Virginia - 2024 - III.A.1. Program Overview

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Spanning from the Atlantic Ocean to the Appalachian Mountains, Virginia’s population of 8.63 million residents continues to increase annually, with 3.1 million residents (36%) residing in the Washington, D.C. metropolitan area, contrasted to 2,202 residents in rural Highland County, in the western edge of the Shenandoah Mountain range.

The Virginia Department of Health (VDH) works to “Protect the health and promote the well being of all people in Virginia”, with the vision to become the healthiest state in the nation. VDH’s core values are service, equity, and making data-informed decisions Virginia’s Title V Program resides within the Division of Family Health Services in the Office of Family Health Services. Virginia’s Title V Leadership Team provides programmatic oversight and ensures Title V’s alignment and connectivity across programs in VDH’s Division of Child Health Services, Division of Prevention and Health Promotion, and Division of Population Health Data. Virginia’s Title V Program strives to eliminate health disparities, improve birth outcomes, and improve the health and wellbeing of Virginia’s mothers, infants, children, and youth, including children and youth with special healthcare needs (CYSHCN) and their families. There are 15 state program managers, approximately 70 state-level staff and contractors, and over 110 local health district staff who are actively engaged in the development and implementation of the strategies and activities within Virginia’s Five-Year State Action Plan.

In Virginia, Title V serves as the foundational funding stream for state, regional, and local MCH programs, and is a critical public health infrastructure component. Title V provides essential financial and technical support to approximately 75 state programs and contracts across multiple statewide systems of services, including programs administered in local health districts, community collaborations and coalitions, and partnerships with other state and national organizations. Additionally, Title V funding supports the delivery of clinical services and health education within each of Virginia’s 35 local health districts (LHDs).

NEEDS ASSESSMENT

Virginia conducted a comprehensive statewide needs assessment in 2019. The key priorities identified during this assessment shape and drive the objectives and strategies for the 5-year period from 2020-2025. Virginia’s Title V leadership and domain subject matter experts engage in ongoing programmatic strategy and priority/goal setting across the six MCH population health domains: women/maternal health, perinatal/infant health, child health, adolescent health, children and youth with special healthcare needs, and cross-cutting/systems building.

Virginia’s Title V program prioritizes the state’s maternal and child health population who have been historically marginalized or made vulnerable through social injustices that negatively impact communities of color. This has led us to target our work to increase health equity through supporting community-driven solutions and tailoring efforts that have a direct link to eliminating the Black/White maternal and infant mortality disparity.

Strategic alignment and facilitation occurs across focused, multidisciplinary, collaborative, and inclusive internal and external subject matter experts and stakeholders that serve Virginia’s MCH population. Virginia’s Title V program also leverages robust family engagement–community, family, youth, and cultural brokers who are actively involved in the planning, development, and evaluation of programs across all domains.

