Oversight and Authority

 

The Virginia Department of Health (VDH) is the lead state entity providing core public health functions and essential services. The VDH Strategic Plan establishes the agency’s mission to protect the health and promote the well-being of all people in Virginia, with a vision to become the healthiest state in the nation.

 

To execute this mission, Virginia’s Plan for Well-Being (PfWB) 2023-2027 is a shared vision to improve the health of all Virginians. It outlines priority areas and includes strategies to improve the health of all people in Virginia. It is a tool for health care professionals, government agencies, community-based organizations, advocates, academicians, policymakers, and other stakeholders to use to catalyze action that will leverage resources and focus work towards measurable improvement. Grounded in data, the Plan for Well-Being identifies strategies to improve outcomes around five priority areas identified by the State Health Assessment Advisory Council in August 2022. A sixth priority area was identified in the spring of 2023, based on the increase of drug overdose deaths and the need to address this issue from a statewide perspective over the PfWB development time period. These priority issues include infant mortality, firearm deaths, obesity, substance use and drug overdose, mental health, and housing, transportation, and economic stability.

 

The scope of the agency’s services includes ensuring food and water safety, disease and injury prevention and surveillance, emergency preparedness, health equity, and setting licensure and certification standards. As the leading public health agency in the state, the central office is located in Richmond, the state’s capital. The State Board of Health provides leadership in planning and policy development and supports VDH in implementing a coordinated, prevention-oriented program that promotes and protects the health of all Virginians. The agency is led by the State Health Commissioner, with additional oversight from the Chief Operating Officer and Deputy Commissioners distributed across four main operating divisions: Population Health & Preparedness, Administration, Community Health Services, and Governmental and Regulatory Affairs.

 

Virginia’s MCH Program

VDH is responsible for the administration of programs carried out with allotments under Title V. Virginia’s MCH program implements strategies that have broad population health impact. The VDH Office of Family Health Services (OFHS) houses the state Title V program and complementary MCH programs. OFHS programs include the Women, Infants, and Children's Nutrition Program (WIC) in the Division of Community Nutrition; disease prevention and health promotion in the Division of Prevention and Health Promotion; protecting and improving the health of women, infants, children, adolescents, and their families in the Division of Child and Family Health; and providing scientific integrity and quality data analysis, reporting, and program evaluation related to these populations in the Division of Population Health Data. MCH block grant funding is allocated by formula to each of Virginia’s 35 local health districts to support local MCH implementation, with two of these districts being governed locally.

 

Virginia’s MCH program works with and garners partnerships across state agencies and programs, including the Department of Medical Assistance Services, Department of Social Services, Department of Education, and Department of Behavioral Health and Developmental Services. Virginia’s Healthy Start and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Programs are administered through the VDH Division of Child and Family Health.

 

MCH Priorities: Virginia’s Title V MCH programming aligns with the agencies mission and core values by establishing upstream approaches to MCH priorities:

• Maternal/Infant Mortality Disparity: Eliminate the racial disparity in maternal and infant mortality rates by 2025.
• Racism as a Root Cause: Explore and eliminate drivers of structural and institutional racism within OFHS programs, policies, and practices to improve maternal and child health.
• Reproductive Justice & Support: Promote equitable access to choice-centered reproduction-related services, including sex education, family planning, fertility/grief support, and parenting support.
• Upstream / Cross-Sector Strategic Planning: Eliminate health inequities arising from social, political, economic, and environmental conditions through strategic, nontraditional partnerships.
• Oral Health: Maintain and expand access to oral health services across MCH populations.
• Community, Family, & Youth Leadership: Provide dedicated space, technical assistance, and financial resources to advance community leadership in state and local maternal and child health initiatives.
• MCH Data Capacity: Maintain and expand state MCH data capacity, to include ongoing needs assessment activities, program evaluation, and modernized data visualization and integration.
• Strong Systems of Care for All Children: Strengthen the continuum supporting physical/socio-emotional development (i.e., screening, assessment, referral, follow-up, coordinated community-based care).
• Mental Health: Promote mental health across MCH populations, to include reducing suicide and substance use.
• Finances as a Root Cause: Increase the financial agency and well-being of MCH populations.

