PROGRAM OVERVIEW

The Title V Block Grant is one of the largest federal block grant programs and a key source of support for promoting and improving the health and well-being of women, children and children with special health care needs and their families.  Title V is governed by the Health Resources and Services Administration (HRSA) Maternal Child Health Bureau (MCHB).

The Virgin Islands (VI) Title V program supports an array of paramount MCH programs and services.  To improve the health and well-being of women, infants, children, and adolescents, to include children with special health care needs is an inclusionary goal of the VI.

States and jurisdictions submit an application and report in accordance with guidance from the Maternal Child Health Bureau (MCHB).  This year’s application from the VI reflects the continued efforts to provide access to care for the territory’s MCH population.  Data that captures quality evidence used to address the territories health care needs of mothers, infants, children and children with special health care needs are included.  A summary of the Title V Needs Assessment used to identify gaps preventing MCH from meeting its program goals and objectives is reflected. The application encompasses the noteworthy work that the territory has done over the past two years. 

MCH HEALTH AND WELLNESS FETE- STX DISTRICT (LEFT) - STT/STJ DISTRICT RIGHT

Following guidance from the VI Department of Health (VIDOH) and the Center for Disease Control (CDC), VI MCH continues to provide service to the MCH population in the onset of COvid-19.  During the stay at home phase, services were restructured to comply with social distancing. Only 6 families were allowed in the clinic at a time.   Placemats reflecting “Thank you for Practicing Social Distancing” were placed 6ft  apart on the clinic floors. Personal Protective Equipment (PPE) was provided for all MCH employees.

Title V Healthhhcontinue to address the maternal, infant, child, not to exclude children with special health care needs of the territory through the efforts of its clinic and programs, partnership and collaboration with other government, private and non-profit entities, and continued guidance and technical support from our federal partners.  The MCH program has shown enormous growth and progress within the last two years; this as well as the hard work and commitment of the staff is reflected throughout this application.

MCH & CSHCN Overview

The Virgin Islands Department of Health is the designated agency in the Virgin Islands for administering the MCH & CSHCN program pursuant to Title 19, Chapter 7, and Section 151 of the Virgin Islands Code (VIC). The MCH & CSHCN Program offers preventative and primary health care services for mother, infants, children and adolescents to include: prenatal and high-risk prenatal care clinics, postpartum care, well child clinic, immunization, high risk infant and pediatric clinics, care coordination and access to pediatric sub-specialty care for children and adolescents with special health care needs.

In 2019, a jingle created to promote programs and services and re-establish the MCH “brand”.  It is our responsibility to create a strong, positive perception of the MCH program. The first line of the jingle “Come on down to MCH we have great, great service”, depicts the impression that we want our clients to know that we uphold.  The jingle is used in PSAs and other advertisements to promote programs, education, activities and services.

MCH took a public health approach to combat human trafficking. In order to raise community awareness Title V held a Human Trafficking Awareness training.  The focus of the territory-wide training was to provide an understanding of the basics of human trafficking  (force, fraud, coercion) to stakeholders and persons  involved in addressing human trafficking in the USVI. Presenters included Customs and Border Protection (CBP), Homeland Security Investigations (HSI), Virgin Islands Police Department, Family Resource Center, Department of Health and the Department of Human Services.  There were approximately eighty (80) participants territory-wide, 40 per district.  The participants included Departments of Health, University of the Virgin Islands, Family Resource Center, Department of Human Services, and the Department of Education. 

Maternal Health

Having a healthy pregnancy is one of the best ways to promote a healthy birth. Prenatal care is a pertinent part of staying healthy during pregnancy.  The MCH & CSHCN program continue to provide prenatal services territory-wide.  These services include prenatal intake for new patients whom the history, physical, risk assessment, Pap smear, and laboratory referrals are completed, routine follow-up and counselling, teen prenatal and perinatal and perinatal/high risk clinic.