A chart of key priority needs

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	PERFORMANCE MEASURES AND OUTCOMES
	Virginia ranks 14th for the overall health of women and children (2022)		IMPROVING
	Women’s/Maternal Health The maternal health priorities reflect: (i) ongoing need to address maternal morbidity and mortality, mental health for women of reproductive age, and risk factors associated with preterm births; (ii) promote equitable access to choice-centered, reproduction-related services, including sex education, family planning, fertility/grief support, and parenting support; (iii) maintain and expand state MCH data capacity, to include ongoing needs assessment activities, program evaluation, and modernized data visualization and integration; and (iv) maintain and expand access to oral health services. Title V strategies work with a diverse set of partners to improve the outcomes for women before, during, and after pregnancy.
11th overall for the health of women (2022)		WORSENING
46.3% of women had a preventive dental visit during pregnancy (NPM 13.1)		STABLE
Percentage of women reporting that they wanted to become pregnant later or never was 19.9% (2021)		IMPROVING
38.7% of pregnancies were described by women as unintended (2021)		IMPROVING
Maternal morbidity rate was 73.8 per 10,000 delivery hospitalizations (NOM 2)		WORSENING
non-Hispanic White – 55.5;		WORSENING
non-Hispanic Black – 124.6;		WORSENING
≥35 years – 98.6		IMPROVING
Maternal mortality rate was 26.8 per 100,000 live births (NOM 3)		WORSENING
non-Hispanic White – 24.6;		WORSENING
non-Hispanic Black – 55.0		WORSENING
Leading causes of pregnancy-associated deaths were COVID-19, accidental overdose, cardiac conditions, cancer, hemorrhage, and chronic disease exacerbations
Percentage of women who experienced postpartum depressive symptoms following a recent live birth was 11.2% (2021)		IMPROVING
Percentage of women who did not attend postpartum care due to COVID-19 pandemic was 7.1% (2021)		IMPROVING
Perinatal/Infant Health Strategies focus on improving birth and infant outcomes and expanding state MCH data capacity to include ongoing needs assessment activities, program evaluation, and modernized data visualization and integration, as well as statewide breastfeeding supportive efforts.
23rd overall for the health of infants (2022)		IMPROVING
87.4% of moms ever breastfed and 19.0% breastfed for 1-10 weeks; 57.7% were still breastfeeding at the time of the VA PRAMS survey		IMPROVING
Non-Hispanic White – 60.7%;		IMPROVING
Non-Hispanic Black – 43.2%;		IMPROVING
Non-Hispanic Other – 63.8%;		WORSENING
Hispanic – 58%		IMPROVING
Infant mortality rate was 5.9 per 1,000 live births (2020)		WORSENING
White – 4.6;		STABLE
Black – 10.1;		IMPROVING
Hispanic – 6.5		WORSENING
Leading causes of infant mortality: Respiratory distress disorders, accidental suffocation/strangulation, disorders related to short gestation & low birth weight, and sudden infant death syndrome
Child Health Title V’s work in child health focuses on strong systems of care for all children, finances as a root cause, oral health, and mental health.
14th overall for the health of children (2022)		IMPROVING
Percent of children, ages 9-35 months, who received a developmental screening using a parent-completed screening tool in the past year is 34.4% (NPM 6)		IMPROVING
Rate of hospitalization for non-fatal injury among children was 79.1 per 100,000 (NPM 7.1)		IMPROVING
<1 year – 204.6;		IMPROVING
1-4 years – 86.3;		IMPROVING
5-9 years – 49.8		IMPROVING
67% of children ages 1-5 years and 89.4% of children ages 6-11 years had a preventive dental visit (NPM 13.2)		IMPROVING
Adolescent Health Adolescent Health focuses include mental health, oral health, finances as a root cause, and strong systems of care for all children.
Rate of hospitalization for non-fatal injury among adolescents was 180.2 per 100,000 (NPM 7.2)		WORSENING
10-14 years – 92.0;		IMPROVING
15-19 years – 265.8		WORSENING
44.9% of middle school students experienced at least one form of bullying, bullying on school property or cyberbullying (2021) Those who experienced cyberbullying were more likely to report suicidality (48.9%), not feeling good about themselves (62.6%, n = 328), ever drank alcohol (32.0%), and ever-used electronic vapor products (14.1%).		IMPROVING
17.9% of high school students were victims of any form of bullying (2021) Those who experienced cyberbullying were more likely to report feeling sad for 2 weeks or more (74.0%), current alcohol use (40.6%), suicidality (56.4%), purposely hurting themselves without wanting to die (51.7%), electronic vapor products use (34.1%) and current marijuana use (24.6%).		IMPROVING
14.4 % of adolescents received services necessary to make transitions to adult health care (NPM 12)		WORSENING
88.6 % of adolescents (ages 12-17) had a preventive dental visit (NPM 13.2)		IMPROVING
Teen pregnancy rate is 15.1 per 1,000 females ages 15 to 19 years		IMPROVING
Children with Special Health Care Needs CYSHCN focuses on strong systems of care for all children, finances as a root cause, and community, family, and youth partnerships.
Percent of children with special health care needs (CSHCN) is 18.5% (NOM 17.1)		IMPROVING
43.9% of CSHCN had a medical home (NPM 11)		WORSENING
19.5% of CSHCN age 12-17 years were engaged in transition services to adult health care (NPM 12)		IMPROVING
66.4% of CSHCN continuously and adequately insured (NPM 15)		WORSENING
Cross-Cutting / Systems Cross-cutting strategies include upstream/cross-sector planning, and racism as a root cause.
Expand capacity to document and track referrals of infants from the Newborn Screening Program to CSHCN programs
Develop and sustain the VDH Youth Advisor Program
Implement MCH workforce development policies addressing racial equity
Maintain and expand family engagement