 

Geography

 

The Commonwealth of Virginia encompasses 42,774 square miles (110,784 km2), including land and water areas, making it the thirty-fifth largest state by total area. The state is geographically located in the mid-Atlantic area of the United States, between the Atlantic Coast and the Appalachian Mountains; Washington D.C., the nation’s capital, and Maryland to the north; the Atlantic Ocean to the east; North Carolina to the south; and Tennessee, West Virginia, and Kentucky to the west. Land is distinctly divided by the Appalachian Mountains in the west, countryside, rolling hills, growing cities, and sandy beaches in the east where the Chesapeake Bay separates the contiguous portion of the Commonwealth from the two-county peninsula of Virginia's Eastern Shore. Many of Virginia's rivers flow into the Chesapeake Bay, including the Potomac, Rappahannock, York, and James.

 

Population Density & Urbanization

Virginia has 11 Metropolitan Statistical Areas, with Northern Virginia (Washington-Arlington-Alexandria), Hampton Roads (Virginia Beach-Norfolk-Newport News), and Richmond-Petersburg being the three most populous. The Commonwealth is divided into 133 localities (95 counties and 38 independent cities) with a population density of 200.6 per square mile. The largest independent cities are Virginia Beach (457,658), Chesapeake (247,172), Norfolk (238,556), the state’s capital Richmond City (225,676) and Newport News City (185,069). Norfolk forms the urban core of the Hampton Roads metropolitan area, which has a population over 1.7 million people and is the site of the world’s largest naval base, Naval Station Norfolk.

 

Over 3.1 million people, or 37% of the population, live in Northern Virginia. The most populous jurisdiction (and county) in the state is Fairfax County in Northern Virginia, with a climbing population of nearly 1.15 million. Fairfax County has a major urban business and shopping center in Tysons Corner, Virginia's largest office market. Neighboring Prince William County (477,224) is Virginia's second most populous county, and is home to Marine Corps Base Quantico, the FBI Academy and Manassas National Battlefield Park. According to an article in the Washington Post, analysis of U.S. Census Bureau data has shown that Prince William County has leapfrogged Virginia Beach to become the second-most-populous jurisdiction in Virginia. Three out of four of the state's largest counties, now in Northern Virginia, account for 21.9% of the state’s population growth. Loudoun County in Northern Virginia with its 413,574 residents surpasses Chesterfield County in the Richmond MSA with its 359,798 residents. 

 

Virginia is a place where state averages hide the contrasting stories of its subpopulations. There are approximately 1.0 million residents living within rural areas of the state, compared to over 7.5 million within urban areas. Virginia Department of Health has grouped the Commonwealth’s localities into 35 health districts and 5 health regions. The Northern region, composed of Alexandria, Arlington, Fairfax, Loudoun, and Prince William health districts, is densely populated and include 3 of the 50 richest places in America according to Bloomberg, 2020. Conversely, the Southwest region, made up of Alleghany, Central Virginia, Cumberland Plateau, Lenowisco, Mount Rogers, New River, Pittsylvania/Danville, Roanoke City, and West Piedmont health districts, is rural with a rugged and mountainous terrain and is the least populous and least racial/ethnically diverse. Its terrain and vast geographic area pose many transportation barriers. The Central region is composed of Chesterfield, Crater, Chickahominy, Henrico, Piedmont, Richmond City, and Southside health districts. The Northwestern region is made up of Central Shenandoah, Lord Fairfax, Rappahannock, Rappahannock/Rapidan, and Blue Ridge (formerly Thomas Jefferson) health districts. These two regions have a mix of urban, suburban and rural areas. The urban areas are home to large state colleges/universities and are business districts. The suburban areas are more residential than industrial. The rural areas are agricultural. The Eastern region, composed of Chesapeake, Eastern Shore, Hampton, Norfolk City, Peninsula, Portsmouth, Three Rivers, Virginia Beach, Western Tidewater health districts, runs along the east coast (Chesapeake Bay and Atlantic Ocean) and includes the Eastern Shore, a peninsula separated from the mainland by the Chesapeake Bay. The Eastern Shore Health District is sparsely populated and has a high level of poverty. The Eastern area has the largest concentration of military bases and facilities of any metropolitan area in the world. The coastal area has many bridges and tunnels that create transportation barriers to services. Individuals in the area also experience severe traffic congestion on a daily basis. Occasionally, hurricanes and tropical storms affect the area and can result in flooding and environmental health concerns.

