Nevada’s Title V Maternal and Child Health (MCH) Program is dedicated to working with diverse public and private partners statewide to improve the health of families. Funded partners implement activities serving women of childbearing age, pregnant persons, infants, adolescents, and children, including children and youth with special health care needs (CYSHCN). Nevada utilizes Title V MCH funding to collaborate with partners and strengthen community engagement and activities ensuring all MCH populations can access quality health education and preventive services.
Nevada’s Title V MCH Program is housed in the Maternal, Child and Adolescent Health (MCAH) Section; Bureau of Child, Family and Community Wellness (CFCW); Division of Public and Behavioral Health (DPBH); Nevada Department of Health and Human Services (DHHS). The Nevada Title V MCH Program website can be accessed at: http://dpbh.nv.gov/Programs/TitleV/TitleV-Home/. The Title V MCH Program is committed to funding evidence-based or informed activities and programming to improve the health and wellbeing of the MCH population in Nevada.
Accomplishments and Priorities by Population Domain
Domain: Women/Maternal Health
According to 2019 Behavioral Risk Factor Surveillance System (BRFSS) data, 65.6% of Nevada women ages 18-44 years received a preventive visit in the past year compared to 72.8% of women nationally. Furthermore, according to 2019 National Vital Statistics System (NVSS) data, 75.4% of pregnant women in Nevada received prenatal care beginning in the first trimester, compared to 77.6% in the US during the same year. This percentage is lower for uninsured women in Nevada, with only 60.8% receiving early prenatal care. The Title V MCH Program partners with statewide and regional MCH coalitions, community-based programs, and public and private partners to increase insurance coverage rates and receipt of timely prenatal care among this population.
Nevada’s Title V MCH Program collaborates with partners to identify and reduce modifiable risk factors for improving birth outcomes, including racial and ethnic health disparities. Participation continued in the Association of Maternal Child Health Programs (AMCHP) “Infant Mortality Collaborative Improvement and Innovation Network (IM-CoIIN) 2.0.” Partners include Local Health Authorities (LHAs), March of Dimes, Division of Health Care Financing and Policy (DHCFP or NV Medicaid), DPBH Office of Public Health Investigations and Epidemiology (OPHIE), Nevada Healthy Start, Washoe County Fetal Infant Mortality Review (FIMR) Committee, Nevada Maternal Mortality Review Committee (MMRC), and the Nevada Home Visiting (NHV) Program. The Nevada IM-CoIIN team convened monthly to address preterm births and Social Determinants of Health (SDOH) related to Pre/Interconception Care. The IM-CoIIN ended August 2020, and team members participated in an exit interview with recommendations to implement anti-racist strategies to intentionally address the roots of racial injustice in maternal and infant health.
Twelve partner organizations in eight counties provide critical screenings to women of childbearing age, especially women living in rural and frontier areas and people who live with increased risk. Screenings include those for postpartum depression; Screening, Brief Intervention, and Referral to Treatment (SBIRT); One Key Question campaign; and others. Collaboration with NHV promotes relevant maternal and infant screenings to MCH populations with higher risk. MCAH staff led state-funded statewide reproductive health efforts through the state’s Account for Family Planning (AFP) legislation and funding.
Title V MCH staff have facilitated a COVID-19 and MCH data presentation in collaboration with the DHHS Office of Analytics during Maternal and Child Health Advisory Board (MCHAB) meetings since August 2020. MCAH staff have also discussed Nevada Office of Minority Health and Equity (NOMHE)-planned equity and COVID-19 toolkit distribution opportunities and shared materials from NOMHE and other quality organizations about racism and public health, health equity, health disparities and racism, and racism and pregnancy outcomes.
Title V MCH Program staff post MCH-specific COVID-19 resources on the program website and are engaged in COVID-in-pregnancy surveillance monitoring discussions with CDC as part of an OPHIE-led team. Staff also monitor multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, share COVID-19 resources to partners to support rapid information sharing, and have reached out to partners and subawardees to understand how COVID-19 is affecting their efforts and activities.
Domain: Perinatal/Infant Health
According to the National Immunization Survey, Nevada’s rate for ever breastfeeding increased from 2010-15. In 2016, Nevada’s rate decreased slightly but remained in line with the national average (79% and 83.8%, respectively). Nevada’s rate increased in 2017 to 81.8%, and the national average remained similar at 84.1%. Nevada’s 2016 rate for exclusive breastfeeding at six months was 21.7%, slightly below the national average (25.6%).
