better serve children and families through a network of federal, state, University, and local community and family-based partners. CYSHCN Program Director and staff participate in community and family-led coalitions and committees, including being an appointee to the Nevada Governor’s Council on Developmental Disabilities (NGCDD) and Newborn Screening Program Advisory Board, co-lead on the Nevada Mountain States Regional Genetic Network, Pritzker Foundation Nevada Team, and Healthy Start, and attending the Nevada Early Intervention Interagency Coordinating Council.
Nevada’s CYSHCN Program continues promotion of the MHP, a virtual resource which provides reliable information about medical conditions, care, and knowledge of valuable local and national services and resources, improving care coordination among children with and without special health care needs. The CYSHCN Program partners with the Nevada Center for Excellence in Disabilities (NCED) Family Navigation Network, Nevada’s designated Family to Family Health Information and Education Center, which promotes the MHP, access to health care resources, referrals to adequate insurance coverage, care coordination services, and the CYSHCN toll-free hotline. A program accomplishment is the collaboration with the Rape Prevention and Education (RPE) Program and partners to create a resource on sexual assault prevention for those with developmental disabilities.
Nevada’s CYSHCN Program manages the Critical Congenital Heart Disease (CCHD) Registry which tracks infant CCHD screenings. The CYSHCN and Adolescent Health and Wellness Program are collaborating with NCED to expand resources on health care transition and health literacy.
Domain: Cross-Cutting/Life Course
Nevada’s Title V MCH Program collaborates across systems with PRAMS to collect data on women who smoke or use substances during pregnancy and secondhand smoke. Survey questions asked about substance use during the respondent’s most recent pregnancy. For 2020 births, when asked about prescription pain medication use during pregnancy, 3.87% said yes, which is an increase from the 2.68% who said yes in 2019, but a decrease from the 5.4% who said yes in 2018. Methadone use during pregnancy continued a downward trend in 2020, with 0.53% of respondents indicating use. In 2019, 0.85% said yes, and 1% said yes in 2018.
In 2017, heroin, amphetamines, methamphetamines, cocaine, tranquilizers, hallucinogens, LSD, sniffing gas, and glue or huffing use were all under 1% each. However, in 2018, reported amphetamine and cocaine use were greater than 1%, at 1.13% and 1.17% respectively. In 2019 and 2020, this trend reversed, and no substances were above 1%.
*For 2017 and 2018 weighted data, PRAMS had a response rate of 40.6% and 39.4%, respectively, both under the CDC threshold of 55%. 2019 data and 2020 data had response rates of 42% and 43%, respectively, which were below the CDC threshold of 50% for those years. Therefore, all data should be interpreted with caution.
Nevada PRAMS staff applied for supplemental opioid funding in 2017 and were awarded funds in September 2018. Thirteen additional questions regarding opioid use during pregnancy were included in the 2019 and 2020 surveys. Data from the opioid use questions for 2019 and 2020 births found the most reported prescription pain medications were Codeine (1.5%, 1.8%), Oxycodone (1.1%, 1.2%), and Hydrocodone (1.1%, 1.4%). Other prescription pain medications like Tramadol, Hydromorphone, Oxymorphone, Morphine, and Fentanyl were under 1% each for 2019 and 2020.
In response to Nevada’s legalization of medical and recreational marijuana, informational resources on pregnancy and marijuana use are disseminated. Nevada’s Title V MCH Program partnered with the Department of Taxation to distribute Child Injury Prevention and Pregnancy and Marijuana prevention materials to all marijuana dispensaries in Nevada. According to Nevada PRAMS, when asked about marijuana use during pregnancy in 2020, 10.7% of women said yes; this is a 94% increase from 2017. Title V MCH Program efforts focused on reducing substance use in pregnancy and interconception for women of childbearing age include promotion of the SoberMomsHealthyBabies.org website and associated media campaigns, marijuana prevention education materials, substance use during pregnancy provider guides (in labor and postpartum), CARA family information, and ASTHO OMNI activities on reduction of substance exposed infants and neonatal abstinence syndrome. Nevada’s Title V MCH Program participation in CARA Infant Plan of Safe Care substance exposed infant workgroups, IM-CoIIN, NHV, Families First related efforts, and perinatal quality efforts all support progress in this domain.
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