 

Demographics

 

Virginia is the 12th most populous state in the U.S., with an estimated population of nearly 8.7 million people (World Population Review).

 

Race/Ethnicity

Among people reporting one race alone, 67.2% identified as White, 20.3% identified as Black, 0.5% American Indian and Alaska Native, 7.5% Asian, and 0.1% Native Hawaiian and Pacific Islander (2021: ACS 5-Year Estimates Data Profiles, Demographic and Housing Estimates). There were 10.2% of individuals that identified as Hispanic or Latine/x. According to the Census Bureau, Virginia ranks 9th in having the largest African American population (HHS Office of Minority Health Resource Center).

 

Virginia sits on ancestral lands of various Indigenous Tribes that were firmly established before the English settlement in Jamestown, and have made significant contributions to the survival of new settlers in Virginia. The Commonwealth of Virginia consists of 11 state recognized tribes (Virginia Indians), 7 which are federally recognized tribes (Federally Recognized Indian Entities). Of those identifying as American Indian and Alaska Native with one specified tribe alone, 14.4% identified as Central American Indian, 10.8% identified as Cherokee, 7.2% identified as Mexican American Indian, 3.2% identified as South American Indian, and 15.3% identified as an Other American Indian Tribe (2021: ACS 5-Year Estimates Data Profiles, American Indian and Alaska Native Alone for Selected Tribal Groupings). Indigenous populations largely reside in the Three Rivers Health District in the eastern part of the Commonwealth.

 

There were over 1.7 million women of childbearing age (15-44 years) in 2021, with race and ethnicity composition consisting of 56.0% non-Hispanic White, 20.5% non-Hispanic black, 8.2% non-Hispanic Asian or Pacific Islander, 0.3% non-Hispanic Native American or Alaska Native, and 11.7% Hispanic (any race) (2021: CDC WONDER Population Estimates). The Virginia population, like that of the nation, is becoming more racially and ethnically diverse where 12.5% of the population are foreign-born (2021: ACS 5-Year Estimates Data Profiles, Selected Social Characteristics).

 

Age and Sex

In the Commonwealth of Virginia, gender identification was 49.5% as male and 50.5 as female, with an estimated 97.9 males per 100 females. The age breakdown of Virginians is 5.8% under 5 years, 22.0% under 18 years, and 15.5% of persons 65 years or older (2021: ACS 5-Year Estimates Data Profiles, Demographic and Housing Estimates). There were 186,643 grandparents, and 35.2% were responsible for their grandchildren under age 18 (2021: ACS 5-Year Estimates Data Profiles, Demographic and Housing Estimates).

 

Economic Well-Being

 

Educational Attainment

Educational attainment is a predictor of personal wealth and well-being and is directly related to social disparities. In Virginia, 5.5% have a 9th to 12th grade education with no diploma, 23.8% are high school graduates or equivalent, 22.8% have a bachelor’s degree, and 17.6% have a graduate or professional degree (2021: ACS 5-Year Estimates Data Profiles, Selected Social Characteristics).

 

Economy/Income/Poverty

Virginia’s economy is diverse, including local and federal government, military, farming, business, manufacturing, tourism, and healthcare/medical. Virginia has over 4.4 million civilian workers, and 15.4% are in service occupations. The unemployment rate in Virginia was 4.6% as per ACS 2021, below the national rate of 5.5%. The median household income in Virginia is $80,615 compared to $69,021 in the U.S. (2021: ACS 5-Year Estimates Data Profiles, Selected Social Characteristics).

