Maine’s Title V Maternal and Child Health (MCH) Program, in partnership with the US Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA), is responsible for promoting the health of all mothers and children, including children with special health needs and their families.

Role of Title V

The Maine Title V program supports a statewide system of comprehensive and family-centered services. The Maine Center for Disease Control and Prevention (Maine CDC) houses the Title V Program along with other MCH programs such as WIC, Maine Families Home Visiting, Injury Prevention and Public Health Nursing (PHN). These programs work collaboratively to address the needs of the MCH population across the state.

Title V utilizes a significant portion of federal funding to support staff in the areas of PHN, CSHN and injury prevention to ensure meeting the needs of the state’s MCH population. Title V serves as a systems builder by funding the Maine Maternal, Fetal and Infant Mortality Review Panel, epidemiological surveillance, including the Maine Integrated Youth Health Survey, and program evaluation.

Maine Title V does not operate in isolation. Partnerships with other organizations are essential in our ability to expand capacity and reach across the state. The Title V Program collaborates with hospitals, Office of MaineCare Services, Office of Child and Family Services, Department of Education, Child Development Services, the Developmental Disabilities Council, universities and other stakeholders. Family involvement is encouraged in the areas of needs assessments, program planning and evaluation. To enhance capacity, the Title V Program contracts with several external agencies to ensure needed services are available to the MCH population.

Women/Maternal Health

Access to High Quality Healthcare

Access to care includes access to primary care, family planning services, prenatal care, oral health care, as well as mental health and childcare. Access to care is not universal across the state; women living in rural areas, minority populations, and women without health insurance, have more challenges accessing care. Having regular preventive health visits can help increase access to family planning and ongoing screening of physical and mental health conditions.

In 2020, about 75% of Maine women of reproductive age had a preventive medical visit in the previous 12 months. Maine ranked 13th highest in the U.S. on this measure and has slowly been improving since 2018.

Improve Care for Mental Health

In 2021, about 1 in every 4 (24%) pregnant persons had depression in the three months prior to getting pregnant. About 75% of pregnant persons had a health care visit prior to becoming pregnant. Of those who had a health care visit before they became pregnant, about 74% reported that a health care worker screened them for depression. During the prenatal period, 89% of pregnant people were screened for depression and 95% were screened in the postpartum period. These data suggest that Maine’s strategies of increasing the proportion of women who receive preventive care and encouraging mental health screening prior to pregnancy can effectively identify women with mental health challenges and refer them to treatment.

Analyses of perinatal mental health were conducted using PRAMS to inform Maine’s Title V priority, as well as highlight Maine DHHS collaboration on the topic of mental health. These analyses revealed that depression diagnoses prior to and during pregnancy have been increasing in recent years and factors such as stressful life events, unintended pregnancy, food insecurity, and intimate partner violence are associated with an increased risk of depression during pregnancy.

Perinatal/Infant

Infant Mortality

In 2021, 90.5% of Maine infants were most often placed to sleep on their backs only. Maine’s percentage is the second highest among states that participate in the Pregnancy Risk Assessment Monitoring System survey. The U.S. rate in 2020 was 79.8%.

The Maine CDC partners with all 22 birthing hospitals, safe sleep certified through Cribs for Kids, to reimburse them for safe sleep kits. We work with providers to ensure they check with the birthing person during pregnancy on where they plan for their infant to sleep and ensure families have the resources they need. We provide safe sleep training to all Office Child and Family Services caseworkers, Public Health Nursing, Maine Families home visitors and Office of Family Independence staff.

Increased Breastfeeding

Maine has had great success in encouraging breastfeeding (BF) initiation and promoting breastfeeding duration. Among Maine infants born in 2019, 86.6% were ever breastfed and 28.7% were exclusively breastfed for at least six months (both the 18th highest in the U.S.).

The Maine CDC and partner organizations assisted hospitals in adopting the tenants of Baby Friendly by ensuring staff were trained on breastfeeding best practices. Hospitals also worked to connect women, unable to produce milk and wish to use breastmilk, to milk donor sites. During the formula shortage in June of 2022, Northern Light Hospital opened a breast milk donation center.

All home visiting sites have certified lactation counselor trained staff available to support BF mothers, with several sites offering BF support groups. Maine’s WIC program provides extensive BF supports to eligible enrolled mothers, including lactation counseling and provision of breast pumps. 57% of public health nurses that provide MCH services are certified lactation counselors. 

Child Health

Early Detection and Intervention for Developmental Delay

When a developmental delay is not recognized early it can make it difficult for children to learn when they begin school. According to the 2020-2021 National Survey of Children’s Health, about 49% of Maine parents of children ages 9-35 months report that they were asked to complete a developmental screening tool for their child within the previous year. Maine ranked 2nd highest on this measure.