Nevada’s Title V MCH Program partners with the Nevada Women, Infants, and Children (WIC) Program, MCH coalitions, breastfeeding coalitions, community-based programs, LHAs, the public, and private partners to increase breastfeeding rates by improving access to breastfeeding supports for new mothers.
Nevada WIC breastfeeding campaigns are designed to increase awareness, promote WIC breastfeeding services, and normalize breastfeeding in public locations. Eighty-nine Nevada businesses have signed the pledge to provide welcoming environments to those who breastfeed. Nevada Healthy Start, co-funded by the Nevada Title V MCH Program, promoted breastfeeding to increase breastfeeding initiation among participants using an equity lens. Nevada Healthy Start conducted eight outreach activities between October 2018 and March 2019. Washoe County FIMR reviewed 49 cases in FFY2019. Nevada Title V MCH Safe Sleep efforts include funding a statewide Cribs for Kids Program, statewide English and Spanish radio and television media campaigns, and statewide distribution of children’s books with safe sleep messages. Cribs for Kids distributed 810 Safe Sleep Survival Kits, a 7.9% increase from FFY2018. The NHV Program also promotes breastfeeding and safe sleep to participants.
Nevada Title V MCH activities related to decreasing substance use in pregnancy and participation in the Association of State and Territorial Health Officials (ASTHO) Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative (OMNI), Nevada Comprehensive Addiction and Recovery Act (CARA), and IM-CoIIN efforts support this domain. The Nevada Title V MCH Program continues Safe Sleep and Injury Prevention education with Indian Health Service clinics. Trainings provided include Infant Safe Sleep, car seat installation, Ages and Stages Questionnaires (ASQs), and Shaken Baby Syndrome and Abusive Head Trauma. Pregnancy Risk Assessment Monitoring System (PRAMS) data informs improving this domain.
Domain: Child Health
According to the 2018-19 National Survey of Children’s Health (NSCH), Nevada (30.6%) is below the national average (36.4%) for children ages nine through 35 months who received a developmental screening using a parent-completed screening tool in the past year. This percentage increased for Nevada from 27.9% in 2017-18. Nevada’s Title V MCH Program collaborates with public and private partners to improve the rate of children receiving timely developmental screening and increase the number of applicable entities trained on developmental screening. The Title V MCH Program implemented the ASQ: Social Emotional 2nd Edition (ASQ-SE2) parent training and screenings statewide, including distributing the CDC Milestone Moments bilingual booklets and a Training of Trainers session.
Nevada’s Title V MCH CYSHCN Program promotes the Medical Home Portal (MHP), which improves access to healthcare by assisting and supporting professionals and families using the Medical Home model to care and advocate for CYSHCN and non-CYSHCN. From FFY 2019-20, there was a 416% increase in MHP website views, from 12,437 to 64,132 and the number of unique users increased from 5,961 to 28,657.
The Title V MCH-funded Kindergarten Health Survey conducted annually by the Nevada Institute of Children’s Research and Policy (NICRP) shows an increase in overweight children and a decrease in obese children entering kindergarten. The 2019-20 survey showed 11.1% of kindergartners were overweight and 21.3% were obese, increases from 2018-19 (at 10.7% and 20.9% respectively). The Title V MCH Program funded two obesity prevention/physical activity promotion seasonal social media campaigns in FFY 2020 to help address this issue. Child health is also supported via Bullying and Suicide Prevention efforts in partnership with the Nevada Department of Education (NDE) and with the DPBH Office of Suicide Prevention (OSP).
Domain: Adolescent Health
One in five births to a teen (15-19 y.o.) in Nevada is a repeat teen birth, it is important to decrease this, with emphasis on identifying and addressing health disparities. To improve teen birth measures, the Nevada Title V MCH Program partners with state and local teen pregnancy prevention programs, NHV, MCH Coalitions, LHAs, community- programs, and private partners to increase access to educational materials, including funding LHAs and rural/frontier Community Health Nurses (CHNs) to provide education and promote Medicaid coverage of Long Acting Reversable Contraceptives (LARCs) post-partum. The National Governor’s Association Learning Network to Improve Insurance Enrollment and Access to Health Care for Adolescents ages 15-18 y.o. continues with efforts initially focusing on Clark County and expanding statewide.
Domain: Children and Youth with Special Health Care Needs
CYSHCN should have access to a medical home, according to the 2018-19 NSCH, only 30.3% of CYSHCN in Nevada have a medical home, well below the national average of 42.3%, but an increase from 2017-18 (26.3%). Comparatively, 41.8% of children without special health care needs in Nevada have a medical home, much closer to the national average of 49%. Nevada’s CYSHCN Program provides resources and support to community agencies serving children ages birth to 21 years. The CYSHCN Program funds a variety of community programs to better serve children and families through a network of federal, state, Family Voices affiliate, University, and local community and family-based partners. The CYSHCN Program participates in community and family-led coalitions and committees, including the Nevada Governor’s Council on Developmental Disabilities (NGCDD), Newborn Screening Program Advisory Board, and the Nevada Early Intervention Interagency Coordinating Council.