 

Compared to the U.S. population, a lower percentage of Virginia families lived in households with incomes below the federal poverty level (9.7% vs. 12.3% for the U.S.) and a lower percentage of children under age 18 lived in households with incomes below the federal poverty level (13.0% vs. 17.0% for the U.S.). However, wealth varies significantly across the state.  The percentage of children living in poverty was 13.1% in 2021 (2021: ACS 5-Year Estimates Data Profiles, Poverty Status in the past 12 months). For the years 2020-2021, 17.7% of children with special health care needs lived in families with incomes less than 100% of the federal poverty level (2020-2021 National Survey of Children’s Health (NSCH)). This is in comparison to children without special health care needs, of which 13.8% are in families with incomes less than 100% of the federal poverty level.

 

Housing

The factors that relate to housing have the potential to affect health in major ways. These factors include physical conditions within homes, conditions in the neighborhoods surrounding homes, and housing affordability. Among occupied housing units in Virginia, 33.4% are rented. In renter-occupied units, nearly half (47.3%) pay 30 percent or more of their household income to rent (2021: ACS 5-Year Estimates Data Profiles, Selected Housing Characteristics). In 2019, 63% of Virginia children lived in low-income households with high housing cost burden (KIDSCOUNT Data Center) with the median rent in Virginia at $1,326. The median home value for owner-occupied units in Virginia is $295,500 (2021) compared to $248,400 in 2016, a 19.0% increase in median home value. Communities without safe and affordable housing affect the overall ability of families to make healthy choices and access to quality homes.

 

Food Security

Food insecurity is a social and economic condition where access to food is limited or uncertain. In Virginia, 704,270 people are facing hunger, and 1 in 11 are children (Feeding America). According to 2021 America’s Health Rankings, 7.8% of Virginia households were unable to provide adequate food for one or more household members due to lack of resources. Charity and government assistance programs are necessary to help bridge the meal gap. In 2021, 44.9% of households receiving Supplemental Nutrition Assistance Program (SNAP) benefits have children (Feeding America).

 

Community and Social Well-Being

 

Social and emotional support

Research has supported that social and emotional support from others can be protective for health. Overall, nearly one-third of Virginia children were living in single parent households (KIDSCOUNT Data Center). There were 3.2% of children in the care of grandparents. The majority of Virginia parents (77.9%) report that they have someone to turn to for day-to-day emotional support with parenting or raising children (NCHS 2020-2021). There were 63.6% of high school students that have an adult to go to for help with a serious problem, a decrease from the previous survey year (Virginia YRBS).

 

Racism and Discrimination

Racism and discrimination are among other social determinants of health that negatively influence health. During their pregnancy, mothers expressed experiencing discrimination or harassment due to their race, ethnicity, or culture (6.5%); insurance or Medicaid status (4.1%); weight (6.5%); and marital status (2.1%). Approximately 19.7% of Non-Hispanic Black mothers, 1.9% of Hispanic mothers, and 15.4% of mothers identifying as another race reported discrimination or harassment due to their race, ethnicity, or culture (Virginia PRAMS 2021). Among high school students, 19.4% have been a victim of teasing or name-calling because of their actual or perceived race or ethnic background.

 

Health Care Access

 

Primary Care Access and Health Insurance Coverage

Based on the 2021 ACS 5-Year Estimates, 92.1% of Virginians have health insurance of some kind, where 75.2% were private and 30.0% were public. Virginia expanded the Medicaid program on January 1, 2019, a significant change in health care policy that was realized without the expenditure of state dollars. More than 380,000 Virginia adults are enrolled and receiving services under the new eligibility rules. Among the uninsured population, 4.9% were under the age of 19, 13.8% were young adults (ages 24 to 34), 21.6% had less than a high school education, and racial identification was 6.4% as White, 8.7% as African American, 13.2% as American Indian and Alaska Native, and 22.9% Hispanic or Latine/x (2021 ACS 5-Year Estimates).

