Program Overview

The mission of the DC Department of Health (DC Health) is to promote health, wellness and equity across the District and protect the safety of residents, visitors, and those doing business in our nation’s capital.  With a commitment to achieving health equity, our strategic priorities are to:

1. Promote a culture of health and wellness
2. Address social determinants of health
3. Strengthen public-private partnerships
4. Close the chasm between clinical medicine and public health
5. Implement data-driven and outcome-oriented approaches to program and policy development

Residing in DC Health’s Community Health Administration, 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, especially among low-income residents and those with special health care needs.  In the District, health characteristics of women who had live births during 2019-2020 demonstrate stark differences when stratified by race/ethnicity. Non-Hispanic Black women had higher proportions of experiencing a previous preterm birth (7.6%), smoked prior to pregnancy (6.7%), being overweight or obese (60.8%), had diabetes prior to becoming pregnant (1.7%), and had hypertension prior to becoming pregnant (5.2%) than their White counterparts (1.9%, 1.0%, 27.2%, 0.5%, 1.1%, respectively). 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. In 2015, The DC Department of Health (DC Health) and Title V program established a framework for improving perinatal health and ensuring that:

• 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 organization 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.

The Title V Maternal and Child Health Block grant provides vital financial support for the needs assessment, strategic planning, implementation, and evaluation of programs and initiatives to address identified MCH needs in the District. Utilizing findings from the Five-Year Needs Assessment (2020) and emerging needs identified over the course of the COVID-19 public health emergency, the District has identified eight MCH priority needs:

1. Improve women’s reproductive health
2. Decrease perinatal and infant health disparities
3. Improve mental health of children and adolescents
4. Enhance positive youth development to decrease high risk behaviors
5. Enhance coordination for early intervention services to support healthy child development
6. Improve access to healthcare and healthful foods among women and children
7. Improve access to healthcare among children with special healthcare needs
8. Improve access to healthcare among adolescents
9. Improve oral health of pregnant women, children and adolescents

These priority needs have shaped the selection of the following National Performance Measures for the Title V MCH Block Grant:

• Well-women Visits - (Percent of women, ages 18 through 44, with a preventive medical visit in the past year)
• Breastfeeding - Percent of infants who are ever breastfed, Percent of infants breastfed exclusively through six months
• Developmental Screening - Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year
• Medical Home - Percent of children with and without special health care needs, ages 0 through 17, who have a medical home
• Transition - Percent of adolescents with and without special health care needs, ages 12 through 17, who received services to prepare for the transition to adult health care
• Medical Home - Percent of children with and without special health care needs, ages 0 through 17, who have a medical home
• Oral Health - Percent of children, ages 1 through 17, who had a preventive dental visit in the past year
• Preventative Dental Visit – Percent of women who had a preventive dental visit during pregnancy

The following State Performance Measures and Evidence-Based or-Informed Strategy Measures have been selected and will be tracked:

• Well-Woman Visits-Increase the percentage of women who are Medicaid beneficiaries that received a primary care visit within the past year
• Risk appropriate perinatal care – Decrease the proportion of Medicaid beneficiaries who deliver a low-birth-weight infant
• Mental Health- Increase the percent of children and adolescents, ages 3-17 with mental health needs who received counseling
• Teen Pregnancy Prevention- Decrease the percentage of live births to teenagers ages 15 to 19 
• Healthy Food Access- Percent children living in households that were food insecure at some point during the year
• Percent of women that participated in PRAMS and reported attending a preventative medical visit in the past year.
• Reduce percent of women that reported experiencing implicit bias or discrimination in PRAMS
• Percent of women provided with in-person or telephonic breastfeeding consult services
• Percent of women referred for breastfeeding peer counseling support
• Increase the percent of staff who completed breastfeeding education training
• Percent of Infants enrolled in home visiting utilizing safe sleep best practices.
• Increase the percentage of infants with newborn screening test results outside normal limits for a newborn screening disorder that receive prompt and appropriate follow-up testing.
• Increase early initiation of perinatal care by pregnant mothers in the first trimester
• Percent of children and adolescents with and without special health care needs referred to a medical home
• Percent of children and youth provided with preventive oral health services through a SBHC
• Percent of Medicaid enrolled children ages 1-17 years receiving preventive dental care from
• Percent of women enrolled in Medicaid that received oral health education services

