Section III.A.1. Program Overview

North Dakota’s Framework:

The mission of the NDDoH is to improve the length and quality of life for all North Dakotans. To accomplish the mission, the NDDoH is committed to improving the health status of the people of North Dakota; improving access to and delivery of quality health care and wellness services; promoting a state of emergency readiness and response; achieving strategic outcomes using all available resources; strengthening and sustaining stakeholder engagement and collaboration; and managing emerging public health challenges. The NDDoH includes six sections: 1) Administrative Services, 2) Laboratory Services, 3) Health Statistics and Performance, 4) Disease Control and Forensic Pathology, 5) Health Response and Licensure, and 6) Healthy and Safe Communities. Employees in these sections provide public health services that benefit North Dakota citizens and ultimately make the state a healthier place to live. The below figure details relevant indicators of the health and well-being of the North Dakota population, including the maternal and child health (MCH) population-based data from the 2020 Census.

The Healthy and Safe Communities section is responsible for administrating the state’s Title V program. There are four divisions and one office in the section which all have programs and/or funding that link to the MCH priority areas: 1) Division of Community and Health Systems, 2) Division of Family Health and Wellness, 3) Division of Health Promotion, 4) Division of Special Health Services (SHS), and 5) the Health Equity Office. Title V also provides a portion of funding to the vital services of information technology, contract and grant management, and epidemiological support that assist MCH staff with critical job functions.

The Title V Director serves as the Section Chief for the Healthy and Safe Communities Section and serves as a member of the NDDoH’s senior management team; thereby, increasing leadership and visibility for MCH within the department.

Five-Year MCH Needs Assessment

Title V programs and priority areas set their own goals. The overarching Title V goals were established as a result of the 2021-2025 comprehensive Five-Year Needs Assessment. The Title V Leadership Team (Title V Director, Children with Special Health Care Needs (CSHCN) Director, Health Equity Director, MCH Epidemiologist and the State Systems Development Initiative (SSDI) Grant Coordinator) meet regularly to assure these goals are being met. In addition to the Five-Year Needs Assessment, the 10-step conceptual framework continues to be followed for the on-going needs assessment process.

Prevent Child Abuse North Dakota (PCAND) administers the state’s Maternal, Infant, and Early Child Home Visiting (MIECHV). A partnership between PCAND and the NDDoH was used to complete the 2020 MCH needs assessment process. PCAND and the NDDoH hosted several information-gathering partnership meetings, Work-As-One: Needs Assessment Integration, between November 2018 and December 2019. These meetings were held to learn what other agencies/programs are doing around needs assessments and explore collaborating and streamlining needs assessment processes. After having discussions with other states, North Dakota determined that the State Health Improvement Plan (SHIP) and State Health Assessment (SHA) would also be integrated into the process. In January 2020, meeting attendees were tasked with assisting in the prioritization process by providing feedback for each specific data area. The input from partners that was obtained helped the Title V Leadership Team to establish the North Dakota Title V MCH priorities that are in place today.

The needs assessment process requires ongoing analysis of sources of information about MCH status, risk factors, access, capacity, and outcomes. Needs assessment of the MCH population in an ongoing collaborative process, one that is critical to program planning and development and enables the state to target services and monitor the effectiveness on interventions that support improvements in the health, safety, and well-being of the MCH population.

The North Dakota Work-As-One Needs Assessment Integration team

Identified Priorities:

The following priority needs outline the overarching goals in each of the five Title V population health domains. Focus areas were created within each priority to further delineate and communicate the most pressing needs for the populations. This internal process was designed to organize and identify the highest priority areas for Title V effort and investment.

Women's/maternal domain: Well-woman visit with an emphasis on minority and low-income women

• North Dakota Priority: Percentage of women, ages 18 through 44, with a preventive medical visit in the past year.

• Significant Accomplishment: Title V staff assisted to help successfully implement the extension of Medicaid eligibility to 12 months postpartum. This will officially go into effect on January 1, 2023.

Perinatal/infant domain: Breastfeeding with a priority amongst minority, low-income, and American Indian women

• North Dakota Priority: a) Percentage of infants who are ever breastfed; b) Percent of infants breastfed exclusively through 6 months.