 

Health Care Professional Shortages and Birthing Hospitals

In 2021, the Bureau of Labor Statistics reported 4,060 Family Medicine Physicians in Virginia, and 500 obstetricians/gynecologists. There were 670 pediatricians, 4,880 dentists and 270 dental specialists or orthodontists, and 210 Oral and Maxillofacial Surgeons in the state. There are needs recognized across the state that can be unique to different areas of the state, such as transportation barriers and availability of providers. There were 60 counties/ census tracts in Virginia designated as Primary Care Health Professional Shortage Areas (HPSAs), 10 in Dental Care, 38 in Mental Health, and 223 counties/census tracts designated as medically underserved areas (HRSA Data Warehouse). In addition, Virginia has 51 birthing hospitals that serve pregnant people in the Commonwealth as of 2023 (see Figure), and 55 counties (41.4%) are considered either maternity care deserts or having low access to maternity care (March of Dimes). Virginia has lower median allowed values for vaginal and C-section deliveries (including professional and facility costs) occurring at in-network hospitals than the national median, but higher median charged values to uninsured patients or delivering at out-of-network hospitals (Fair Health).

 

Performance Measures and Outcomes

 

DOMAIN: Women’s/Maternal Health

According to America’s Health Rankings (2022), Virginia ranks 11th overall for the health of women.

 

NPM 13.1: Preventive Dental Visit During Pregnancy – Data from the Pregnancy Risk Assessment Monitoring System (PRAMS) showed that 46.3% of moms had a preventive dental visit during pregnancy (2021 VA PRAMS). Preventive dental care in pregnancy is recommended by the American College of Obstetricians and Gynecologists (ACOG) to improve lifelong oral hygiene habits and dietary behavior for women and their families.

 

SPM 4: Pregnancy Intention: Mistimed or Unwanted Pregnancy – The percentage of women reporting that they wanted to become pregnant later or never was 19.9% (2021 VA PRAMS). The concept of unintended pregnancy helps in understanding the fertility of populations and the unmet need for contraception and family planning (CDC 2019). In Virginia, 38.7% of pregnancies were described by women as being unintended.

 

NOM 3: Maternal Mortality – Maternal mortality is a sentinel indicator of health and health care quality worldwide. In 2019 Virginia's governor announced a goal to eliminate the racial disparity in the maternal mortality rate in Virginia by 2025. The maternal mortality rate was 28.5 per 100,000 live births, with a rate of 26.3 per 100,000 among White women and 43.9 per 100,000 among Black women (2017-2021). The Black/White Maternal Mortality Ratio was 1.7 (SOM 2).

 

NOM 2: Severe Maternal Morbidity – The rate of severe maternal morbidity in Virginia is 73.8 per 10,000 delivery hospitalizations, where hemorrhage accounts for 29.5 per 10,000 (2020). Increases were seen among other medical, obstetric, renal, and respiratory complications. Disparities exist among race/ethnicity (non-Hispanic Black – 124.6), health insurance (Medicaid – 92.8, Uninsured – 109.5), and maternal age (≥35 Years – 98.6).

 

SPM 6: Mental Health & Well-Being - The percentage of women who experience postpartum depressive symptoms following a recent live birth was 11.3% (2021 Virginia PRAMS). 23 of 35 Local Health Districts have chosen mental health as a priority.

 

DOMAIN: Perinatal/Infant Health

According to America’s Health Rankings (2020), Virginia ranks 25th overall for the health of infants.

 

NPM 4: Breastfeeding – Research shows that breastfeeding provides many health benefits for moms and babies, including lower risk of type 2 diabetes and certain cancers for moms, and protection from illness for babies. Virginia PRAMS (2021) showed 87.4% of respondents ever breastfed,19.0% breastfed for 1-10 weeks, and 57.7% were breastfeeding at the time of the survey. There were some differences observed in continuation by race, whereby at the time of the survey 60.2% of Non-Hispanic White moms were breastfeeding at the time of the survey, 63.8% of Hispanic moms, and 43.2% of Non-Hispanic Black moms.

