Through the implementation of data-driven, evidence-based/informed initiatives, Texas remains committed to the Title V vision of improving the health and well-being of the nation’s mothers, infants, children and youth, including children and youth with special health care needs (CYSHCN) and their families. Texas continues to emphasize ongoing surveillance, needs assessment, evaluation, and research for programming throughout the lifecourse. Texas focuses on enhancing family partnerships, addressing community-level drivers, and reducing health disparities in all population domains. State priorities to support this vision reflect the specific needs identified through a comprehensive five-year needs assessment (NA). The Texas Department of State Health Services (DSHS) recently completed this NA, which informed the State Priority Needs (SPNs), National Performance Measures (NPMs), and State Performance Measures (SPMs).

The Texas Title V Maternal and Child Health (MCH) NA consisted of a four-pronged approach for data collection and analysis and included surveys, key informant interviews, focus groups, and analysis of existing data and surveillance data. Through collaboration and engagement with MCH stakeholders and families, Texas DSHS worked to ensure that there was broad representation of the diverse experiences, populations, regions, and needs that reflect the diversity of Texas. The SPNs that were identified through analysis of the NA findings and through partner feedback are:

1. Implement health equity strategies across all maternal and child health populations. 
2. Improve nutrition across the life course.
3. Improve the cognitive, behavioral, physical, and mental health and development of all MCH populations.
4. Increase family support and ensure integration of family engagement across all MCH programming.
5. Support health education and resources for families and providers.
6. Promote safe, stable, nurturing environments to reduce violence and the risk of injury.
7. Improve transition planning and support services for children, adolescents, and young adults, including those with special health care needs.
8. Support comprehensive, family-centered, coordinated care within a medical home model for all MCH populations.
9. Improve maternal and infant health outcomes through enhanced health and safety efforts.

Based on the NA findings, Texas selected the following NPMs and developed the following SPMs for the FY21-FY25 Title V MCH Block Grant cycle:

Through NPMs, Texas is focusing on breastfeeding, safe sleep, developmental screening, injury prevention, medical home and transition for children with special health care needs, and maternal and household smoking. SPMs include community inclusion for CYSHCN, child obesity, infant mortality disparities, maternal morbidity disparities, and maternal health and safety. Though many of the performance measures remain the same from the previous five-year cycle, the strategies, activities, and programming have evolved and will continue to see enhancements throughout the coming years due to ongoing evaluation and NA. Family Partnerships, Community-Level Drivers, and Health Disparities and Inequities remain a focus of all areas of Title V programming and serve as the foundation of efforts to move the needle for all MCH populations in Texas.

Texas MCH provides education, awareness, support, and resources to improve the health of women, infants, children, adolescents, and CYSHCN throughout Texas. For regional population-based activities, critical partnerships inform the development and implementation of precision public health activities in local areas by focusing on data, state and national priorities, and community needs to prioritize and determine local initiatives.

As COVID-19 continues to affect the lives of Texans, Texas Title V has played a critical role in supporting families, assisting with state public health follow-up efforts, and providing essential data and epidemiology supports to agency and state leadership.

Maternal and Women’s Health

There continues to be a focus on severe maternal morbidity and maternal mortality. DSHS has made progress in building infrastructure and capacity to promote prenatal care, health, and wellness among women of child-bearing age (WCBA) through the efforts of women’s health programming and other statewide initiatives, such as the Maternal Mortality and Morbidity Review Committee (MMMRC) and Healthy Texas Mothers and Babies (HTMB). The MMMRC is a 17-member group that is legislatively mandated to study maternal mortality and morbidity in Texas. Through HTMB, Texas aims to improve maternal and infant health by advancing quality and evidence-based prevention for all Texas mothers and babies. HTMB engages community partners to strengthen networks for collaboration, innovation, and collective impact through local community coalitions and workgroups. The HTMB Perinatal Quality Improvement Network drives system changes to support adoption and diffusion of quality improvements for maternal and infant health and safety. This is accomplished through the MMMRC, the Texas Collaborative for Healthy Mothers and Babies (TCHMB), and the Texas Ten Step Star Achiever Initiative to improve maternity care practices in birthing facilities.

DSHS was designated as the lead coordinating agency to implement Alliance for Innovation on Maternal Health (AIM) bundles. The TexasAIM initiative was launched in June 2018. Nearly all of Texas’ hospitals with obstetric lines of service are enrolled in TexasAIM. These hospitals represent approximately 98% of all the birthing hospitals in Texas and provide care for approximately 99% of the births in Texas and approximately 9.9% of the births in the nation. After a pause due to COVID-19, TexasAIM’s Severe Hypertension in Pregnancy Learning Collaborative and Opioid and Substance Use Disorder Innovation and Improvement Learning Collaborative activities will resume in FY2023. TexasAIM continues to provide support for the Obstetric Hemorrhage bundle on an as-needed basis. To increase family and medical professional awareness about serious pregnancy-related complications and urgent maternal warning signs, DSHS is implementing the Hear Her Texas public outreach campaign.  DSHS continues outreach efforts through collaboration with partners to educate the public on risks of tobacco exposure among pregnant women and children. DSHS incorporates tobacco prevention messaging into clinical policy, provider and Community Health Worker training, and other platforms.

