Domain: Cross-Cutting/Systems Building

Planning for October 2023-September 2024

Objective

By 2025, reduce the percentage of Minnesotans that did not receive routine medical care they needed because of cost by 35%.

State Performance Measure

(SPM 1) Percent of Minnesotans that did not get routine medical care that they needed because of cost.

Minnesota’s Title V program has chosen to focus priority goals on Minnesotans accessing needed care rather than insurance coverage alone. Therefore, measurement for this priority area is focused on the proportion of Minnesotans reporting an unmet need for medical care due to cost.

By FY2024 Minnesota aims to reduce the percentage of Minnesotans that did not get routine medical care that they needed because of cost to 5.6%.

Community-Identified Priority Need: Accessible and Affordable Health Care

For more information on the importance of Accessible and Affordable Health Care on the lives of people living in Minnesota see the Cross-Cutting 2022 Annual Report.

Strategies and Activities

A.  Strategy A: Recognize and Reduce Systemic Racism, Discrimination, and Marginalization in Health Care

1. State Level Activities
   1. Promote and Provide Training on Accessibility in Health Care and Other Community Settings for Children and Adults with Disabilities

For the rest of this five-year block grant cycle, MDH intends to work toward providing general health guidance and training to health care professionals on how to promote accessibility for people with disabilities and their families. Moving into FY2024, based upon feedback received in May 2023 Health Care Homes Learning Days, Title V staff will continue to work with the Minnesota Health Care Homes Program and the Heath Care Home Learning Collaborative to develop and promote a training module for health care providers focused on better serving persons with disabilities.  The module will be based on the presentation provided at the May 2023 Health Care Homes Learning Days and revised using feedback provided.  The module will be held long-term on the MDH Learning Center, a platform that provides access to in-person and online educational opportunities on various health-related topics.

2. Partner with Minnesota’s State Medicaid Program to Identify Populations Most Likely to Experience Inequities in Health Settings

In FFY2024, MDH will work strategically to improve collaboration with the state’s Medical Assistance (Medicaid) Program to identify inequities and disparities among CYSHN and MCH populations who use Minnesota public health care programs. More specifically, Title V staff will work with the state’s Medicaid Director to identify gaps and opportunities for improvement within the current Minnesota Title V and Medicaid MOU to finalize and implement a revised MOU. 

3. Address Disparities in Data Available on Minnesotans with Disabilities

In  2024, Title V staff will partner with the MDH Center for Health Equity (CHE) to establish and lead an ongoing data workgroup to address gaps in data available related to persons with disabilities, including children and youth with special health needs. Specifically, the workgroup aims to: 

• Identify current data sources and existing baseline data. 
• Collaborate to improve data partnerships focused on persons with disabilities with other state agencies such as the Minnesota Department of Employment and Economic Development, Minnesota Department of Human Services, and Minnesota Department of Education. 
• Develop a workgroup focused on the creation of a disability data dashboard to address data disparities using intersectional data measures.

MDH work around disabilities must be integrated within a health equity lens, recognizing the impact of both independent and intersectional disparities within the community (e.g., race, rural, poverty, etc.). Title V staff will continue to work to ensure focus on persons with disabilities in the overall work of the CHE. 

B.  Strategy B: Expand Access to Health Care by Increasing Availability of Community-Based and Remote Services

1. State Level Activities
   1. Provide Road Map/Technical Assistance to Expand Opportunities for Collaboration Between the Health Care System and Schools

Title V staff will continue to improve collaboration with schools, school nurses, and school-based clinics as primary entry points to improved health care for children. In FFY2024, MDH will:

