The New Hampshire (NH) Title V program is a partnership of the US Department of Health and Human Services, Health Resources and Services Administration (HRSA) with the NH Department of Health and Human Services’ Maternal and Child Health (MCH) section, and the Bureau for Family Centered Services (BFCS) which oversees programs for Children and Youth with Special Health Care Needs (CYSHCN). Together, these local entities support core Title V public health functions including direct, enabling, population-based, and infrastructure-building services in maternal and child health including CYSHCN.
Title V’s programming focus comes from MCH and CYSHCN populations’ priority needs. A comprehensive five-year needs assessment was conducted in 2019-2020. Following an extensive data review, specific input from the public and stakeholders, as well as a capacity assessment, a list of priority issues emerged to form the basis of programming through 2025. Ongoing needs assessments are carried out routinely each year (e.g. focus groups, client satisfaction surveys, stakeholder workgroup meetings) to assure that programming remains consistent with needs, and to date the list of priorities established in 2020 are unchanged:
Priority need #1: Improve access to needed healthcare services for all populations.
NPM#10: Percent of adolescents, ages 12‑17 with a preventive medical visit in the past year.
Domain: Adolescent Health
and
NPM#12: Percent of adolescents with and without special health care needs, ages 12‑17 who received services necessary to make transitions to adult health care
Domain: Children with Special Health Care Needs
Priority need #2: Decrease the use and abuse of alcohol, tobacco and other substances among pregnant women.
NPM#14.1: Percent of women who smoke during pregnancy
Domain: Women/Maternal Health
Priority need #3: Increase the focus of Title V on the Social Determinants of Health and the resolution of barriers impacting the health of the MCH population.
SPM#1: Percentage of MCH-contracted Community Health Centers who meet or exceed the target of their Enabling Services workplan
Domain: Cross-cutting/Systems-building
Priority need #4: Improve access to mental health services for children, adolescents and women in the perinatal period.
SPM#3: Percentage of enrolled pediatric primary care providers who received pediatric mental health teleconsultations from the Pediatric Mental Health Acre Access (PMHCA) Program
Domain: Cross-cutting/Systems-building
Priority need #5: Decrease unintentional injury in children ages 0‑21.
NPM#5: Percent of infants: a) placed to sleep on their back; b) placed to sleep on a separate approved sleep surface; c) placed to sleep without soft objects or loose bedding
Domain: Perinatal/Infant Health
and
NPM#7.2: Rate of hospitalization for non-fatal injury per 100,000 adolescents ages 10‑19
Domain: Adolescent Health
Priority need #6: Increase family support and access to trained respite and childcare providers.
SPM#2: Percentage of children and youth with special health care needs enrolled in BFCS services who report access to respite care
Domain: Children with Special Health Care Needs
Priority need #7: Improve access to standardized developmental screening, assessment and follow-up for children and adolescents.
NPM#6: Percent of children, ages 9‑35 months, receiving a developmental screening using a parent-completed screening tool in the past year.
Domain: Child Health
Specific strategies aiming to improve these performance measures are delineated in each population domain, in the State Action Plan table.
NH MCH has grown substantially in the past decade. Forty-one percent (41%) of the workforce has been in their position within DHHS for less than ten years and 63% are under the age of 50. MCH has 29 positions (25 FTEs including a contracted 1.0 FTE Epidemiologist and three part-time staffers for an additional 1.8 FTEs). Positions have been developed to implement more activities related to the Title V performance measures, such as the full-time Perinatal Coordinator and the Child-Adolescent Clinical Coordinator. MCH currently has seven programmatic units: Data/Decision Support; Infant Surveillance; Injury Prevention; Home Visiting; Quality Improvement and Clinical Services; Women’s Health; and Community Engagement Programs (formerly Early Childhood Systems).
BFCS has 18 positions that provide leadership for programs and services for children with special health care needs and their families. Title V services for CYSHCN are organized in accordance with the Standards for Systems of Care for Children and Youth with Special Health Care Needs Version 2.0. Title V funds the following BFCS positions: the CYSHCN Director/Bureau Chief, Data Analyst, Evaluation Specialist, Systems of Care Specialist, Clinical Program Manager, one Nurse Consultant, two nurse Health Care Coordinators, one Health Care Coordinator, one Eligibility Technician, and two administrative support staff.
