Montana’s Title V Program is in the Maternal Child Health Coordination (MCHC) Section, one of six in the Family & Community Health Bureau (FCHB), in the Early Childhood Family Support Division (ECFSD).  Through public and private partnerships and collaborations with FCHB and ECFSD programs and the County Public Health Departments (CPHDs) contributions, the Title V program focuses on improving health care delivery for the maternal and child population.

Maternal & Child Health Coordination Section

The Title V Director, also the MCHC Supervisor, oversees programs supporting Title V: Oral Health (OH); Fetal, Infant, Child and Maternal Mortality Review (FICMMR); Montana Obstetrics and Maternal Support (MOMS); Primary Care Office (PCO); State Loan Repayment Program (SLRP); and, Title V/Sexual Risk Avoidance Education (SRAE). Many of these programs rely on key partners such as universities, private hospital and health care systems, physicians, the Montana Health Care Foundation, and the Montana Primary Care Association. 

The OH Coordinator provides support to the CPHDs implementing NPM 13 activities.  In-depth activity details are provided in the Women & Maternal Domain report for FFY20 and the Child Domain Application for FFY22, which also includes FY 2021 activity information.  The Hub-Spoke model, whereby a larger populated county, the Hub, supports the smaller-size Spoke counties’ oral health activities.  An OH focus is increasing the number of Spokes for the purpose of professional staff applying fluoride varnish and dental referrals. Public Private Partnerships specific to oral health include, but is not limited to: Blue Cross Blue Shield, Montana Dental Association, and Montana Dental Hygienist Association.

The FICMMR Coordinator ensures that the CPHDs’ local FICMMR teams’, composed of pertinent local professionals, death reviews focus on determining its preventability.  The review results are used for planning, implementing, and evaluating their county injury prevention activity.  The Coordinator conducts a QI review of the team’s review prior to its submission to the National Child Death Review database. FICMMR requirements are included in the CPHDs’ MCHBG contracts. 

The MOMS program aims to deliver training, resources, and support to rural healthcare providers by connecting them to obstetrical/gynecological, perinatal, mental health and substance abuse specialists; thus, creating competency and consistency across perinatal providers. The MOMS/Billings Clinic (BC) contract connects rural providers to urban-based experts using Project ECHO (Extension for Community Healthcare Outcomes).  ECHO facilitates mentoring, guidance, feedback, and education amongst the healthcare providers. The BC is expanding its existing telemedicine efforts to address rural area shortages of OB/GYN, substance use disorder, and mid-level providers of maternal healthcare in Eastern MT. 

The MOMS/University Montana Rural Institute for Inclusive Communities (UMRIIC) partnership is focused on assessing, evaluating, and offering recommendations to increase the percentage of women receiving an annual well-woman visit.  UMRI is coordinating their MOMS needs assessment with the MCHBG, PCO, and Children’s Special Health Service needs assessment.  The results will inform program managers how to address access issues preventing a higher engagement in the annual well-woman visit.

The PCO works to improve the health status of underserved and vulnerable populations. The PCO’s collaborative work with the MT Primary Care Association and MT Office of Rural Health & Area Health Education Center aligns with the MCHBG’s emphasis on improving access to care in MT’s Health Professional Shortage Areas (HPSAs).  The PCO administers  loan repayment programs; the J-1 Physician Visa Program for physicians from other countries; and provides resources and support to medical facilities seeking help with recruiting for Primary Care positions.

The Title V/SRAE program uses evidence-based approaches to implement education exclusively on sexual risk avoidance. It is designed to teach youth self-regulation; success-sequencing for poverty prevention; healthy relationships; goal setting; how to resist sexual coercion; facts of dating violence; and, how to minimize youth risk behaviors such as underage drinking and illicit drug use, without normalizing teen sexual activity.  The Title V/SRAE Program Specialist also is responsible for the NPM 9 - Bullying Prevention State Action Plan.

Family & Community Health Bureau and Early Childhood Family Support Division

Partnership Programs

Critical to Title V services are these FCHB’s sections: Children’s Special Health Services Section (CSHS); Healthy Montana Families Home Visiting (HMF); Supplemental Nutrition for Women, Infants & Children (WIC); Family Planning (FP); and, Epidemiology.

The CSHS Supervisor oversees the MCHBG specific work focused on NPM 11: Medical Home activities, which are supported by these other CSHS programs: Genetic & Cleft Clinics, Newborn Screening and the MT Access to Pediatric Psychiatry Network.  Through partnerships and collaborations established by these programs, all children are afforded health care services, such as referrals for audiology or metabolic services and newborn screenings.   

Home visiting services, offered through HMF’s contracts with CPHDs and non-profits, are voluntary and family-centered to pregnant women; new parents; or families or caregivers with infants and young children under five years of age. The professionally trained home visitor focuses on improving maternal and child health outcomes such as child development and school readiness; child and maternal health; family economic self-sufficiency; positive parenting practices; and reductions in child maltreatment and family violence. Several CPHDs integrate their NPM 5: Infant Safe Sleep and NPM 13: Oral Health activities into their home visiting curriculum.

WIC provides healthcare and nutrition services to low-income pregnant women, breastfeeding women, and children under the age of five with a family income below 185% of the federal poverty level. WIC’s mission is to partner with other services that are key to childhood and family well-being. ECFSD programs and WIC collaborate by supporting breastfeeding and immunization services and referrals to social service programs.

By administering MT’s Title X Clinics, the FP program ensures accessible, quality family planning services to adults and teens. There are 22 Title X Clinics, many of which are co-located with CPHDs, often sharing staffing and office resources while serving the same clients as the local MCHBG program.

County Public Health Departments

Public health in MT is decentralized, with much of the work done by CPHDs. Annually, the FCHB contracts with an average of 50 CPHDs interested in participating in the MCHBG, who submit quarterly and annual reports on their identified National and/or State Performance Measure activity and evaluation plans.  MCHBG funding, when combined with their local or other state funding, plays a critical role in the CPHD’s capacity for providing needed services to their county residents.

University of Montana Rural Institute for Inclusive Communities

UMRI has been a long-standing partner with CSHS to provide evidence-based transition resources to Montana’s youth and families. UMRI works to: maintain and expand the 15-member Consumer Advisory Council; maintain and disseminate a health care transition (HCT) guide; develop evidence-based/informed HCT training and resource materials; conduct

distance learning opportunities; maintain a transition website; and, provide technical assistance to other initiatives related to HCT. 

As described in the MOMS section, UMRI continues to support updates to the MCHBG Needs Assessment. In 2020, UMRI assisted with collecting CPHDs’ information on the MCHBG 5-Year Needs Assessment through surveys and key informant interviews, as well as analyzing results and final selection of performance measures.

Healthy Mothers Healthy Babies (HMHB)

The ECFSD continues to support HMHB’s Safe Seats for Baby and Safe Sleep for Baby programs.  At no cost to families, the Safe Seats for Baby provides car seats and training by a Child Passenger Safety Technician on correctly installing and using the seat. Their Safe Sleep for Baby Program supports a safe sleep environment for babies by providing families in need with a Pack ‘N Play.

ECFSD Programs

ECFSD programs, such as the Child & Adult Care Food Program; Child Care Development Fund; No Kid Hungry and Early Learning/Family Support; are staunch supporters of sharing maternal and child health information, educational resources, and training opportunities with their stakeholders including child care providers, local non profits, and schools.  In return, their information is shared with the Title V partners.