The program employs two Nurse Mid-Wives, one in each district that provides prenatal services to non- high- risk clients.  When detected, the Nurse mid-wives refer all high-risk clients to the perinatologist. The territory has one perinatologist employed by the Department of Health.  The coordinated effort between the nurse mid-wives and the perinatologist has contributed to the low maternal mortality rate in the territory over the years.  The perinatologist provides service to the entire high-risk pregnant population in the territory.  Prior to the birth of the baby, the pregnant mother is introduced to the MCH high risk clinic.  This ensures the continuity of care for mother and baby.

Child Health

THE VI MCH program is one of the few programs that continue to provide direct services.  Services continue to well children 0-21 which includes health physicals, immunization, home visitations for health supervision as needed, high risk clinic, well baby clinics, new-born metabolic screening with genetic counselling for parents with newborn with positive results.  Because of the high rate of obesity in children in the nation, the USVI included, MCH monitors the BMI of all children.  The BMI is captured by the Department of Health’s electronic health records (EHR) system.

Parents of all babies born in the territory’s hospitals receive education on safe sleep and Sudden Infant Death Syndrome (SIDS). During the well-baby two-week visit, MCH public health nurses reinforce the teaching on SIDS. The well visit allows nurses to follow-up on early discharges from the hospital.  In collaboration with the Department of Human Services (DHS), the MCH clinic provides home visits when necessary to ensure the health and safety of the territory’s children. The WIC program supports all mothers with the desire for breastfeeding. MCH continues to encourage moms to breastfeed.  

Children with Special Health Care Needs

It is a well-known fact that unless addressed effectively, delays or disabilities experienced by a child from birth to 3 years of age can have a significant impact on his or her foundation for positive learning. The MCH continues to focus on the overall health and well-being of all children with special health care needs in the territory. 

The program continues to provide monthly diabetes clinics under the supervision of our staff pediatrician who works with the MCH social worker for off island evaluations and referrals, in the absence of an endocrinologist. Within the last two years our neurological needs have increased. Pediatric Neurological services is provided in the territory on a quarterly basis.   We continue to see babies born to Zika positive moms as well as those born to non-Zika positive moms. The supervision and monitoring of hemoglobin opathies children in the hemothology clinic continues. In the absence of a Pediatric hemathologist, all necessary referrals are initiated. In the St. Thomas/STJ district, the Asthma and Allergy pediatric population referrals are made to the East End Medical Center. In the St. Croix district once the clientele is established, an asthma clinic will be created. However, in the interim all asthmatics are followed by the paediatricians with an asthma plan that includes asthma control and asthma education.   An asthma home -based program will be developed to ensure that the homes are allergens free and environmentally healthy.  

Although some of the pediatric subspecialty providers are not in the territory, services continue.  The MCH social worker with direction from the staff pediatrician initiates the referral to MAP. The San Jorge children’s hospital in Puerto Rico and the Nicholas Children’s hospital in Florida has provided the necessary support for pediatric subspecialties.  The pediatric specialty services most often utilized are cardiology, urology, hematology an endocrinology. 

Adolescent Health

The MCH & CSHCN Program wants to advocate for Adolescents to have access to basic levels of health care. Discussions and strategic planning have been focused on how and where to provide confidential, appropriate care for their adolescents. The goal of MCH is to engage Providers through surveys on the best practices to address the concerns of their adolescent patients and ways to guide their development to managing their own health.  It is felt that Service providers will “play an integral role in the coordination of the comprehensive services that influence the health behaviors of adolescents”. Moreover, providers have the capacity to understand and facilitate entry to specialized services for those adolescents who require them.

Maternal, Infant, Early Childhood Home Visiting Program (MIECHV)

The MCH program is currently the lead in the territory for the MIECHV grant geared to improve health and developmental outcomes for at-risk children through evidence –based home visiting programs. The territory implemented two different models in the Virgin Islands; Nurse Family Partnership (NFP), located in the St. Thomas/St. John district and Healthy Families of America (HFA), located in the St. Croix district.  In 2019 collectively, both programs served 140 families. In 2019, thirteen (13) families graduated from the NFP program and three (3) from the HFA program.