Nevada’s CYSHCN Program continues promotion of the MHP, a virtual resource which provides reliable and useful information about medical conditions, care, and knowledge of valuable local and national services and resources, improving care coordination among children with and without special health care needs. The CYSHCN Program partners with a Family Voices entity which helps to increase MHP promotion, access to health care resources, referrals to adequate insurance coverage, care coordination services, and the CYSHCN toll-free hotline. A recent program accomplishment is the collaboration with the Rape Prevention and Education (RPE) Program and partners to create a resource on sexual assault prevention for those with developmental disabilities.
Nevada’s CYSHCN Program also manages the Critical Congenital Heart Disease (CCHD) Registry, ensuring Nevada-born infants are screened for CCHD. The CYSHCN and Adolescent Health and Wellness Program (AHWP) are collaborating with the Nevada Center for Excellence in Disabilities (NCED) to expand resources on health care transition and health literacy.
Domain: Cross-Cutting/Life Course
Nevada’s Title V MCH Program collaborates across systems with PRAMS to collect data on women who smoke or use substances during pregnancy and secondhand smoke. Survey questions asked about substance use during the respondent’s most recent pregnancy. For 2019 births, when asked about prescription pain medication use during pregnancy, 2.68% said yes, which is a decrease from the 5.4% who said yes in 2018. When asked about methadone use during pregnancy in 2019, 0.85% said yes, compared to 1% in 2018. In 2017, Heroin, amphetamines, methamphetamines, cocaine, tranquilizers, hallucinogens, LSD, sniffing gas, and glue or huffing use were all under 1% each. However, in 2018, reported amphetamine and cocaine use were both greater than 1%, at 1.13% and 1.17% respectively. In 2019, this trend was reversed, and none of the substances were above 1%.
*For 2017 and 2018 weighted data, PRAMS had a response rate of 40.6% and 39.4%, respectively, both under the CDC threshold of 55%. 2019 data had a response rate of 42%, which was below the CDC threshold of 50% for that year. Therefore, all data should be interpreted with caution.
To gain more data about opioid use during pregnancy, Nevada PRAMS staff applied for supplemental opioid funding in 2017 and were awarded funds in September 2018. Thirteen additional questions pertaining to opioid use during pregnancy were included in the 2019 survey. Data from the thirteen opioid use questions for 2019 births showed the most reported over-the-counter pain medication used during pregnancy was acetaminophen, with 55.2% of respondents reporting use. Other over-the-counter pain medications were used less frequently, such as Ibuprofen (13.4%), Aspirin (6.6%), and Naproxen (1.7%). For prescription pain medications, the most reported were Codeine (1.5%), Oxycodone (1.1%), and Hydrocodone (1.1%). Other prescription pain medications like Tramadol, Hydromorphone, Oxymorphone, Morphine, and Fentanyl all were under 1% each.
Of those reporting prescription pain medication use, the most reported ways of obtaining the pain relievers were from a doctor in the Emergency Room (27.1%), their Primary Care or Family Care Doctor (24.5%), OB-GYN, midwife, or prenatal care provider (22.9%), or a friend or family member (20.9%). Of note, 13.7% responded they received the pain relievers without a prescription in some other way.
In response to Nevada’s legalization of medical and recreational marijuana, informational resources on pregnancy and marijuana use continue to be disseminated. Nevada’s Title V MCH Program partnered with the Department of Taxation to distribute Child Injury Prevention and Pregnancy and Marijuana prevention materials to all marijuana dispensaries in Nevada. According to Nevada PRAMS, when asked about marijuana use during pregnancy in 2018, 11.6% of women said yes; this is a 95% increase from the percentage responding yes in 2017. Title V MCH Program efforts focused on reducing substance use in pregnancy and interconception for women of childbearing age continue to include promotion of the SoberMomsHealthyBabies.org website and associated media campaigns, marijuana prevention education materials, the Substance Use during Pregnancy Provider Toolkit, and ASTHO OMNI activities on reduction of substance exposed infants and neonatal abstinence syndrome (NAS). Nevada’s Title V MCH Program participation in CARA Infant Plan of Safe Care substance exposed infant workgroups, IM-CoIIN, home visiting, and perinatal quality efforts all support progress in this domain.
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