The Maine WIC, Public Health Nursing and Maine Families programs conduct developmental screens, document any developmental concerns and refer parents to the child’s medical provider for further review as indicated by the screening result.

Optimize Children’s Physical and Oral Health

In Maine, 33.6% of youth aged 6-11 years are physically active for at least 60 minutes per day. In 2020-2021 Maine ranked ninth on this performance measure.

The Maine CDC collaborates with Maine Roads to Quality, Department of Education, Maine Afterschool and Let’s Go! to identify sites (schools, childcare, and out of school programs) with policies that do not meet national standards for providing adequate and appropriate physical activity (lacking recess, physical education periods) and provides targeted professional development to enhance policies and practices that impact the quality and quantity of physical activity for children that attend those sites.

In 2020-2021, about 77% of Maine parents reported that their child had a preventive dental visit in the past year which is similar to the U.S. (75.1%), but the lowest in New England.[1] Maine’s performance on this measure has declined over time. In 2016-2017, 85% of Maine children had a preventive dental visit.

The Maine School Oral Health Program (SOHP) works to reduce tooth decay among Maine children and adolescents grades Pre-K through six. The SOHPs approach combines increased oral health literacy, providing classroom oral health resources for school nurses and collaboration with other dental stakeholders on oral health messaging.

Adolescent Health

Bullying Prevention

Based on Maine Integrated Youth Health Survey (MIYHS) data, the percent of high school students reporting that they were bullied on school property and the percent who have been electronically bullied had been declining, but in 2019 both percentages increased slightly, but not significantly. We do not know yet whether school closures necessitated by COVID-19 had any impact on bullying behavior. Schools and communities are increasingly recognizing the impact of bullying and harassment on students’ education success and mental and physical health. The Maine Department of Education (Maine DOE) provides ongoing training and technical assistance for school systems on implementation of required comprehensive model bullying and harassment prevention policies and procedures as well as trainings in other areas of best practice bullying prevention (http://maine.gov/doe/bullying). The Maine Center for Disease Control and Prevention’s Title V program supports Maine DOE staff to provide best practices in addressing bullying and harassment behavior in school settings, including integration of restorative justice practices.

Adolescent Mental Health

Unmet mental health needs represent a significant burden on the wellbeing of adolescents in Maine. In 2019, 32.1% of Maine high school students reported feeling sad or hopeless for two or more weeks at least one time in the past 12 months, a significant increase from 2017. We do not yet have data from the 2021 MIYHS to determine how the pandemic impacted adolescent mental health. However, based on syndromic data from emergency departments in Maine, there was an increase in visits to the emergency room for suicidal ideation and attempts during COVID-19. This was especially the case for adolescent girls. To address these concerning trends, the Maine Adolescent Health and Injury Prevention program supports programs that increase access to high-quality behavioral health services and prevention initiatives that emphasize resiliency and connectedness.

Children with Special Health Needs (CSHN)

Transition to Adult Care

In 2020-2021, parents of 33.8% of Maine CSHCN ages 12–17 reported that their adolescent received services to assist with transition; this is significantly higher than data from 2019-2020 and higher than the national figure of 20.5%. Among non-CSHCN parents, 29.6% reported that their child received services necessary for transition; this is significantly higher than the national average of 16.0%. Maine’s overall (CSHCN and non-CSHCN) percentage on this measure (30.8%) was the highest in the U.S. in 2020-2021; Maine ranked 3rd on this measure among CSHCN. An examination of the components of transition indicates that Maine providers could improve transition for youth by working more with youth to help them better understand how their health care changes when they reach age 18, including the need to shift to adult health care.

The Maine Parent Federation (MPF), Maine’s support organization for families of CSHN, focuses on care coordination and transition support. Through its Youth Coordinator, MPF provides training and Transition Resource Fairs through local school districts and offers both in-person and virtual Supported Decision-Making Training for students and professionals.

Care Coordination

In 2020-2021, only about 61% of parents of Maine CSHN reported that their children received effective care coordination when needed. Maine ranks 21st on the percent of children who receive effective care coordination.

The CSHN Program partners with the Maine Parent Federation to provide awareness of available care coordination resources.  The CSHN Program also collaborates with Help ME Grow, Child Development Services and the Maine Pediatric and Behavioral Health Partnership.

To increase access to care coordination for families, the CSHN Program works with the Maine Parent Federation family support navigators to respond to and assist with family needs.

[1] National Survey of Children’s Health, 2020-2021.