 

NOM 9.1: Infant Mortality – Infant mortality is a sentinel measure of population health that reflects the underlying well-being of mothers and families, as well as the broader community and social environment that cultivate health and access to health-promoting resources. The infant mortality rate in Virginia is 5.9 per 1,000 live births (Virginia Vital Statistics System, 2021). A significant disparity exists in infant deaths between racial groups in Virginia, where non-Hispanic Black women had an infant mortality rate of 10.1, twice that for non-Hispanic White women (4.6 per 1,000 live births). Reduction in the disparity in infant mortality remains a priority of the upcoming 2023-2027 Virginia Plan for Well-Being. The Black/White Infant Mortality Ratio is 2.2 (SOM 1).

 

NOM 9.5: Sudden Unexpected Infant Deaths (SUID) – Sleep-related infant deaths are among the leading causes of infant death. The SUID rate in Virginia is 102.4 per 100,000 live births (National Vital Statistics System, 2020); with disparities among race/ethnicity (non-Hispanic Black – 213.7), health insurance (Medicaid – 218.2, Uninsured – 100.9), and maternal age (<20 Years – 251.7).

 

Newborn Screening – The Virginia Newborn Screening program consists of dried blood spot (DBS) newborn screening, the Early Hearing Detection and Intervention (EHDI) and CCHD follow-up teams. The DBS and EHDI teams track and follow-up on all out-of-range results, facilitates access to specialty services for further testing and confirmation of diagnosis, and infants that are diagnosed with a newborn screening disorder are referred to Care Connection for Children Centers (CCC) for care coordination services. EHDI also refers diagnosed infants to Early Intervention (EI).

 

DOMAIN: Child Health

According to America’s Health Rankings (2022), Virginia ranks 14th overall for the health of children. The child mortality rate was 16.2 per 100,000 children ages 1-9 (NOM 15).

 

NPM 6: Developmental Screening – The percent of children, ages 9-35 months, who received a developmental screening using a parent-completed screening tool in the past year is 34.4% (2019-2020) in Virginia, compared to the U.S. at 34.8%. Early identification of developmental disorders is critical to child well-being and is an integral function of primary care.

 

NPM 7.1: Injury Hospitalization (ages 0-9 years) – Data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) showed the rate of hospitalization for non-fatal injury among children was 79.1 per 100,000 in 2020. Among age groups, the annual indicator was 204.6 for children less than one year of age, 86.3 among children ages 1-4, and 49.8 among children ages 5-9. Reducing the burden of nonfatal injury can greatly improve the life course trajectory of infants and children, resulting in improved quality of life and cost savings.

 

NPM 13.2: Preventive Dental Visit (ages 1-11 years) – The NSCH showed that 57.5% of children age 1-5 years and 87.7% of children age 6-11 years had a preventive dental visit (2019-2020). Insufficient access to oral health care and effective preventive services affects children’s health, education, and ability to prosper.

 

DOMAIN: Adolescent Health

The adolescent mortality rate was 34 per 100,000 children ages 10-19 (NOM 16.1). The adolescent motor vehicle mortality rate was 9.6 per 100,000 adolescents ages 15-19 (NOM 16.2).

 

NPM 7.2: Injury Hospitalization (ages 10-19 years) – The HCUP-SID showed the rate of hospitalization for non-fatal injury among adolescents was 180.2 per 100,000 in 2020. The annual indicator was 92 among age 10-14 years and 265.8 among age 15-19 years. 17.9% of high school students were victims of any form of bullying. Those who experienced cyberbullying had higher reports of feeling sad for 2 weeks or more (74.0%), current alcohol use (40.6%), and considered suicide (51.7%). In addition, LGBT students reported feeling sad more than heterosexual students (62.9% vs 30.4%) Virginia YRBS, 2021). The adolescent suicide rate was 11.7 per 100,000 adolescents ages 15-19 (NOM 16.3). Adolescent suicide is currently a focus of the State Child Fatality Review Team.