Worsening – Change in rate or percentage of 1% or greater in the wrong direction

Stable – Change in rate or percentage was 1% or less

Improving – Change in rate or percentage of 1% or greater in the right direction

IMPROVING THE HEALTH AND WELLBEING OF VIRGINIANS

Virginia’s Title V Program is committed to the assurance of health and wellbeing for all people in the Commonwealth. Title V’s programs and services focus on issues of equity, addressing the needs of underserved populations, and where there is demonstrated need. Funding supports strong programmatic efforts that synthesize the key state priorities into actionable strategies.

WOMEN/MATERNAL HEALTH The health and wellbeing of people of reproductive age is significantly impacted by the care they receive. Broad initiatives by Virginia’s Title V Program to decrease the disparity in Black-White maternal mortality includes strengthening data-driven strategies in partnership with our MCH Epidemiology Team, utilizing community stakeholders to implement maternity mortality review team recommendations, increasing access to doula support for all Virginians, improving access to pregnancy prevention, and ensuring that pregnant women have their dental health needs met. Strong mental health initiatives address substance use in pregnant and parenting people, and pregnancy loss support in collaboration with our Reproductive Health Unit.

PERINATAL/INFANT HEALTH A critical priority remains supporting healthy pregnancies and improving birth and infant outcomes. Partnerships with birthing hospitals, the Virginia Neonatal Perinatal Quality Collaborative, Virginia’s network of home visiting programs, all 35 local health districts, and local stakeholder groups strive to ensure healthy and supportive environments for Virginia’s babies through perinatal programming that supports breastfeeding, assures infant safety, and scaffolds around substance-exposed infants.

CHILD HEALTH Early identification of developmental delays and social-emotional challenges is a critical priority. Core program components include training providers to support parents in completing Ages & Stages Questionnaires and identifying and promoting best practices that assure families receive appropriate referrals for further assessment, specialized intervention, or ongoing monitoring. Close partnership home visiting and various interagency initiatives prepare a workforce poised to seamlessly support health, development, learning, and school success. Strategies regarding injury prevention and oral health are prioritized for Virginia’s children as well.

ADOLESCENT HEALTH A comprehensive structure exists to reduce adolescent and young adult suicide rate as well as to increase protective factors and improve systems to reduce risk factors associated with adolescence. Virginia’s Title V program implements evidence-based comprehensive sexual education programs, provides suicide prevention trainings to professionals interacting with adolescents, supports pregnant and parenting teens through the Resource Mothers program, and ensures that school nurses have ongoing professional development and support.

CHILDREN AND YOUTH WITH SPECIAL HEALTHCARE NEEDS Through excellent stakeholder partnership to provide diagnostic and case management support in Care Connection for Children and Child Development Clinic across the state, Virginia’s children with special healthcare needs receive coordinated and ongoing comprehensive, interdisciplinary support to ensure their access to medical homes and transition services.

CROSS-CUTTING/SYSTEMS-BUILDING Virginia’s robust newborn screening program ensures early connections for families to supportive services. Virginia’s two youth advisors provide expertise, guidance, and feedback on current and future public health initiatives, and additional collaborative work examines and addresses methods through which racial equity is advanced across all MCH populations.

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III.A.1. Program Overview - Virginia

III.A.1. Program Overview - Virginia