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. In 2022, DC Health’s Community Health Administration developed the Framework for Improving Community Health to guide its actions to improve population health in the District of Columbia. The framework is designed to: Prevent the leading causes of death, Protect and promote the health of mothers and children, and ultimately eliminate racial and ethnic disparities in health.

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.  It 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 rates of experiencing a preterm live birth (12.4%) and one in ten non-Hispanic Black mothers had gestational hypertension, significantly higher than non-Hispanic white and Hispanic mothers in the District. Other maternal pre-pregnancy health characteristics and health behaviors among Non-Hispanic Black women showed that (6.7%) smoked before pregnancy, (60.8%) were overweight or obese, (1.7%) had diabetes before becoming pregnant, and (5.2%) had hypertension before becoming pregnant compared to their White counterparts (1.0%, 27.2%, 0.5%, 1.1%, respectively). In 2021, 93% of white non-Hispanic mothers had some type of health care visit in the 12 months before pregnancy compared to 61% of Black Non-Hispanic mothers.

The driving principles of our approach include: using a life course perspective, recognizing that a person's health is determined by factors present before 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.

DC Health’s framework to improve MCH outcomes is based on the overarching goal of ensuring 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 the 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, care coordination, support services, and document Quality Improvement and Quality Assurance 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, mom, and dad 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.

Findings from the Five-Year Needs Assessment (2020) and emerging needs identified since that time have informed the selection of nine MCH priority needs:

1. Improve women’s reproductive health.
2. Decrease perinatal and infant health disparities.
3. Improve the 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 informed the selection of the National and State Performance Measures and Evidence-Based or-Informed Strategy Measures for the Title V MCH Block Grant.

In FY22, 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 quarterly.  In June 2021, as part of the new FY21-FY25 five-year grant cycle, nine 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, a limited number of health systems, and high political will to improve MCH outcomes) while addressing priority needs. The annual National Maternal and Infant Health Summit was launched in the District to create an opportunity to bring together elected officials, health experts, and community members to have a focused conversation regarding perinatal health and racial disparities in birth outcomes.

The District Title V director and other Title V team members participate in different committees and task forces such as the Maternal Mental health task force, Maternal Mortality Review Committee, Perinatal mental health taskforce, Healthy Youth and Schools Commission, Community Schools Advisory Committee, The Coordinating Council on School Behavioral Health, Domestic Violence Fatality Review Board, Lactation Commission, Fetus and Newborn Committee, Child Fatality Review Committee’s (CFRC) Infant Mortality Review (IMR) Sub-Committee and Mayoral Perinatal and Infant Health Advisory Committee to promote better MCH outcomes in the District.

Title V Population Domains:

A synopsis of DC Title V activities grouped based on the District’s Title V population domains is discussed below.

Women/Maternal Health

The DC Pregnancy Risk Assessment Monitoring System (PRAMS) estimates that 67.0% of mothers who gave birth in 2021 had a health care visit for a regular visit with an OB/GYN and 51.6% had a health care visit with a family doctor in the 12 months before pregnancy. The health status of mothers, infants, and children is an important indicator of the future health status of DC residents. Improving women’s reproductive health and promoting equitable access to care are some ways to ensure a healthier future for DC residents.

In FY22 DC Health continued to fund and support PRAMS, an ongoing, population-based survey of DC residents who delivered a live-born infant. PRAMS collects data on maternal behaviors and experiences from preconception to the postpartum period.

The District continues to prioritize increasing access and utilization of preventive healthcare services for women of reproductive age, especially those with healthcare access limitations.  In FY22, Title V continued to fund two FQHC La Clínica de Pueblo’s, Mujeres Saludables (Healthy Women) Program and Unity Health Care Well Woman Project focusing on NPM1. Both grantees are aimed at increasing the utilization of preventative services among patients of reproductive age and decreasing no-shows for well-women and prenatal appointments.  They employed a family practice model of care rooted in a holistic approach and utilized strategies like SDOH screening, integrating referrals to the special supplemental nutrition program for Women, Infants, and Children (DC WIC), and media campaigns to eliminate barriers to care.

