The Department of Health and Senior Services (DHSS) utilizes various opportunities to seek input from stakeholders, community and family partners, and program participants in program decision-making. MCH assessment data, trends, priorities, performance measures, strategies, and outcomes are regularly presented to stakeholders and Title V MCH implementing partners. MCH leadership engages and solicits input from local public health agencies (LPHAs), community-based organizations, primary care and safety-net providers, and family partners to inform ongoing strategy development and implementation. Input is solicited through individual and group presentations, the DHSS website, webinars, stakeholder convenings, advisory groups, and participation in inter-agency committees and task forces.

Message to Partners for Public Input on Proposed Use of Funds

To solicit public input on the FY 2024 Title V MCH Block Grant application and proposed use of funds (PUF), the PUF document was posted on the DHSS website MCH Block Grant and Public Notice webpages, published in the LPHA weekly newsletter, the Friday Facts, and disseminated via email to a diverse group of MCH stakeholders. This included administrators from the 115 LPHAs, other LPHA team members, healthcare providers, hospitals, non-profit and other community organizations, other government agencies, community members, and family partners.

The MCH Director sent the following email message to over 900 MCH partners statewide.

Dear MCH Stakeholder,

Each year, the Missouri Department of Health and Senior Services (DHSS) receives funds from the Health Resources and Services Administration (HRSA)/Maternal Child Health Bureau (MCHB), in the form of the Title V Maternal and Child Health (MCH) Services Block Grant, to be used to promote and improve the health and well-being of Missouri’s pregnant women, mothers, infants, children, adolescents, children and youth with special health care needs (CYSHCN), and their families. The block grant requires DHSS, as the state MCH agency, to solicit public comments from consumers and partners across the state regarding the application and proposed use of funds for the next federal fiscal year (FFY). As a valued partner of Missouri’s Title V MCH Block Grant Program, we value your input and appreciate the diversity of perspective and scope of experience your partnership contributes.

We invite you to review the attached FFY 2024 Proposed Use of Funds (PUF) document and send us any comments or questions you have for the Department’s consideration. In addition to the proposed breakdown and distribution of funds for FFY 2024, the document also provides a general overview of the types of services supported through the block grant, and includes the FFY 2021 – 2025 MCH priorities and overarching principles. The FFY 2024 Proposed Use of Funds may also be accessed at https://health.mo.gov/information/publicnotices/publiccomment.php.

Please send your feedback on the proposed use of funds no later than July 19, 2023 to MCH@health.mo.gov or reply to this email.

Please feel free to share this message and the PUF with any Missouri citizens, as well as other stakeholders and partners serving the MCH population. I encourage you to contact me to share any information, suggestions, questions, or concerns and/or discuss opportunities for collaboration.

Thank you for participating in this important work, sharing your expertise and serving Missouri’s MCH populations.

Responses, summarized below, were received from a total of 12 partners and stakeholders.

• “I was wondering how this works in relation to our current MCH grant/contract plans? Thanks.” (LPHA team member experienced with the MCH Services contract)
• “I would like to see education on clean drinking water from public health and MCH perspective. Not the standard drinking water messaging by regulators. Not education overwhelmed by fluoride, or particular industry practices, or any subjects that may cause some of the public to put up guards or negative responses by industry groups or policy makers. But solid education on importance of clean drinking water to public health. Also would like to see continued work with reducing lead. Otherwise I think the proposal looks good, for what it’s worth. Thank you MCH Program for your work! We are glad to be partners in public health with you.” (LPHA administrator)
• “I would love to see the return of state-wide chronic disease prevention programming. We try to do our best on social media, etc but I feel some actual programming would be very beneficial. Please let me know if you have any questions or concerns. Thank you for all you do! I appreciate you and your team!” (A LPHA team member experienced with the MCH Services contract)
• “We have reviewed this and are pleased to see oral health included as a priority.  The specification for funds to be used for direct care services, enabling services and public health service & systems is also impressive. We have no additional comments at this time.  Thank you for the opportunity to review. (Missouri Coalition for Oral Health)
• “We are pleased to pass along Health Forward Foundation’s comments regarding the proposed use of funds for the Title V Maternal and Child Health block grants for FY 2024. We have offered our comments in consultation with one of our community leaders to help provide perspective from those working directly with birthing people and children who are most likely to be positively impacted by these block grant funds. We also stand ready to provide additional comments and resources on these community investments, should you have the need. Please feel free to reach out directly to Health Forward Foundation’s President and CEO or myself (Policy Impact Strategist) should you have any additional questions or other needs related to these comments. Thank you so much and we look forward to continued partnership in this space.”