 

NPM 12: Transition (ages 12-17 years) – The NSCH (2020-2021) showed only 19.5% of adolescents received services necessary to make transitions to adult health care. Health care transition focuses on building independent health care skills – including self-advocacy, preparing for the adult model of care, and transferring to new providers.

 

NPM 13.2: Preventive Dental Visit (ages 12-17 years) – The NSCH (2020-2021) showed that 74.2% of adolescents had a preventive dental visit.

 

Pregnancy Intention – The teen pregnancy rate has been declining, with the rate in Virginia being 15.1 per 1,000 females aged 15 to 19 years (Virginia Vital Statistics System, 2021). Differences exist among race/ethnicity and regions within the state. Hispanic/Latine/x and non-Hispanic Black teens had the highest teen pregnancy rates in 2021 at 30.8 and 25.1 per 1,000 females aged 15-19 respectfully. The Eastern (20.9), Southwestern (19.1), and Central (18.3) regions had rates higher than the state rate. The public savings in 2015 due to declines in the teen birth rate have totaled an estimated $72 million (Power to Decide, 2020).

 

DOMAIN: Children with Special Health Care Needs

The percent of children with special health care needs (CSHCN), ages 0 through 17, in Virginia is 18.5% (NSCH 2020-2021).

 

NPM 11: Medical Home (CSHCN ages 0-17 years) – The NSCH (2020-2021) showed that 43.9% of CSHCN had a medical home. Children with a stable and continuous source of health care are more likely to receive appropriate preventive care.

 

NPM 12: Transition (CSHCN ages 12-17 years) – The NSCH (2020-2021) showed that 19.5% of CSHCN age 12-17 years were engaged in transition services to adult health care. Transition to adult care is important to gain independent health care skills, prepare for an adult model of care, and transfer to new clinicians to continue services.

 

NPM 15: Continuous and Adequate Insurance (CSHCN ages 12-17 years) – The NSCH (2020-2021) showed that 66.4% of CSHCN were continuously and adequately insured. There were 34.1% of CSHCN that had public insurance only, 58.9% private insurance only, and 1.4% uninsured.

 

DOMAIN: Cross-Cutting/Systems Building

 

SPM 1: Cross-Cutting (Early and Continuous Screening) – Early identification of developmental disorders is critical. The newborn screening and birth defects surveillance program seek to maintain the VaCARES Registry and expand capacity to document and track referrals of infants from the Newborn Screening Program to CSHCN programs.

 

SPM 2: Cross-Cutting (Youth Leadership) – Through the development of a Youth Advisor Program, the Adolescent Health Program seeks to increase equity in VDH’s public health initiatives by incorporating youth voice into the development, planning and management of public health initiatives that impact young people.

 

SPM 3: MCH Workforce Development (Racial Equity) – The VDH MCH Program will provide dedicated space, technical assistance, and learning opportunities that advance racial equity among MCH workforce.

 

SPM 5: Cross-Cutting (Family Leadership) – The VDH MCH Program seeks to maintain and expand family engagement to assure families of children with special health care needs partner in decision making at all levels and are satisfied with the services they receive.

 

State Statutes and Other Regulations

 

Statutes

The state plan for the Virginia CYSHCN Program is found in the Virginia Administrative Code (VAC). The plan closely mirrors some of the recommendations of AMCHP and the Maternal and Child Health Bureau.  In the plan, the Virginia CYSHCN Program is defined along with the program scope and content.  The CYSHCN unit includes four programs: Care Connection for Children, Child Development Services Program, Sickle Cell Program, and Bleeding Disorders Program. In addition, the CYSHCN Program connects with newborn screening services in the VAC and has responsibilities in support of newborns confirmed to have certain conditions as described on the newborn screening panel. In addition, the General Assembly passed legislation in 2020 for the Board of Health to adopt regulations to implement an adult comprehensive sickle cell network, as well as funding to support the adult clinics' infrastructure. The regulations have been incorporated in the VAC, and outlines the scope and services the adult comprehensive sickle cell network provides.