• Significant Accomplishment: For the period of Federal Fiscal Year (FFY) 2021, fourteen new businesses were designated as Infant Friendly Workplaces.

Child domain: Physical activity and nutrition (overall obesity prevention)

• North Dakota Priority: The percentage of children, ages 6 through 11, who are physically active at least 60 minutes per day.

• Significant Accomplishment: North Dakota was chosen as one of three states by the Association of State Public Health Nutritionists to participate in the Children’s Healthy Weight State Capacity Building Program. This helps states identify ways to increase MCH nutrition competency and optimize nutrition-related data sources (https://asphn.org/chw-state-capacity-building-program/).

Adolescent domain: Adolescent well visits emphasizing overall health, including depression screening, obesity prevention, and immunization

• North Dakota Priority: Percentage of adolescents, ages 12 through 17, with a preventive medical visit in the past year.

• Significant Accomplishment: North Dakota’s Children with Special Health Care Needs (CSHCN) Director, a Title V staff member, and North Dakota Medicaid partners comprised a core team chosen to receive technical assistance from the Center for Healthcare Strategies to improve attendance at annual Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) visits.

Children with Special Health Care Needs (CSHCN) domain: Transition from pediatric to adult health

• North Dakota Priority: Percent of adolescents with and without special health care needs, ages 12 through17, who received services necessary to make transitions to adult health care.

• Significant Accomplishment: Following year-two of data collection, every pediatric provider in the state received a transition toolkit for providers from Got Transition. Sustained work efforts to continue dissemination of transition toolkits will remain an action item for Title V staff.

Crosscutting domain (state priority measure): Maternal and Child Health (MCH) Workforce Development

• A well-trained maternal and child health (MCH) workforce is the first line of defense to prevent disease, protect health and keep the MCH population safe. State Title V staff are able to avail themselves of various professional development opportunities in order to build their capacity as part of the MCH workforce. Most recently, state staff and partners are currently able to register for courses to obtain a MCH Certificate through a contract with North Dakota State University.

Crosscutting domain (state priority measure): Implement North Dakota state mandates delegated to the North Dakota Department of Health’s Title V/MCH Programs

• Priorities are often influenced by state mandates, which are generally reflective of expressed needs within the state over time. North Dakota has several mandates addressing the health of the maternal and child health (MCH) population that direct Title V work efforts and require significant resources for successful implementation. The inclusion of these mandates epitomizes the successful federal/state partnership by honoring a state's unique priorities.

Crosscutting domain (state priority measure): Vision Zero, North Dakota’s traffic safety strategy

• Vision Zero. Zero fatalities. Zero excuses. – was unveiled in January 2018 (https://visionzero.nd.gov). The strategy promotes personal responsibility and recognition that serious injuries and fatalities are preventable.

Five-year action plans containing evidence-based, evidence-informed and/or promising practice strategies were developed with collaborative partnerships for all priorities. (https://www.health.nd.gov/north-dakota-mch-work-plans).

Assuring Comprehensive, Coordinated, Family-Centered Services

North Dakota places a high value on family-centered partnerships, family feedback, and collaboration. An example includes the Division of Special Health Services (SHS) partnership and contracted services with Family Voices of North Dakota. Family Voices of North Dakota supports statewide family-centered care for all children and youth with special health care needs and/or disabilities. SHS also utilizes a Family Advisory Council composed of family members of individuals with special health care needs. This council advises SHS on the family/parent perspective regarding issues, needs, and services, influences the direction of policies, contributes to program improvement, and ensures a voice for families and individuals with special health care needs to improve the system of care. CSHCN programs use meetings with this council to gather feedback from families to identify specific needs and future directions for meaningful services.

Efforts to Improve Outcomes

The strength of North Dakota Title V lies in the established and new partnerships that help expand the work of reaching women, infants, children, CSHCN and families. Federal and non-federal funds are leveraged to deliver programs, services and create a statewide system of collaboration. However, it should be noted that due to the smaller size of the state, forming new partnerships has been challenging within select MCH domains. Each population domain describes opportunities for braiding and layering of funds and resources within the completed annual reports and annual plans, work efforts utilizing quality improvement strategies, and methods to include health equity into programmatic activities. This has ensured that activities are meeting the needs of the MCH population, as a wide variety of perspectives take part in creating the annual work plans.