In FY21, the DC Health Title V Program has provided funding and/or oversight and strategic direction for more than 35 MCH-related programs and initiatives. The Title V team convenes monthly meetings with DC Health staff supporting these various programs and initiatives, and convenes the MCH Advisory Council of external stakeholders on a quarterly basis.  In June 2021, as part of the new FY21-FY25 five-year cycle, 9 new community-based projects were awarded Title V funding through a competitive solicitation process. Title V strategies build upon the District’s strengths (high insurance coverage, a small geographic area, limited number of health systems and high political will to improve MCH outcomes), while addressing priority needs. During FY21 the COVID-19 pandemic continued to impact District government operations, healthcare and community-based program delivery with workforce challenges, adjustment challenges to hybrid operational models, and adjustment challenges to the emerging and exacerbated needs of the population. However, here are some examples of how the Title V MCH Block Grant supported our community in FY21.

Women/Maternal Health

DC Health engages in data-driven approaches to inform program and policy implementation. As such, Title V provides oversight of the DC Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS is state-specific population based-surveillance system with the mission to improve maternal health and reduce infant morbidity by producing actionable data on attitudes and experiences before, during, and shortly after pregnancy. In FY21, DC PRAMS incorporated the “COVID-19 Experience & Vaccine” supplement to be able to conduct trend analysis on the COVID-19 challenges and experiences of pregnant women and mothers.

The District continues to prioritize increasing access and utilization of preventive health care services for women of reproductive age, especially those with healthcare access limitations.  In FY 2021, Title V continued to fund La Clínica de Pueblo’s, Mujeres Saludables (Healthy Women) Program aimed at increasing the utilization of preventative services among Latinx patients of reproductive age and decrease no-shows for well-women and prenatal appointments. As a Federally Qualified Health Center (FQHC) and NCQA- recognized Level III Patient Centered Medical Home (PCMH), La Clínica del Pueblo (La Clínica) continues to employ a family practice model of care that is rooted in a holistic approach aimed at eliminating barriers to care.

Perinatal/Infant Health

DC Health funded and collaborated with the District of Columbia Hospital Association (DCHA) to develop and administers the District of Columbia Perinatal Quality Collaborative (DCPQC). The DCPQC serves as the Healthy Start Community Action Network (CAN) for the District of Columbia and the District’s champion for reducing maternal mortality, improving maternal and infant health outcomes aimed at narrowing racial and place-based disparities in maternal health. Key activities for FY21 included facilitating the Collaborative’s enrollment and participation in the Alliance for Innovation on Maternal Health (AIM) including the selection of the “Severe Hypertension in Pregnancy” patient safety bundle.

The District has engaged in several policy efforts aimed at improving perinatal health. The Better Access for Babies to Integrated Equitable Services Act of 2020 (BABIES Act of 2020) made necessary equitable changes to the now amended Community Health Omnibus Amendment Act of 2018. It now requires individual and group health benefit plans to cover required newborn screenings, authorize civil fines and penalties for the failure of hospitals and birthing facilities to comply with newborn screening, privacy, reporting, and discharge requirements, establish a report card that assesses the performance of hospitals and birthing facilities in meeting newborn screening, inpatient services, and discharge requirements, and establish a Perinatal and Infant Health Advisory Committee to provide recommendations to the Mayor and the DC Health Director regarding improving perinatal health and assuring access to quality perinatal health services. DC Health Title V staff operationalize the requirements of these policies.

Child Health

DC Health continues to oversee the DC Maternal, Infant, Early Childhood Home Visiting (MIECHV) program. DC Health’s goal is to provide evidence-based home visiting services to families of prenatal women and children ages 0-5 years old, living in very low-income communities through the implementation of evidence-based home visiting models. In FY 21, DC MIECHV implemented Parents as Teachers (PAT) and Healthy Families America (HFA) within one Local Implementing Agency - Mary’s Center. A total of 404 participants (219 children and 185 adults) were enrolled from high-risk neighborhoods, including 9.7% of households indicating homelessness, and 86% of MIECHV families categorized as low-income. In FY 21, DC Health continued to work closely with the Office of the State Superintendent of Education (OSSE) to share data on MIECHV participants referred for a developmental screening with OSSE’s Strong Start Program. Help Me Grow DC (HMG DC) serves as a centralized access point, commonly referred to as a call center for District residents, child health providers and other professionals seeking information, support and referrals for pregnant women and children from birth to age five.  In FY21 HMG DC partnered with all the Managed Care Organizations within the District which include CareFirst, Amerihealth, MedStar, and Health Services for Children with Special Needs which allows for HMG DC to streamline processes to provide effective care coordination to families who do not have medical insurance and need additional services and supports. In FY21, HMG DC continued to partner with the District of Columbia Mental Health Access to Pediatrics (DC MAP) to leverage support for District families to receive urgent mental health support without anticipating a waitlist. DC MAP is a district-wide initiative, funded in part by DC Health through an interagency partnership with the Department of Behavioral Health (through American Rescue Plan Act – Pediatric Mental Health Care Access New Area Expansion project funding), that helps health care providers with enhanced training and support to care for children and adolescents with behavioral health needs.