 

Section 32.1-77 of the Code of Virginia authorizes the Virginia Department of Health (VDH), led by the State Health Commissioner, to prepare and administer the state’s Title V plan for MCH.

 

Section 32.1-64.1 through 69.2 also codifies the Virginia Early Hearing Detection and Intervention (EHDI), the dried blood spot (DBS) and Critical Congenital Heart Disease (CCHD) newborn screening (NBS) programs, as well as the Virginia Congenital Anomalies Reporting and Education System (VaCARES) program, the state's birth defect surveillance program.  Associated regulations for EHDI, DBS and CCHD can be found in Chapters 71 and 80 of the Department of Health's Administrative Code.

 

Section 32.1-283.1 codifies the Child Fatality Review Team (since 1994), while Section 32.1-283.8 codifies the Maternal Mortality Review Team (since 2019).

 

Updates to Previously Reported Virginia Legislation and Initiatives

Virginia House Bill 1157 (2018 General Assembly) provides that the Department of Health shall serve as the lead agency with responsibility for the development, coordination, and implementation of a plan for services for substance-exposed infants in the Commonwealth. It details that plans shall (i) support a trauma-informed approach to identification and treatment of substance-exposed infants and their caregivers and (ii) include (a) options for improving screening and identification of substance-using pregnant women, (b) use of multidisciplinary approaches to intervention and service delivery during the prenatal period and following the birth of the substance-exposed child, and (c) referral among providers serving substance-exposed infants and their families and caregivers. The report and plan have been approved and has been posted to the legislative information system in May 2021.

 

Children’s Cabinet: In June 2018, the former Virginia Governor Ralph Northam issued Executive Order No. 11 reestablishing the Children’s Cabinet (Press Release). The former First Lady led the effort to improve quality of and access to early childhood education programs across Virginia, support the early childhood education workforce, and ensure that Virginia made the most of early childhood education resources. The Children’s Cabinet prioritized issues including early childhood development and school readiness, nutrition and food security, and systems of trauma informed care and safety for school-aged youth. Information on previous meetings of the Cabinet and workgroups can be found here https://www.governor.virginia.gov/childrens-cabinet/meeting-materials/. The Children’s Cabinet did not continue into the new administration in 2022.

 

House Bill 1950 (2021 General Assembly) directed the VDH Office of the Chief Medical Examiner (OCME) to convene a workgroup to assess the feasibility of implementing the Fetal Infant Mortality Review Team (FIMRT), in which the Director of the Division of Child and Family Health served as a member. Although a report was published with the findings and recommendations from this workgroup in December 2021, a bill was not submitted in the 2022 legislative cycle to allow for its implementation at this time.

 

Virginia House Bill 2111 (2021 General Assembly) established the Maternal Health Data and Quality Measures Task Force for the purpose of evaluating maternal health data collection to guide policies in the Commonwealth to improve maternal care, quality, and outcomes for all birthing people in the Commonwealth. The 2023 General Assembly directed the Task Force to also explore the role of implicit bias training for providers. A final report of recommendations due in December 2023. 

 

New Legislation and Initiatives

The 2022 and 2023 General Assembly sessions brought forth legislation that impacts Virginia’s MCH populations, and VDH MCH staff have been involved in various capacities of their implementation. The following are significant legislation that passed, but not inclusive of all efforts:

• House Bill 229 (2022) Social determinants of health; VDH shall collect & analyze information including demographic data.
• House Bill 1567 (2023) Perinatal Health; VDH to convene a work group to evaluate strategies to reduce maternal and infant mortality rates through expansion of the perinatal health hub model.
• Senate Bill 1254 (2023) Maternal Mortality Review Team; directs the MMRT to provide reports on an annual basis rather than a triennial basis.
• Senate Bill 1531 (2023) Virginia Neonatal Perinatal Collaborative; Directs the Secretary of Health and Human Resources to convene a work group to make recommendations to strengthen the Collaborative in doing quality improvement initiatives on a statewide basis.