In non-needs assessment years, input on the Title V MCH Block Grant is gathered routinely from stakeholders who are not members of the MCH staff, through task force or advisory committee meetings attended or led by MCH staff, through multidisciplinary work group meetings and through meetings with staff of Title V MCH-funded agencies and their respective advisory groups.

Many programmatic meetings, particularly those that are legislated, such as the Newborn Screening Advisory Committee and the non-review portions of the Child Fatality Review Committee are also open to the public. The DHHS website posts public notices of these meetings and the meeting minutes, if appropriate. MCH makes presentations to the Legislative Health and Human Services Oversight Committee several times each year to report on the work of legislated committees such as Maternal Mortality and Newborn Screening. Information about the MCH Block Grant and State Action Plan is also provided for potential input.

Public Surveys: Because it was a needs assessment year, a general population survey was implemented between November 2019 and January 2020 in both an electronic and a hard-copy format. Respondents were recruited to participate in a variety of ways. A survey link was on the front page of the MCH website with an invite to take part.

In addition hard copy surveys were distributed to patients at all Title V funded CHCs. Respondents came from all ten NH counties; 79% were the parent or guardian of a child under 21, and 20% were the parent, guardian or advocate of a child with special health care needs. When asked to rank the services or resources on which Title V should focus the following were the top five:

1. Parenting support;
2. Youth programs and support;
3. Substance misuse recovery;
4. Assistance in getting health insurance and
5. Access to healthcare

The reported principle difficulties encountered in trying to get health services included:

• Affording the cost of services;
• Not knowing where to get services;
• Getting to and from appointments;
• Long wait times for appointments and
• Finding time to go to appointments

An open-ended question on the biggest unmet health needs of women, children (including those with special health care needs) and families in their community showed that support transportation, mental health and insurance topped the list.

Stakeholder surveys: Title V staff used workgroup meetings of various stakeholder groups to discuss all Title V related activities, ongoing or emergent needs, as well as the needs assessment process, and to solicit input on a stakeholder survey. Participatory stakeholder groups included:

• Watch Me Grow;
• Spark NH (the former Governor’s early childhood advisory council);
• Office of the Child Advocate;
• Newborn Screening Advisory Council;
• Medical Home Advisory committee;
• Autism Council
• NH Pediatric Improvement Partnership
• Early Hearing Detection and Intervention advisory board;
• Office of Health Equity
• MCH and BFCS contractors;
• Community Health Center Directors
• Legislative Commission of Primary Care Workforce;
• NH Citizens Health Initiative;
• WIC Nutrition Program;
• Planned Parenthood of Northern New England;
• Dartmouth-Hitchcock Medical Center Patient/Family Advisory Council;
• School Nurse Association
• Department of Education, Office of Student Wellness and
• Medicaid managed care organizations (MCOs).

The surveys were introduced and Title V was discussed at the organizations’ meetings above. Notes were taken and survey links were provided. Several one-hour “special” meetings were held with all Title V funded MCH and BFCS contractors. The stakeholder surveys revealed similar findings to those of the public survey, though complementary. The themes of “support”, “transportation”, “mental health” and “substance use disorder” were heavily mentioned in many of the respondents’ survey answers, in the questions on gaps, suggested focus areas and unmet needs. An additional open-ended question related to the strengths of Title V was added which elicited responses such as programs, services and funding.

The concepts of both support and access were defined broadly in the survey. However, the responses showed that in order to be truly useful input, definitions need to be narrowed in both categories. This will take place in future surveys and show the benefit of adding in-person discussions and even focus groups (to be discussed later).

Web Posting: As “sister programs” MCH and BFCS maintain separate webpages on the DHHS website. In addition to using this as a way to communicate about surveys and meetings, the State Snapshot is posted on both pages and the Title V Block Grant Plan Overview and full plan are posted on the MCH page with contact information where individuals are encouraged to provide input or feedback to the plan and activities.

