Section III.A.1. Program Overview

North Dakota’s Framework:

The vision of the North Dakota Department of Health and Human Services (NDDHHS) is to make North Dakota the healthiest state in the nation. The NDDHHS fosters positive, comprehensive outcomes by prompting economic, behavioral, and physical health, ensuring a holistic approach to individual and community well-being. This mission statement underscores the incredible work that is already underway across NDDHHS today. It also reflects the NDDHSS’s commitment to keep the well-being of individuals and communities at the forefront of their efforts. To learn more about the NDDHHS strategic priorities and guiding principles, please visit https://www.hhs.nd.gov/about-us

The Public Health Division within NDDHHS comprises five sections: 1) Healthy and Safe Communities, 2) Health Response and Licensure, 3) Health Statistics and Performance, 4) Disease Control and Forensic Pathology, and 5) Laboratory Services. Employees in these sections provide public health services that benefit North Dakota citizens and ultimately make the state a healthier place to live. The four core goals of the Public Health Division are to create healthy and vibrant communities; enhance and improve systems of care; strengthen population-based health interventions; and promote public health readiness and response.

The Healthy and Safe Communities (HSC) section is responsible for administrating the state’s Title V program and has a mission to support individuals, families, and communities by providing quality preventive programs and services that equitably protect and enhance the health and safety of all North Dakotans. There are four units in the section which all have programs and/or funding that link to the MCH priority areas: 1) Community Engagement, 2) Family Health and Wellness, 3) Health Promotion and Chronic Disease Prevention, and 4) Special Health Services (SHS). Title V also provides a portion of funding to the vital services of information technology, contract and grant management, and epidemiological support that assist MCH staff with critical job functions.

The Title V Director also serves as the Unit Director for the Special Health Services Unit and is a member of the HSC leadership team, which helps to promote and enhance visibility for MCH across the department.

The figure below details relevant indicators of the health and well-being of the North Dakota population, including the maternal and child health (MCH) population. This data is from the 2020 Census, 2022 Blue Cross Blue Shield Health and Well-Being of North Dakotans Report, and North Dakota Vital Statistics.

Five-Year MCH Needs Assessment

Title V programs and priority areas set their own goals. The overarching Title V goals were established as a result of the 2021-2025 comprehensive Five-Year Needs Assessment. The Title V Leadership Team (Title V Director, Children with Special Health Care Needs (CSHCN) Director, Family Health and Wellness Unit Director, MCH Epidemiologist and the State Systems Development Initiative (SSDI) Grant Coordinator) meet regularly to assure these goals are being met. In addition to the Five-Year Needs Assessment, the 10-step conceptual framework continues to be followed for the on-going needs assessment process.

Prevent Child Abuse North Dakota (PCAND) administers the state’s Maternal, Infant, and Early Child Home Visiting (MIECHV) program. A partnership between PCAND and the former North Dakota Department of Health (NDDoH) was used to complete the 2020 MCH needs assessment process. PCAND and the NDDoH hosted several information-gathering partnership meetings, Work-As-One: Needs Assessment Integration, between November 2018 and December 2019. These meetings were held to learn what other agencies/programs are doing around needs assessments and explore collaborating and streamlining needs assessment processes. After having discussions with other states, North Dakota determined that the State Health Improvement Plan (SHIP) and State Health Assessment (SHA) would also be integrated into the process. In January 2020, meeting attendees were tasked with assisting in the prioritization process by providing feedback for each specific data area. The input from partners that was obtained helped the Title V Leadership Team to establish the North Dakota Title V MCH priorities that are in place today.

The needs assessment process requires ongoing analysis of sources of information about MCH status, risk factors, access, capacity, and outcomes. Assessment of the MCH population is an ongoing collaborative process, one that is critical to program planning and development and enables the state to target services and monitor the effectiveness of interventions that support improvements in the health, safety, and well-being of the MCH population.

The North Dakota Work-As-One Needs Assessment Integration Team

Identified Priorities:

The following priority needs outline the overarching goals in each of the five Title V population health domains. Focus areas were created within each priority to further delineate and communicate the most pressing needs for the populations. This internal process was designed to organize and identify the highest priority areas for Title V effort and investment.

Women's/maternal domain: Well-woman visit with an emphasis on minority and low-income women

• North Dakota Priority: Percentage of women, ages 18 through 44, with a preventive medical visit in the past year.
• Significant Accomplishment: Title V staff leveraged local community-based organizations to reach ethnic and racially diverse populations of women, improved postpartum health for women by collaboratively extending Medicaid services postpartum, and implemented projects around doula care, increasing postpartum depression screening, and enhanced access to family planning services to improve women’s health in the interbirth interval.