“Health Forward Foundation (HFF) respectfully submits comments on the proposed use of Title V Maternal and Child Health (MCH) block grant funds. Our comments are rooted in Health Forward’s purpose, values of trust, equity/inclusion/antiracism, partnership, learning and stewardship and reflect our policy priorities and goals. Our comments also align with DHSS’ vision for optimal health and safety for all Missourians, in all communities, for life, as well as the 10 MCH Essential Services. Our comments emphasize our communities of focus – people of color and people in rural areas – whose health outcomes are impacted by structural racism, structural urbanism, and other systemic barriers.

In sum, we recommend that block grant funding be focused on the following themes:

1) Supporting improved data, including disaggregated data, for mortality reviews;

2) Improve access through funding culturally-responsive pre-natal and post-partum care by community based organizations (CBOs);

3) Increasing the diversity of people of color underrepresented in the Maternal and Child Health healthcare workforce;

4) Ensuring housing and nutrition for birthing people is easier to access;

5) Exploring payment and delivery models linked to quality of care, and;

6) Enhancing clinical and home visits through community-based services like community health workers (CHWs) helps outcomes for both mother and child.

I am happy to speak with you to answer any questions or continue in thought partnership. Thank you for all that you do to keep Missouri birthing persons and their children healthy, safe, and thriving as they grow together.”

Community Leader Insights (MCH leader insights as a community based perinatal support organization working to eliminate maternal and child health disparities for Black and Brown communities)

• “Another important aspect of CBOs in this space is that, oftentimes health care providers are not best positioned to help these communities as “[health care] providers are woefully ignorant about the communities they serve! Who is helping them [providers] become community literate?”
• “Many “Black and brown children live within systematically designed environments that are just more unsafe…old, unhealthy homes and poor food availability and poor educational opportunities,” and are negatively impacting child and adolescent health.”
• “Clinicians will need to implement more intrapregnancy visits that focus on contraception, mental health, and pre-pregnancy wellness,” especially now that Missouri has expanded post-partum Medicaid coverage to 12 months.”
• “Please view the DocuCourse “Pregnancy and Prejudice” here for greater insight.”