Much of Title V funding is braided to support staff and into contracts to implement strategies consistent with the MCH Block Grant’s Five Year State Action Plan. Title V funds the Quality Improvement and MCH Clinical Services unit in full or in part, which includes the Child-Adolescent Health Nurse Consultant, the Perinatal Coordinator, the Pediatric Mental Health Care/Access Program Coordinator, and the QI/QA and Clinical Services Program Manager. MCH also utilizes Title V funding for a PhD level public health epidemiologist from the University of New Hampshire (UNH).
MCH and the BFCS work with professional training pipelines in the State, such as the increasing number of NH based colleges and universities awarding degrees in public health, as well as out-of-state online programs. MCH and the BFCS work with interns from many programs, such as the HRSA funded Leadership Education in Neurodevelopmental and Related Disabilities at UNH, CDC’s Public Health Associate and Fellow Programs, and summer graduate school interns set up through AMCHP and most in-state colleges and universities.
BFCS demonstrates its commitment to family engagement and partnership throughout its programs and activities. New Hampshire Family Voices (NHFV), a long-standing partner whose staff consists of parents of CYSCHN, are co-located with BFCS staff and provide leadership across the State to families and family-serving agencies. Family support activities under the Partners in Health Program include the requirement for each regional agency to have a family council that serves as an advisory body.
BFCS continues to partner with NHFV to plan and facilitate training opportunities for CYSHCN and their families. Family Support Coordinators frequently seek assistance to recruit, retain and strengthen family support advisory council members. While this partnership model has been used primarily with Partners in Health, it has been identified as a critical program component to be carried over into the new model being developed for care coordination.
MCH program staff worked with New Hampshire Family Voices (NHFV) to increase family partnership and engagement. The recommendations developed are serving as guiding principles for family engagement, which has subsequently been written into all MCH contract deliverables for those contractors who are public serving. All of the Title V funded Community Health Centers (CHCs) have a mandate for 51% of their advisory committees to be community members and/or clients.
MCH’s Quality Improvement and Clinical Services Programs is working with and financially supporting colleagues at the Northern New England Perinatal Quality Improvement Network (NNEPQIN) with the goal of establishing a representative Perinatal Community Advisory Council (PCAC). The PCAC will be a key component in MCH and NNEPQIN’s strategy in fostering accessible, respectful and safe perinatal care in the State. Focus groups were held in spring and summer of 2021 and informed the PCAC recruitment. The first PCAC meeting was held on June 7, 2022 and will continue to meet monthly via Zoom. It is anticipated that the meetings will be co-chaired, will remain confidential with the members deciding what type of feedback and recommendations to share with NNEPQIN and MCH.
During the annual writing and review of MCH programs’ workplans, goals and objectives, each program seeks to incorporate family engagement into its approach. MCH’S Early Hearing Detection and Intervention (EHDI) program involves several parents in their CQI process as well as the NH chapter of Hands and Voices. MCH’s Home Visiting program is focusing on family engagement with contractors as part of a larger CQI effort, devoting time during the monthly Local Implementing Agency (LIA) supervisors’ meeting to provide training on how to involve families. At one meeting this past year, the federally led HVCOIIN’s Parent Leadership Toolkit was reviewed as was the NH Children’s Trust’ (NHCT) family engagement campaign and their Strengthening Families Summit, Parents Leading the Way. Family engagement in CQI is discussed in all coaching sessions.
The success of NH’s Title V programs is based in part on integral partnerships, both funded and non-funded, with governmental partners as well as community based agencies. Leveraging federal, state, and local program resources contributes to the service delivery capacity of NH’s Title V program. This is evident in the almost four-year-old Early Childhood Integration Team (ECIT), of which both MCH and the BFCS staff are part of the leadership. The ECIT brings together all programs serving young children, with and without special health care needs, from birth through eight years of age, and their families. Members represent Home Visiting, WIC, Housing, Child Care, and Early Supports and Services, to name a few.