Perinatal/infant domain: Breastfeeding with a priority amongst minority, low-income, and American Indian women

• North Dakota Priority: a) Percentage of infants who are ever breastfed; b) Percent of infants breastfed exclusively through 6 months.
• Significant Accomplishment: As of April 25, 2024, 199 workplaces have been designated Infant Friendly in North Dakota.

Child domain: Physical activity and nutrition (overall obesity prevention)

• North Dakota Priority: Percentage of children, ages 6 through 11, who are physically active at least 60 minutes per day.
• Significant Accomplishment: The MCH North Dakota School Health Specialist and Nutritionist collaborated with the NDDHHS Community Engagement Unit (CEU) Tribal Health Liaisons to identify partners on reservations to increase access to nutritious food. Collaboration between Title V staff and the CEU occurred as they worked together with partners on a North Dakota reservation to assure access to healthy food with the development of the Spirit Lake Food Distribution program.

Adolescent domain: Adolescent well visits emphasizing overall health, including depression screening, obesity prevention, and immunizations

• North Dakota Priority: Percentage of adolescents, ages 12 through 17, with a preventive medical visit in the past year.
• Significant Accomplishment: Title V staff partnered with the University of North Dakota Family Medicine Clinic to increase adolescent well visits to high-risk populations on the Standing Rock Reservation. A pediatrician and team traveled to Standing Rock to offer well-child visits free of charge.

Children with Special Health Care Needs (CSHCN) domain: Transition from pediatric to adult health

• North Dakota Priority: Percentage of adolescents with and without special health care needs, ages 12 through 17, who received services necessary to make transitions to adult health care.
• Significant Accomplishment: Student Transition Toolkits were created and disseminated (mailed) by Title V staff to all 30 Special Education Units in North Dakota.

Crosscutting domain (state priority measure): Maternal and Child Health (MCH) Workforce Development

• A well-trained MCH workforce is the first line of defense to prevent disease, protect health and keep the MCH population safe. State Title V staff are able to avail themselves of various professional development opportunities in order to build their capacity as part of the MCH workforce. Most recently, state staff and partners are currently able to register for courses to obtain a MCH Certificate through a contract with North Dakota State University (NDSU). Additional opportunities for staff are being explored, such as contracting with NDSU to develop and offer a one-day MCH Leadership Institute.

Crosscutting domain (state priority measure): Implement North Dakota state mandates delegated to the North Dakota Department of Health’s Title V/MCH Programs

• Priorities are often influenced by state mandates, which are generally reflective of expressed needs within the state over time. North Dakota has several mandates addressing the health of the maternal and child health population that direct Title V work efforts and require significant resources for successful implementation. The inclusion of these mandates epitomizes the successful federal/state partnership by honoring a state's unique priorities.

Crosscutting domain (state priority measure): Vision Zero, North Dakota’s traffic safety strategy

• Vision Zero. Zero fatalities. Zero excuses. – was unveiled in January 2018 (https://visionzero.nd.gov). The strategy promotes personal responsibility and recognition that serious injuries and fatalities are preventable.

Five-year action plans containing evidence-based, evidence-informed and/or promising practice strategies were developed with collaborative partnerships for all priorities. https://www.NDDHHS.nd.gov/north-dakota-mch-work-plans.

Assuring Comprehensive, Coordinated, Family-Centered Services

North Dakota places a high value on family-centered partnerships, family feedback, and collaboration. An example includes the SHS Unit partnership and contracted services with Family Voices of North Dakota. Family Voices of North Dakota supports statewide family-centered care for all children and youth with special health care needs and/or disabilities. SHS also utilizes a Family Advisory Council composed of family members of individuals with special health care needs. This council advises SHS on the family/parent perspective regarding issues, needs, and services, influences the direction of policies, contributes to program improvement, and ensures a voice for families and individuals with special health care needs to improve the system of care. CSHCN programs use meetings with this council to gather feedback from families to identify specific needs and future directions for meaningful services.

Efforts to Improve Outcomes

The strength of North Dakota Title V lies in the established and new partnerships that help expand the work of reaching women, infants, children, CSHCN, and families. Federal and non-federal funds are leveraged to deliver programs, services and create a statewide system of collaboration. However, it should be noted that due to the smaller size of the state, forming new partnerships has been challenging within select MCH domains. Each population domain describes opportunities for braiding and layering of funds and resources within the completed annual reports and annual plans, work efforts utilizing quality improvement strategies, and methods to include health equity into programmatic activities. This has ensured that activities are meeting the needs of the MCH population, as a wide variety of perspectives take part in creating the annual work plans.