Perinatal/Infant Health

DC Health is driven to continue supporting efforts addressing infant mortality, especially among infants of non-Hispanic black mothers with a significantly higher infant mortality rate (10.0 per 1,000 live births) compared to infants of Hispanic mothers (3.6 per 1,000 live births) and infants of non-Hispanic white mothers (2.0 per 1,000 live births).

The DC Title V team collaborates with the District’s HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA) to address emerging infectious disease issues among pregnant women and infants in the District. As part of efforts towards addressing these issues, DC Health is planning a collaborative community outreach plan to promote awareness on diagnosis and treatment to providers and pregnant women. Strategies to reinforce screening guidelines with providers and ensuring access to quality prenatal care will be implemented.

DC Health has continued to fund and collaborate with the District of Columbia Hospital Association (DCHA) to develop and administer the District of Columbia Perinatal Quality Collaborative (DCPQC). Key activities for FY22 included facilitating the Collaborative's participation in the Alliance for Innovation on Maternal Health (AIM); implementing and evaluating programs and services designed to promote patient safety; educating providers, patients, and the larger community on data-driven quality maternal health care and associated outcomes; and fostering a culture of high quality, accountable, and accessible maternal health services in the District.

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. DC Health Title V staff operationalize the requirements of these policies.

In FY22, Title V supported DC’s Early Hearing Detection and Intervention (EHDI) Program expansion of the OZ Newborn Screening Database. DC EHDI anticipates Telepathy EHDI to be implemented in all birthing hospitals. Telepathy EHDI is a software tool that captures results directly from screening devices and will assist in the reduction of missing newborn hearing screening results.

The DC Breastfeeding coalition continued to utilize Title V funds to focus on NPM 4 to promote, protect and support culturally sensitive programs and activities that build awareness and understanding of the preventive health benefits of breastfeeding in FY22. Through strategies involving breastfeeding research, providing advocacy and educational activities, lactation support training, and breastfeeding consults, the Coalition seeks to reduce health disparities -- particularly among racialized families living in DC communities with limited resources.

Child Health

The 2020-2021 National Survey of Children’s Health states that 66.2% of parents of children ages 9 through 35 months did not complete developmental screening. Birth to three years of age are critical years of social, emotional, and cognitive development that prepare children for school and beyond.  Because development is critical in ages 0-5, DC strategically targets children with programs that help families navigate the developmental stages. DC Health staff continues to oversee the DC Maternal, Infant, Early Childhood Home Visiting (MIECHV) program through the implementation of two (2) evidence-based home visiting models with fidelity: Parents as Teachers (PAT) and Healthy Families America (HFA).

Parents as Teachers (PAT) is an evidence-based home visiting model that provides virtual or in-home visiting services in Wards 5,7, and 8 from pregnancy until the child is three years old.

Under the Birth-to-Three for All DC Amendment Act of 2018, DC Health has provided local funding for evidence-based and promising practice home visiting programs. The local home visiting programs in DC include Nurse Family Partnership First Time Mother’s Home Visiting program, an evidence-based program designed to improve pregnancy outcomes, child health and development, and the family's economic self-sufficiency. The target population is pregnant women in their first or second trimester preparing to give birth to their first child, and services last until the child’s second birthday. The Perinatal Health Worker Training Program (PHWT) program prepares women to serve within their own communities. Women receiving training through the PHWT program are uniquely positioned to serve the perinatal community in a myriad of capacities, including direct perinatal care and support, advocacy and policy engagement, and entry-level social work and public health careers. The Parenting Support Program is a home visiting program that supports parents with intellectual disability or other developmental disabilities (IDD) who are pregnant or parenting children ages 0-5. In FY 22, Enrollment numbers were as follows: Mamatoto completed 37 trainings, Parents as Teachers: 58, Parenting Support: 24, and Nurse Family Partnership: 21 Families.

In FY22, DC Health continued to partner with the Office of the State Superintendent of Education (OSSE) on NPM 6 to facilitate data sharing 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 FY22, 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 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. DC Health and DCPS coordinated efforts to increase access to required childhood vaccinations by expanding the reach of SBHC locations to all district residents ages 4 to 19.