Social Media: A web-based presence like social media is becoming widely used by the MCH section as it can promote programming and inform on health policies.[1] Using social media enables MCH and thus Title V as a whole to disseminate messages in real time to inform about immediate health risks, but also to share healthy lifestyle and prevention strategies. Social media allows large numbers of people to rapidly access and disseminate information.[2] Title V and its contracted agencies can use social media to disseminate time-sensitive health information, and can circulate information that encourages behavior change. Using social media can also stimulate the involvement of the public through comments and conversation.

In an effort to maximize its communication reach, MCH has utilized the DPHS Facebook, Twitter, and Instagram social media accounts since April 2017. The DHPS Facebook page can be found at www.facebook.com/NHPubHealth, and the DPHS twitter handle is @NHPubHealth. The DPHS social media strategy allows programs to actively engage with the community by raising awareness of public health issues that can improve health and prevent disease. Consistent messaging helps educate the target audience about important health issues. From May 1, 2019 to April 30, 2020, MCH posted 195 social media posts to the DPHS Facebook and Twitter social media accounts and 38 Instagram posts. Posts include information on every MCH topic area and provide links to where women and families can access services and program information.

The Family Planning Program (FPP) and MCH have utilized the DPHS Instagram and Facebook accounts to run targeted advertisements in an effort to promote available services. MCH used this advertisement feature to engage the public on how well MCH was doing to address needed services for families and individuals. The target population for these advertisements were reproductive age (15-44 years old) men and women. This effort has provided the program with positive results: from May 1, 2019 to April 30, 2020, the FPP and MCH reached 335,086 individual social media users.

Consistent posting of MCH programs’ information on social media platforms increases the number of individuals reached. Piloting the FPP targeting strategies for specific populations through social media advertisements has demonstrated that this marketing strategy is effective for reaching specific aged individuals. By using this marketing strategy, this outreach effort can lead to increased knowledge of MCH health programs and resources available, as 81% of Americans use social media. Generally, social media users have multiple accounts across many platforms (73%)[3] which is why NH DPHS has increased its efforts to use popular social media platforms.

Focus groups: On behalf of BFCS, NHFV hosted seven virtual focus groups with 22 participants from across the state, representing nine of the State’s 10 counties. They also conducted two one-on-one telephone interviews. To incentivize engagement, participants were each given a $25 Walmart gift card, funded by Title V.

The MCH section intended to host two focus groups of pregnant women to explore maternal attitudes, experiences and behaviors around the subjects of safe sleep and smoking during pregnancy. Due to the COVID-19 epidemic and resulting mandatory statewide suspension of all non-essential gatherings, the MCH focus groups were cancelled. So while these did not contribute to the needs assessment process, it is the intention of MCH to re-schedule these to collect this very important information which will guide ongoing efforts within the State Plan to address both safe sleep and smoking during pregnancy.

Outreach to BFCS specific stakeholders: The Bureau for Family Centered Services (BFCS) has been actively involved in a variety of public input activities with an emphasis on identifying barriers to care as well as unmet needs in the system of care for CYSHCN. In addition, public input is solicited on the effectiveness and impact of services currently offered under the Title V Block  Grant. These activities have included feedback from clients, community members, and providers alike regarding the variety of programs that have been integrated under BFCS, including Special Medical Services (SMS), Partners in Health, Family Support for the Developmental Disabilities system and Part C Early Intervention, due to their shared commonality of serving children with special health care needs using a family centered approach.

New Hampshire Family Voices (NHFV) remains a critical component of the Bureau’s services. Family involvement and engagement is central to family support. To strengthen this relationship, NHFV representation has been added to the planning committee for Joint Coordinators meetings when Coordinators of all BFCS programs/services come together for a day of learning to improve communication, coordination and collaboration among agencies. As a member of the Charting the Life Course Steering Committee, their input has been welcomed and valued. In addition, NHFV included PIH Family Support Coordinators (FSCs) in the planning of an event, “Building Blocks for Your Council” in which FSCs were invited to attend with up to three members of their PIH Family Council.