• “I want to thank you for your outstanding example of leadership and modeling how to collaborate with partners. I would like to have a better understanding of what the Public Health and Service Systems - Coordination and Systems Development category means in terms of activities/services that are eligible.” (Department of Mental Health partner)
• “Addressing National Priority Area “Improve pre-conception, prenatal and postpartum health care services for women of child bearing age – Well Woman Care (Women/Maternal Health)”: Is there interest/intention for education, training, hiring of Medication Assisted Treatment providers within medical settings to address substance use needs/stabilization prior to referral to other treatment providers (particularly, Alcohol Use Disorder and Opioid/Stimulant Use Disorders) during all stages of maternal health? Recommend focus on education and training of screening, identification and treatment of postpartum depression, trauma and other social determinates of health to build infrastructure for the use of dyadic Evidence Based Practices (EBP) treatments such as Child Parent Psychotherapy and TF CBT)  to promote early relational health of infants and mothers thus mitigating the impact of ACE scores and long term health outcomes.”
• “Thank-you for sending over this information. MHD (MO HealthNet Division) has reviewed your proposal and does not have any questions or concerns at this time. If there are any projects you would like assistance on, please do not hesitate to reach out to us.” (MO HealthNet partner)
• “Thank you for sharing.” (MO HealthNet partner)
• “Nice work! Thank you for your partnership and support.” (internal partner)
• “Looks wonderful to me!” (SHCN Family Partner)
• “Non-profit community based organizations are an important partner in making lasting sustainable improvements in health and wellness. There are 24 YMCA associations serving 70 communities in Missouri. Several YMCA evidence-based health initiatives directly address the priority areas of the Title V Maternal and Child Health Services Block Grant: maternal health, injury prevention, and reducing obesity among children and adolescents. YMCA’s Diabetes Prevention Program helps those at high risk for gestational diabetes make lifestyle changes to reduce risk. Research shows our CDC approved curriculum can reduce the number of cases by 58%. Drowning is the #1 cause of preventable death for children ages 1-4. Per the CDC, drowning rates for black children are significantly higher in all age categories of children, adolescents, and young adults. Drowning is the leading cause of death for children with Autism Spectrum Disorder (ASD). Access to a pool, swimming lessons and standardized Safety Around Water curriculum have been proven to reduce the risk of drowning. Healthy Weight and Your Child is an evidence based intervention to address childhood obesity. Our curriculum has shown significant and sustained reductions in body mass index, waist circumference, and sedentary activities, and an increase in self-esteem. WE can partner with local communities and the State to offer our programs and improve health outcomes at no-cost to Missourians.”

Responses were sent by the MCH Director to each person/organization who provided comment on the PUF. DHSS highly values input from MCH stakeholders and fellow Missourians, and all input will be taken into consideration in ongoing Title V MHC Program discussion and planning.
 

Engagement/Input for Ongoing Title V MCH Block Grant Implementation

Ongoing opportunities for input regarding the Title V MCH Block Grant are also available throughout the year. Virtual and in-person Public Health System meetings involve DHSS senior management and LPHA administrators and include discussions focused on a variety of public health topics including MCH issues.

DHSS seeks input from those considered “MCH Stakeholders” at other meetings, such as: Maternal-Child Learning Action Network, MO HealthNet Maternal Health Coordination, Missouri Perinatal Quality Collaborative/Maternal Child Learning Action Network, ParentLink Advisory Board, Genetics Advisory Committee, Council for Adolescent and School Health (CASH), Missouri Injury and Violence Prevention Advisory Committee (MIVPAC), Pregnancy Associated Mortality Review (PAMR) Board, Women’s Health Council, Early Childhood Comprehensive System Steering Committee, Parent Advisory Council, Safe Sleep Coalition, Missouri Brain Injury Advisory Council, Community Health Worker Advisory Committee, Missouri Bootheel Regional Consortium, Bootheel Babies and Families, Nurture KC, Missouri Child Psychiatry Access Project Steering Committee, and Missouri Association for Infant and Early Childhood Mental Health, to name a few. Collaborative calls with Healthy Start grantees allow an opportunity to share resources and discuss program updates and opportunities for collaboration.

DHSS recognizes the critical role of Title V MCH funds in addressing the ongoing needs of Missouri’s MCH population. Input from the MCH stakeholders and public served an important role in the development of this application and ongoing development and implementation of the State Action Plan. DHSS collaborates with partners and stakeholders and continually seeks opportunities to obtain input from other sources, and stakeholder engagement is an ongoing priority. Responses received in response to the PUF provide the opportunity to engage with new stakeholders and inform the public of the Title V MCH Services Block Grant history, purpose, goals, funding methodology, and performance measurement and the Missouri MCH State Action Plan.

The DHSS Maternal Child Health Block Grant webpage lists Missouri’s National and State Priority Areas, provides links to key Title V MCH resources, and has a direct link to email any questions and/or comments regarding the MCHBG. The FFY 2024 Application and FFY 2022 Annual Report will be added to this webpage once the final document is available and will remain available throughout the duration of the grant. A link is also currently on the webpage to direct the reader to the Title V Information System (TVIS) website.