Another key in-state partner for Title V is DHHS’s Division of Behavioral Health Services, which houses the bureaus for Behavioral Health, Children’s Behavioral Health, and Drug and Alcohol Services. MCH works collaboratively with this Division on projects including suicide prevention and perinatal substance exposure. MCH and BFCS staff are members of the Children’s Behavioral Health’s System of Care Advisory Council. Much like the ECIT, this group aligns members from across DHHS and beyond in the mission to promote and improve the State’s children’s system of care principles and values.
MCH works with on a regular basis with the NH Children’s Health Foundation, a charitable entity. One of the collaborative projects is on sexual and reproductive health care access, particularly for decreasing unintended pregnancies, with the ultimate goal of reducing and preventing childhood trauma.
The Council for Youth with Chronic Conditions (CYCC), the only statewide organization that has a legislative mandate to focus on the issues affecting children and adolescents with chronic health conditions, represents another important partnership. Members include families of CYSHCN, the CYSHCN Director, legislators, pediatric specialists, school nurses, service providers, NH Family Voices, and other program administrators in DHHS.
New Hampshire has a State Emergency Operations Plan (SEOP) found at State Emergency Operations Plan (nh.gov). DHHS staff all are trained annually (virtually) in emergency response protocol and systems. NH’s Title V is proactive in its emergency preparedness planning and coordinates with partners at the State and local levels to develop emergency preparedness and response plans that include the needs of the MCH and CYSHCN population.
Throughout the pandemic, but particularly this past year, Title V staff from both MCH and BFCS who are registered nurses (RNs) were asked to staff the COVID‑19 vaccine clinics and testing sites held across the State. Staff skilled in data entry also assisted in managing the enormous volume of information from COVID‑19 testing and vaccination efforts.
MCH’s Birth Conditions Program (BCP) has been working collaboratively with the Bureau of Infectious Disease Control (BIDC) within DPHS (the lead on COVID‑19 efforts) and the MCH Epidemiologist to identify and report COVID‑19 outcomes in mothers and infants for the CDC Surveillance for Emerging Threats to Mothers and Babies (SET‑NET) project. As a result of this effort, BIDC and MCH collaboratively applied for and were awarded CDC funding within the Epidemiology and Lab Capacity grant, Project W, “Infants with Congenital Exposure: Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats.”
Most recently, MCH and BFCS supported the Women, Infants and Children Nutrition Program (WIC) in disseminating information on the infant formula shortage, including best nutritional practices with infants, and solutions to current barriers. BFCS Health Care Coordinators have been working with families, Medicaid ,and pharmacies to ensure CSHCN needing specialty formula are able to obtain some.
In this third year of the five-year project cycle, NH Title V will be submitting several requests for technical assistance, including the following.
MCH’s Injury Prevention Program is requesting technical assistance to better integrate its work with the other Title V programs, such as Adolescent Health. Technical assistance would be requested from the Children’s Safety Network to “strengthen their capacity, utilize data and implement effective strategies to make reductions in injury-related deaths, hospitalizations and emergency department visits” (childrenssafetynetwork.org).
To broaden the scope of work on NPM#5 (safe sleep), NH’s Title V will request technical assistance for training on harm reduction within safe sleep efforts in public health. A comprehensive prevention strategy, harm reduction is part of the continuum of care, and harm reduction approaches have proven to prevent deaths and injuries associated with various human behaviors.
Technical assistance will be sought to facilitate a six part webinar series entitled “Telehealth in NH 101.” The objective will be to promote a better understanding of telehealth within the state system, particularly as it intersects with NPM#10 (adolescent well-visit) and NPM#12 (transition to adult health care).
In pursuit of health equity, technical assistance will be requested for guidance and training on the collection and standardization of race, ethnicity, language, and disability data (REALD), as well data on sexual orientation and gender identity (SOGI) within the data systems that are stewarded by DHHS and/or Title V funded contractors.
BFCS will request technical assistance (1) from the MCH Evidence Center to work through strategies for preparing to implement the redesigned program for health care coordination and family support beginning July 2023; and (2) from the Catalyst Center to help NH identify strategies for improving reimbursement for services and financing services not generally covered by private insurance or Medicaid. The MCH Evidence Center will also be approached for assistance with exploring ways to measure the actual impact of the implementation of the Help Me Grow Framework with a focus on meaningful family connection, and to increase the leadership capacity for NH’s CYSHCN workforce.
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