In response to the disruptions caused by the COVID-19 pandemic and a decline in vaccination rates among children, the District’s School-Based Health Center Program (SBHC) partnered with the District-wide Childhood Vaccination Program across various health centers within the District. The seven SBHCs in seven DC Public Schools (DCPS) provided mass vaccinations, including mandatory immunizations required to return to in-person learning. Traditionally, the centers only offer services to enrolled DCPS students where the SBHC program site is located. However, DC Health and DCPS coordinated efforts to increase access to the required childhood vaccinations by expanding the reach of SBHC locations to all district residents ages 4 to 19 from August 2020-September 2021. 

Adolescent Health

Adolescents in the District of Columbia (DC) experience various health issues. Poor mental health has become a significant concern in recent years. According to the 2019 Youth Risk Behavior Survey (YRBS), DC high and middle school students have increasingly reported feeling sad and/or hopeless , especially female students and those who identify as lesbian, gay, bisexual, transgender, or were unsure of their sexual identity.1 Adolescent mental health and disorders were among the health indicators than got worse over the last few years with approximately 16.32% of adolescents experiencing major depressive episodes (MDEs) on average from 2019-2020.2 As a result of the ongoing COVID-19 pandemic, mental health amongst adolescents has further declined due to uncertainty, social isolation, stress, disruptions to daily life and loss of routines, need to quarantine, and loss of family members or loved ones.

In order to help increase linkages to, and navigation through a medical home for adolescents, DC Health encourages and empower students to utilize their school-based health centers as their medical home.  Title V provides support for (DC Health) staff overseeing the locally funded School-Based Health Center Program (SBHC), which plays a role in addressing each of the priority needs. The program aims to improve the physical, social, emotional, and behavioral health of students, as well as minimize the effects of poverty and other adverse childhood experiences, enabling students to thrive in the classroom and beyond. During FY 21, DC Health provided oversight to seven (7) SBHCs operated by four DC Health grantees – Children’s National Hospital, MedStar Health Research Institute, Mary’s Center, and Unity Health Care, Inc. – in seven DC Public high schools and these centers were also utilized to serve families and members of the community for COVID vaccination.

Children with Special Health Care Needs:

DC Health Title V funds the Children’s National Medical Center Parent Navigator Program to implement the strategies of employing and empowering Parent Navigators to provide guidance and support to families about how to access services, work with providers, and other aspects of care coordination for CSHCN. Additionally, these Parent Navigators provide guidance and support to families to encourage adolescents with SHCN in their transition into adult care. DC Title V staff continue to identify and mobilize community stakeholders towards development of a comprehensive CSHN State Plan.

Cross-Cutting/Systems Building

With strategic support from Title V, the DC Women, Infant, and Children (WIC) program aims to improve the health of pregnant and postpartum women, infants, and children up to five years old with low-income (at or below 185% of the Federal Poverty Level) by providing benefits to purchase healthy foods, nutrition education, breastfeeding support and counseling, and referrals to healthcare and social services. DC Health aims to increase the percentage of eligible DC residents reached by WIC. Currently, DC WIC reaches approximately 61% of eligible residents with an average monthly enrollment of 15,226 individuals. Out of that average, roughly 8,078 were children aged 1 to 5 years, 990 were pregnant women, 1,822 were mothers who were breastfeeding, and 728 were postpartum women. In FY21 Title V funded the Oral Health Program (OHP) to carry out strategies to assess and promote oral health with an emphasis on access to comprehensive oral health services for all DC residents through a dental home. The Community Dental Health Coordinator (CDHC) pilot program continued operation in FY 21, with newly trained CDHCs integrating oral health into primary care and support services for pregnant women and children 0-5 years of age.