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 2018, 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 the Fall of 2013, MCH (Maternal and Child Health Service at OSDH) and CSHCN (Children with Special Health Care Needs Program at DHS) released a public input survey, with the help of OFN, to identify emergent needs for the state of Oklahoma’s MCH population. CSHCN also sought input from Sooner SUCCESS on the needs of Medicaid-eligible CYSHCN (children and youth 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. Tribal listening sessions were conducted with eight of the largest tribal nations in the state and their health care providers. Coalition meetings and partner meetings were also used to gather information on needs and the state’s capacity.

MCH, CSHCN, and OFN synthesized and discussed the information received from the public input survey, tribal listening sessions, coalition and partnership meetings, and the data analysis to establish the following Title V priorities for 2016-2020. The 2016-2020 priorities are those most likely to “move the needle” in improving the health of the Oklahoma MCH population (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 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; PRAMS, TOTS and 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:
 

• Began work on a Collaborative Improvement and Innovation Network (CoIIN) team focused on preconception health with various partners: two family planning clinics, four Healthy Start organizations, and a Federally Qualified Health Center. The goal is to develop, implement, and disseminate a woman-centered, clinician-engaged, community-involved approach to the 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.
• Look for partnership opportunities to provide preconception/interconception care and education in the community and increase access to long acting reversible contraception (LARC).
• Provide LARCs via a Medicaid-funded Health Service Initiative to assure access without waiting lists.
• Continue work on MMR and strengthen the MMR Committee.

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 162 cribs to families in need via the crib project for safe sleep and continued the sleep sack hospital program. 
• Oklahoma increased the number of Breastfeeding Friendly Worksites to 220. Oklahoma currently has 8 Baby-Friendly Hospitals delivering more than 15% of all births statewide.
• 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. MCH will continue to promote community efforts, including INTEGRIS hospital-based Milk Bars.
• 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:
 

• Began participating in the Child Safety Learning Collaborative, to increase motor vehicle safety for youth.
• 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.
• Train and identify partners to provide education in local communities on Graduated Driver Licensing, distracted or impaired driving, seatbelt use, and alcohol use while driving as they relate to children and youth.
• Continue funding Poison Control Center education and outreach activities.

Adolescent:

Accomplishments:
 

• Reduced state-wide teen birth rates (15-19 year olds) by approximately 50% since 2000.
• Maintained two 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 and added a new curriculum which addresses healthy relationships for older teens and college-age youth.
• 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.
• Finalize 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.