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 2021, 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 2019, MCH analysts collected data on 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. 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, and the second held in conjunction with the Joining Forces Conference convened by the OFN. 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 life-course 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 life-course 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 (OCCHD) and the Tulsa Health Department (THD) 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) and the Oklahoma Maternal Health Task Force (OMHTF), which aim to improve the care of women and infants throughout the state and the Children’s State Advisory Work Group, which brings together multi-disciplinary professionals in child-serving agencies focused on improving mental and behavioral health for children and youth in the state. CSHCN Title V has contracts in place with the Comprehensive Pediatric Sickle Cell Clinic, Parent Promise Community HOPE Center, JumpStart Clinic, Family Support 360°, the Oklahoma Infant Transition Program, OFN, Sooner SUCCESS, and the JD McCarty Center to provide high quality, family-centered CYSHCN services.

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; Oklahoma Perinatal Quality Improvement Collaborative, 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 System (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; Oklahoma Maternal Health Task Force; Becoming Baby Friendly Oklahoma; Every Mother Counts Initiative, media campaigns, health equity activities, and other-related programs and initiatives.

Maternal/Women:

Accomplishments:

• Began open enrollment on June 1 for newly expanded Medicaid eligibility to adults ages 19-64 whose income was 138% (133% with a 5% disregard) of the federal poverty level or lower.
• Continued Maternal Mortality Review (MMR) and the OMHTF, completing the second Maternal Morbidity and Mortality Annual Report.
• Assisted in training the parentPro home visiting staff on medical norms for the pregnancy and postpartum periods.
• Created and ran public service announcements on streaming services with messages regarding preconception health and healthy pregnancies.

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.
• Continue work with the MMR Committee and OMHTF to reduce disparities in maternal health.
• 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 via the six new maternity clinics.

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 Project (HBEP) and Becoming Baby-Friendly in Oklahoma (BBFOK) Project.
• Distributed 226 cribs to families in need via the crib project for safe sleep and continued the sleep sack hospital program in 28 birthing facilities. 
• Screened 100% of all newborns in Oklahoma through the 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 the media campaign for Preparing for a Lifetime to reduce infant and maternal deaths.
• 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.
• Continued support for Child Passenger Safety (CPS) activities, including staff time for the installation of car seats to families in need and providing staff for community training and technical assistance on child passenger safety.
• Continue work with the OPQIC and partners to address opioid use/abuse in pregnant women and the increasing rates of newborns diagnosed and treated for neonatal abstinence syndrome.

Child:

Accomplishments:

• Provided funding for the Oklahoma Poison Control Hotline for training and technical assistance to families, students, health care providers and child care programs.
• Participated in the Oklahoma State Obesity Plan Stakeholders Group, serving on the early childhood and school age working groups.
• Assisted in the planning, funding and implementation of the new Parent Warmline for Oklahoma families, 1-888-574-5437.
• Maintained school health contracts to support physical and social emotional health activities in the state’s two largest school districts and in one statewide school health organization.
• Implemented Child Health well and sick care visits in pilot health department districts across the state.

Plans:

• Promote bullying prevention and suicide prevention trainings in schools across the state.
• 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.
• Support the provision of well child health visits in county health department clinics in areas of high need.
• Assist state schools and the Oklahoma Department of Education (OSDE) in planning implementation for the new Health Education requirement for public schools.

Adolescent:

Accomplishments:

• Supported eight state-funded adolescent pregnancy prevention projects in local county health departments, and administered the Personal Responsibility Education Program (PREP) grant for OCCHD and THD.
• Hosted the first Adolescent Health Summit, a two-day virtual event for interdisciplinary youth-serving professionals across the state of Oklahoma in June 2021. Topics included: youth mental health, inclusivity, bullying prevention, positive youth development, and youth connectedness.
• Participated in the OSDE work group to update existing Oklahoma Academic Standards for Health Education.
• 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 (PHYCs) 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.
• Host the second Adolescent Health Summit.
• 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 parent-to-parent support, sibling support, training, and opportunities for family leadership via OFN.
• Continued funding the Oklahoma Infant Transition Program (OITP), Sooner SUCCESS, Jump Start/Autism Clinic Family Partner, the OU Pediatric Sickle Cell Clinic, and the Oklahoma Family Support 360⁰ Center.
• Provided supplemental 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 (SSI-DCP) 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, Jump Start, J.D. McCarty, OITP, Parent Promise, Family Support 360°, and the Sickle Cell Clinic to further work in the state for the families of CYSHCN.
• Promote 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 580-471-1990 or Carla.McCarrell-Williams@okdhs.org.