As part of their Family-to-Family contract with BFCS, NHFV utilizes a variety of technological approaches to receiving family input. They have found that “social media continues to grow as a way people are receiving information and resources.” NHFV has a Facebook “public” page for outreach and a private Facebook group to support parent-to-parent linkages and information sharing. NHFV also maintains a Pinterest site with resource boards and a YouTube channel for training videos and presentations. During the COVID-19 Emergency, NHFV has assisted BFCS by establishing a dedicated email where families with CYSHCN can ask questions and/or share concerns. This information has been used to assist DHHS with the distribution of PPE and response planning.

The Medical Home Project Advisory Committee meet in person three to four times throughout the year and are called upon to provide input via email or phone far more frequently, graciously giving of their time and expertise. To define their efforts, members of the Committee developed purpose and vision statements at the beginning of this project period.

In FY18, BFCS had the opportunity to review and revise several Administrative Rules including the ones for Children’s Special Medical Services (Title V activities for CYSHCN) and Family Support Services to Children and Young Adults with Chronic Health Conditions (aka Partners in Health). In FY20, MCH and BFCS worked together with Medicaid to review and revise the Home Visiting Rule as recent legislation was successful in opening eligibility to more pregnant women and infants. As a component of the revision process, all Rules are sent out to contractors for input, public input sessions are held and the suggested revisions are considered by the NH Medical Care Advisory Committee (MCAC), which is a public advisory group established in accordance with 42 CFR § 431.12 to advise the State Medicaid Director regarding NH Medicaid policy and planning. The benefit of having the MCAC review the rules is that this group includes stakeholders who are familiar with the comprehensive healthcare needs of low income population groups and with the resources required for their care. The first two revised rules were approved in December 2018.

Rules for Family Support were revised in fiscal year 2019 and the process included several discussions about the relationship between Area Agencies and PIH agencies related to family support activities for CYSHCN and eligibility. The Area Agencies and State Family Council were asked to provide input and offer suggestions throughout the process. The rule revision team, made up of the Bureaus of Developmental (BDS) and Family Centered Services and legal, considered input to be incorporated into the revision draft.

BFCS conducts a biannual survey of parents/caregivers of CYSHCN enrolled in BFCS programs including Health Care Coordination, PIH Family Support, Nutrition/Feeding &Swallowing Consultation, the Neuromotor Specialty Clinic, Complex Care Network and the Child Development Clinic. Surveys are distributed by mail to English-speaking families; families who identified a primary language other than English were offered the survey by phone with the assistance of the Language Line. In 2018, the overall survey response rate was 19%.

The survey incorporates questions consistent with those used in the National Survey of Children’s Health (NSCH) and topic areas relevant to national initiatives, including Family Centered Care, Strengthening Families, Medical Home Improvement, and Medicaid Case Management. The survey in 2018, consistent with previous surveys, reinforces the benefit of seeking input specific to children enrolled in these programs.

Finally, participation in the 2018 MCH Workforce development skills session in Tempe, Arizona led to participation in an eight month cohort,  where the focus was on gathering stakeholders to create essential functions and operational definitions of a comprehensive developmental screening system that meets NH’s needs. Parent input was gathered using a brief Facebook survey about experiences with developmental screening. This information was used to inform essential function and operational definitions and provide input to the May 2019 Stakeholder meeting with the parent perspective represented.

[1] Fung, I., Tsz Ho Tse, Z., Fu, K. (2015). The use of social media in public health surveillance. Western Pacific Surveillance and Response Journal.

[2] Dosemagen, S. & Aase, L. (January 27, 2017). How Social Media is Shaking Up Public Health and Health Care. Huffington Post.

[3] Smith, A., & Anderson M. (2018). Social Media Use in 2018. Pew Research Center.