In 2019 the program completed a Parent Engagement Survey to determine what families like about the program, what improvements they wanted to see, and how the program can continue to support the families it serves.  Overall, families were satisfied with the MIECHV Program.  They like the connections with the home visitors, from the in-person visits to parenting skills, along with community supports provided.

When COVID hit in March of 2020 and in-person visits were converted to telehealth visits, the program implemented weekly, bi-weekly and currently monthly conference calls for families to engage with one another with support professionals.  The initial calls were to support families with the challenges of the stay at home orders and how to support having multifamily members in the home 24 hours a day, seven days a week.  How to find resources or alternatives to resources that could not be found.

The MIECHV team networked with community partners to provide support to families in the areas of Self-Care, Domestic Violence, and Financial Strategies for coping with COVID, and Parenting Skills – the importance of breastfeeding and cultural sensitivity awareness when raising children of color.

Universal Hearing Screening

The purpose of the Universal Hearing Screening grant is to develop a comprehensive and coordinated, state-wide, Early Hearing Detection and Intervention (EHDI) system of care targeted towards ensuring that newborns and infants are receiving appropriate and timely services, including screening, evaluation, diagnosis, and early intervention (EI). 

In 2019, of the 1,114 babies born in the territory, 1,010 or 90% received hearing screening by one (1) month after birth. All children who are deaf or hard of hearing and their families should have access to timely and coordinated Early Intervention VI EDHI improved timeliness of referrals to Part C Early Intervention Services for new hearing loss cases and assured that consistent messages are presented to parents.

The EHDI program conducted outreach at public schools in the territory and performed hearing screening test to elementary school children. The screenings were conducted on kindergarten and six grade students. The screening result identified students at two schools that required further testing.  The students were referred to an audiologist. In 2019 VI-EHDI screened 1,025 elementary school students in the territory.

Zika

In 2016 MCH received the Zika Response and Preparedness grant from HRSA to have follow-up services for babies in the Zika population.  Those babies are followed for Audiology, Development, Ophthalmology, Orthopaedic, and Neurology services. The grant allowed for care coordination services directly to the families. 

In March 2018, the MCH program in conjunction with VI Epidemiology Division and the CDC partnered and conducted a Zika Health Brigade to provide vision, hearing, brain and developmental screenings to babies born to Zika positive mothers. 111 families were scheduled and 91 arrived for their appointments.  

A second Health Brigade was planned for March 2020 with 181 families scheduled for services, 92 in the STX district and 89 in the St. Thomas/St. John district. However due to the onset of Covid-19, the activity was postponed indefinitely.

The program submitted and received a No Cost Extension that allowed the program to continue to:

• Conduct care coordination,
• Provide transportation to population to assist  mothers with attending appointments
• Implement telehealth to provide the much-needed specialty services providers such as neurology, audiology, ophthalmology, etc.

Prior to the impact of the Covid-19 pandemic, plans were underway to move forward with the implementation of telehealth anticipated to be completed by May 31, 2020.  The contract for the selected company is awaiting signatures for final execution.  As a result of the need of social distancing and the stay at home order in place in the USVI due to Covid-19, many programs, including the MCH & CSHCN program, are being provided remotely, which highlights the need for a telehealth infrastructure.

Project Launch

In 2018, the Virgin Islands MCH program acquired VI Project Launch. The purpose of Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health) is to promote the wellness of young children ages birth to 8 years by addressing the physical, social, emotional, cognitive, and behavioral aspects of their development.  Since its inception, VI Project LAUNCH organized and accomplished various activities for Launch families. In conjunction with WIC and MIECHV, Launch conducted a Baby Shower & Information Session as well as a series of Mental Health Webinars in partnership with JW Behavioral Center.