Arizona’s Title V program benefits from strong organizational relationships with both public and private partners, allowing the program to leverage a variety of federal, state, and private program resources to enhance the program’s capacity.

The Title V program regularly collaborates with other federally-funded programs, such as Federally Qualified Health Centers; Certified Rural Health Clinics; State Office of Rural Health; Critical Access Hospitals; HRSA-funded programs within BWCH (MIECHV, MHIP, Alliance for Innovation on Maternal Health, Primary Care Cooperative Agreement, State Loan Repayment Program, Oral Health Workforce Grant, SSDI); and CDC-funded programs within BWCH (ERASE MM – MMRP, Preventive Health and Health Services Block Grant, PRAMS, SUID).

Arizona Title V’s state level partners include: state-funded MCH programs (High Risk Perinatal Program, Health Start Home Visiting, Teen Pregnancy Prevention, Homeless Pregnant Women); other programs within ADHS (Breastfeeding programs and Empower program for early care and education providers within the Bureau of Nutrition and Physical Activity, car seat and safe sleep injury prevention programs within Bureau of Chronic Disease and Health Promotion, Newborn Screening Program within State Laboratory Services, Arizona Birth Defect Monitoring Program within the Business Intelligence Office, Pediatric Prepared Emergency Services within Emergency Medical Services and Trauma Systems, STD/STI prevention/screening/treatment within Epidemiology and Disease Control, and the Suicide Prevention Program); other state agencies (Arizona Health Care Cost Containment System – state Medicaid agency, First Things First, state universities, Arizona Department of Education, Department of Economic Security’s Division of Developmental Disabilities, and Arizona Department of Child Safety); local county health departments; and tribal nations.

Arizona’s Title V Program also works with a wide variety of non-governmental organizations. Some examples include community-based and non-profit organizations (Arizona Family Health Partnership, Advocates for Youth, El Rio Health Center, Ryan House, Ronald McDonald House, March of Dimes Arizona Chapter, Arizona Mission of Mercy, Arizona Rural Health Association, Arizona Oral Health Coalition); professional associations (Arizona Chapter of the Academy of Pediatrics, American College of Obstetricians and Gynecologists, Arizona Perinatal Trust, Arizona Alliance for Community Health Centers, Arizona Hospital and Healthcare Association); health care providers; for-profit private pharmacies for metabolic formula gap filling service; and media advertising agencies to conduct focus groups and educational campaigns on bullying and maternal and infant health.

A list of the Arizona Title V Program’s key partners can be found in Appendix C.

Strengthening the Integration of Health Care Delivery Systems

Engaging multidisciplinary teams of federal, state, and local leaders allows Arizona’s Title V Program to improve access to quality health care and much-needed services for MCH populations by coordinating to develop program priorities and address problems. These collaborative relationships strengthen Arizona’s comprehensive early childhood systems and support Title V program efforts in early childhood development, breastfeeding, and maternal and infant health outcomes. Partnerships in the area of children’s health aim to improve comprehensive care for children and youth with special healthcare needs and their families, who often seek services across multiple systems – health care, public health, education, mental health, and social services.

Each of these partnerships presents an opportunity for Arizona’s Title V program to continue strengthening the integration of healthcare delivery systems. Key strategies for systems integration work through public-private partnerships included sharing data analysis and reports with partners, supporting and/or funding professional development opportunities to strengthen workforce capacity, and identifying and improving performance measurement capabilities. Some programmatic examples of these strategic partnerships are outlined below.

Evidence-based and promising practice home visitation models that begin during a mother’s pregnancy aim to improve birth outcomes by linking mothers to prenatal health care and providing them with information about fetal development. Other programs begin after the birth of the child; these programs ensure that children have access to health care, receive appropriate well-child care and immunizations, and receive appropriate medical care for illnesses and injuries. Programs provide critical developmental and health screenings and assessments to support maternal and child health. Some programs also provide information to parents about ways to support physical health, such as the importance of nutritious meals and physical activity.

Implementing best practice frameworks supports program development and delivery systems. These include Standards for Systems of Care for Children and Youth with Special Health Care Needs Version 2.0; The Six Core Elements of Health Care Transition™ 3.0 (intended for use by pediatric, family medicine, med-peds, and internal medicine practices to assist youth and young adults as they transition to adult-centered care); and Family Engagement in Systems Tools (FESAT) and Toolkit.

The Primary Care Office promotes its workforce programs through partnerships with universities, residency programs, and non-profit organizations. Through these collaborations, training, and outreach are provided to students, residents, and practicing providers in healthcare service areas in an effort to recruit and retain providers to serve in rural or underserved areas.

The Office of Oral Health (OOH) has a long history of collaboration with the Arizona Health Care Cost Containment Agency, Arizona’s Medicaid agency, with initial support for the Arizona Sealant Program to bill and receive reimbursement for dental services. Over recent years, this collaboration has led to policy change at the agency level and resulted in a requirement being added to the Arizona Medicaid Policy Manual, Early, and Periodic Screening, Diagnostic, and Treatment (EPSDT) section that health plans must work with OOH in providing preventive dental care for children.

Assessing the Effectiveness of Healthcare Delivery Systems and Models

Arizona’s Title V Program devotes significant effort to assessment and evaluation, including analyzing the effectiveness of healthcare delivery systems in meeting the needs of women and children.

The Office of Oral Health (OOH) conducts oral health surveillance by collaborating on Basic Screening Survey data for kindergarten and third-grade students. The information is used to inform the CDC’s National Oral Health Data System for Arizona. Partnerships that make this possible include inter-agency relationships with the Arizona Department of Education, the Arizona Early Childhood Development and Health Board, local county health departments, community health centers, and graduate dental educational institutions.

As a HRSA grantee, the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program completes annual and quarterly performance reporting, develops and implements plans for continuous quality improvement (CQI), and must demonstrate improvement in at least four of six benchmark areas and implement data exchange standards for improved interoperability. The MIECHV performance measurement system includes a total of 19 measures across the six benchmark areas: Improvements in maternal, newborn, and child health; Prevention of child injuries, child abuse, neglect, or maltreatment and reductions of emergency room visits; Improvements in school readiness and child academic achievement; Reductions in crime or domestic violence; Improvements in family economic self-sufficiency; and Improvements in the coordination and referrals for other community resources and supports.

Arizona MIECHV’s home visitation data management system, Efforts-to-Outcomes (ETO), includes seven different programs across three state agency funders. This includes state and federally-funded programs. The first system report, across all funders and models, is the Service Utilization report, allowing immediate access to live data regarding the number of enrolled families, service area, funder, model, and disenrollment rates. Other system reports available also include demographic reports and the ability to view the reports by Zip Code, County, or Primary Care Area contributing to the efficiency and accuracy of data reporting depending on the agency utilizing the information. The coordinated home visitation management system will enhance future MCH assessments and evaluation with home visiting populations in at-risk communities similar to those identified in the MIECHV at-risk communities.