Perinatal/Infant Health

Texas continues to develop, implement, and evaluate comprehensive programs to address known barriers to and increase support for breastfeeding. DSHS implements a robust slate of activities to leverage and build upon previous successes and to address known barriers to breastfeeding. The number of Texas Mother-Friendly Worksites, Texas Ten Step Hospitals, and Baby-Friendly Hospitals continues to grow as DSHS reaches across employment and health care systems to provide information, education, communication, and technical assistance to facilitate system improvement as well as recognition for uptake of recommended practices. More than 85% of Texas births now occur in facilities working to improve utilization of the Ten Steps to Successful Breastfeeding, an evidence-based bundle of practices to improve infant feeding and infant health outcomes.

Texas NA data shows disparities in sleep-related infant deaths. DSHS and the Texas Department of Family and Protective Services (DFPS) continue to work together to address preventable child deaths through development of an interagency strategic communications plan. DSHS drafted a strategic communication plan informed by the American Academy of Pediatrics, the national Safe to Sleep campaign, and the National Action Partnership to Promote Safe Sleep.

Although Texas has made progress in reducing infant mortality, data continues to show disparities between Black and White birth outcomes. Texas developed a SPM to reduce the ratio of White and Black infant mortality by addressing safe sleep, breastfeeding, timely prenatal care, and access to and awareness of other public health interventions among Black women in Texas.

Child Health

Child Health initiatives focus on developmental screening, injury prevention, secondhand smoke reduction, and obesity prevention. Developmental screening is a priority in Texas, as 63% of parents report that they did not complete a developmental screening with their doctor for their child. MCH will lead Help Me Grow Texas (HMGTX), a statewide network of partners working together to build strong, connected communities and healthy, resilient families. HMGTX promotes early identification of developmental concerns, then links children and families to community-based services.

Injury prevention is a large component of both the Child and Adolescent Health Domains. Child injury continues to be one of the leading causes of death for children aged 1 to 14 years of age, and non-natural child deaths frequently involve motor vehicle crashes, drowning, and child abuse and neglect. Title V administers programs including Child Fatality Review (CFR) to understand child deaths through multidisciplinary review on the local level.

Obesity is at the heart of many health issues in Texas across the lifespan. Obesity prevention interventions have the potential to greatly reduce disease burden and improve the overall health of Texans. Expansion and increased use of School Physical Activity Nutrition (SPAN) data to inform population-based and targeted prevention/intervention for obesity reduction will be critical for success.

Reducing secondhand smoke exposure is important throughout the life course. Through collaborative partnerships with the DSHS Tobacco Prevention and Control Program, MCH populations are educated on the health effects of secondhand smoke exposure, especially in pregnant women and children. 

Adolescent Health

By utilizing Positive Youth Development (PYD) as a foundation for activities, DSHS will continue to focus on injury prevention. DSHS sponsors a Youth Engagement Specialist to support youth interested in becoming leaders within their community, region or state through participation in councils, workgroups and committees. DSHS supports prevention initiatives for suicide and self-injury. Through injury prevention efforts, conferences, and Child Fatality Review Team trainings, DSHS works to promote collaboration and best practice sharing among injury prevention professionals to reduce injuries and hospitalizations. DSHS leads statewide initiatives and partners with clinic-based contractors to address these priorities by supporting youth-friendly improvement activities and incorporating best practice as it pertains to obesity, screening and referral of high-risk issues.

Children with Special Health Care Needs (CSHCN)

The CSHCN Systems Development Group (SDG) works to strengthen community-based services to improve systems of care for CSHCN, including clients receiving health care benefits through the State’s CSHCN Health Care Benefits Program. The SDG focuses on meeting federal expectations regarding overarching health care systems components for CSHCN, including establishing medical homes, promoting community inclusion, and planning for the transition to adulthood, including transitioning to adult health care. The Family Delegate for Texas and Texas Parent to Parent are included in program activities to ensure the family voice is included in the development and implementation of CSHCN programming.

Texas leads the Medical Home Learning Collaborative (MHLC), which meets quarterly to exchange best practice resources on implementation of medical home. The MHLC also develops community-based initiatives and collaborates with DSHS regional staff to assist with connecting CSHCN and their families to a medical home. The Children with Medical Complexity Collaborative Improvement and Innovation Network (CoIIN) is a multistate collaborative focused on the population of CSHCN with the greatest medical needs. DSHS formed a state team to engage in quality improvement focused on a cohort of children with medical complexity in Texas.

The SDG develops community-based initiatives to ensure that communities are welcoming, inclusive, and supportive to minimize the sense of isolation experienced by many CSHCN and their families. The SDG developed a transition toolkit and educational resources for families and providers to ensure that all CSHCN are transitioning to adulthood with appropriate supports in place. Community-based initiatives include transition workshops, conferences, and collaboration with DSHS regional staff to prepare families for transition and connect youth with special health care needs to adult services.

To promulgate progress and improve outcomes related to these initiatives, Texas strives to maintain the MCH infrastructure, capacity, and subject matter expertise across all population health domains. For more information on MCH efforts in Texas, please visit http://www.dshs.texas.gov/mch/.