Adolescent Health

Adolescents in the District of Columbia (DC) experience various health issues, including poor mental health.  According to the 2021 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 The survey revealed that 19.3% of middle school students and 25.4% of high school students reported that their mental health was mostly or always not good (including stress, anxiety, and depression, during the 30 days before the survey).

To help increase linkages to and navigation through a medical home for adolescents, DC Health encourages and empowers students to utilize their school-based health centers as their medical home.  Title V supports (DC Health) staff overseeing the locally funded School-Based Health Center Program (SBHC), which addresses each priority need.

During FY22, DC Health oversaw 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. Services provided by each School-Based Health Center include preventive and primary care, sexual and reproductive health care, oral health care, behavioral/mental health care, health education, and linkages/referrals.

In FY22, DC Health began implementing the Human Resource and Service Administration (HRSA) grant that expanded DC's Pediatric Mental Health Care Access (PMHCA) program. DC Health continued the interagency partnership with the District of Columbia Department of Behavioral Health (DBH) to implement the DC Mental Health Access in Pediatrics (DC MAP) program. DC MAP promotes improving behavioral health in the pediatric population by integrating behavioral health with pediatric primary care through consultation, training, and technical assistance.

In FY22, Title V funded a bilingual Family Support Worker to support the achievement of NPM11 at one of the FQHCs. Working within an existing School-Based Mental Health (SBMH) program, the FSW educates students and families about the importance of selecting a medical home and assisting with referrals to care and enrollment into medical home services at Mary's Center.

Children with Special Health Care Needs

The 2020-2021 National Survey of Children’s Health states that 18.3% of District families reported that their child has a special health care need (CSHCN). CSHCNs are more impacted by health inequities than children without special health care needs.  The DC Title V program has prioritized using a systems-level approach to improve quality and access to services for CSHCN.

In FY22, Title V continued to fund and provide programmatic and technical assistance to 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 on accessing 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 CSHCN in their transition into adult care (NPM12). The Title V program has also made it its mission to utilize DC Health's resources to convene and engage multiple stakeholders (internally and externally) to improve the efforts to further reach the CSHCN population in the District.

Title V partnered with the Advocates for Justice and Education, Inc (AJE), a parent-led Community-Based Organization (CBO) based in Ward 8, to support and advocate for CSHCN. An additional CSHCN Subject Matter Expert position was created on the MCH Advisory Council. The assigned AJE representative provides advice on improving the health of CSHCN and required support to their families.

Title V leverages evidence-based resources such as the Blueprint for Change Framework by the Health Resources and Services Administration (HRSA) and CYSHCN current initiatives by the Association of Maternal & Child Health Programs (AMCHP) to guide the development of a 5- year strategic plan, inform activities, and structure stakeholder conversations ultimately to fully meet the needs of the Districts CSHCNs in FY23. A Request for Applications (RFA) to improve care for CSHCN based on the identified goals in the strategic plan will be published in FY24.

Cross-Cutting/Systems Building

Healthy food access is a priority for DC Health. In the District, 32.8% and 26.6% of adult residents do not eat even one serving of fruit or vegetables per day, respectively. Furthermore, 21.2% of Black households with children aged 0-5 reported food insecurity.1 These rates are higher in neighborhoods with poor or limited access to full-service grocery stores. Access to healthy and affordable food options enables people to make healthy food choices. Because of this clear lack of access, DC Health funds Healthy Corner Stores, Joyful Food Market, SNAP-Ed and Produce Plus. Supporting such programs improves the nutrition environment and reduces barriers to accessing healthy foods.

The DC Title V team recognizes the significance of data in identifying and designing crosscutting strategies to enhance impact across the Title V population. Data collected from the programs mentioned in this overview provide a robust understanding of the needs and programmatic impact in the District. However, our team experiences data analysis barriers because of data integration gaps. That is why the State Title V Director supports the State Systems Development Initiative (SSDI) by coordinating internal stakeholders to assess needs in the data infrastructure and propose linkages among MCH-related datasets using modern linkage technology.