• Create new, on-going program to support school-based health centers – In the recent legislative session, a new school health program was created with on-going grants to new and existing school-based health centers, the first ever investment of state resources. The statute also defines school-based health centers to ensure that they meet national standards and provide care regardless of the student’s ability to pay. Over the coming months, the MDH team will design this program and provide updates in future Title V reports.
• Build the Capacity of School-Based Health Care in Minnesota – Build the capacity of Minnesota School-Based Health Alliance (SBHA), a nonprofit organization that supports the sustainability, quality, equity, and expansion of school-based health care near or inside of Minnesota’s schools.
• Build State Capacity to Address Health Needs of Students– MDH and MDE are partnering with the National Association of School Nurses (NASN) to focus on professional development for school nurses in relation to school nursing practice. In addition, MDH and MDE are participating in a national project with the National Association of the American Academy of Pediatrics entitled Training, Education, Assistance, Mentorship, and Support (TEAMS) to conduct an assessment and develop a state action plan to address high priority health needs of students.
• Improve Data Sharing, Collection, and Use – MDH and MN SBHA are working collaboratively with the National SBHA, the University of Minnesota, and the five entities overseeing SBHCs in Minnesota to develop dataset tools that will be made available to schools that are in the planning process for developing a SBHC. The tools will track students’ health services that are used for planning and recovery efforts from COVID-19, such as: the immunization gap, depression screening, flu and COVID-19 vaccinations, asthma management and referrals to mental health providers.
• Build School Capacity to address the Opioid Epidemic - MDH Title V staff will support the implementation of the model policy on Naloxone administration in schools that they partnered with Minnesota School Boards Association to develop in FY2023. The model policy is voluntary for nearly 400 school districts in Minnesota to advance evidence-based practice to save lives amidst the opioid crisis. New technical packages are in completion phase which support implementation, including Naloxone Administration in School Settings - MN Dept. of Health (state.mn.us) and School Toolkit - MN Dept. of Health (state.mn.us)
• Support School Based Health Centers – In collaboration with Minnesota Community Care Clinics (MCC), Mankato State University PONDS Clinic, Minneapolis School Based Clinics, and White Bear Lake School District’s Bear Care Rise Up School Based Clinic, Title V staff will support the integration of mental health services, innovation of screening services and tools, and expansion of services for school based health centers across the state.
  2. Assess and Promote Accessible and Barrier-Free Access to Telehealth and Other Remote Methods of Health Care for MCH Populations

The 2021 Minnesota Legislature passed the Minnesota Telehealth Act, which expands telehealth in Minnesota and extends payment parity to include telephone-only visits through June 30, 2023. As a part of this legislation, MDH was directed to conduct a study of the impact of Minnesota’s telehealth policies under private sector health insurance. An additional component of the study is to be led by MN DHS to focus on the impact of Minnesota’s telehealth policies on Minnesota Health Care Programs.

During FFY2024, MDH, with contracted partners and the Minnesota Study of Telehealth Expansion and Payment Parity Technical Advisory Group, will continue work to assess the use of telehealth for Minnesota populations noting situations of most positive impact and where barriers exist. Two reports are set to be produced – the first by January 15th, 2023, and the second by January 15th, 2024 – highlighting “the impact of telehealth policies on Minnesotans through a lens of quality, access, and affordability, with special attention to the impacts on Minnesota’s communities of color, the disabled community, and on rural residents.”[1]

Title V staff will continue to expand their understanding of the landscape of telehealth across Minnesota, and specifically within MDH and other state agency structures, as well as continue developing partnerships in these areas – particularly around the impact of telehealth policies on MCH and CYSHN populations.

C.  Strategy C: Improve the Quality of Health Care by Promoting Person and Family-Centered Practices

1. State Level Activities
   1. Increase the Availability and Use of Community Health Workers and Other Cultural Brokers

In FFY2024, Title V staff, together with the Health Promotion/Chronic Disease Section (HPCD) at MDH, aim to enhance our partnership with the Minnesota’s Community Health Worker Alliance – a statewide organization that works to build community and systems capacity for better health integration of community health worker strategies. HPCD staff have been working closely with the CHW Alliance on grant proposals such as HRSA’s CHW Training Program and supplemental budget proposals. Staff from the CFH Division will meet with representatives from the alliance and HPCD to further discuss areas for alignment and partnership.

Other cultural brokers who identify and provide ethnic and culturally specific perinatal care for women and families within their communities are doulas and midwives. Although doulas do not provide medical care, they do offer evidence-based information to women and their families that support the informed decision-making process. Title V staff will continue to work with patient groups and culturally based community organizations to identify barriers that birthing people have in accessing a doula or a midwife. They will also identify a means to ensure training and education is tailored for these groups to align with Minnesota’s childbearing population. In FFY2024, Minnesota will lead several activities related to doula and midwifery services, including the following.

Minnesota Doula Workforce Survey

MDH has contracted with community-based research and evaluation firm to develop a survey aimed at building a more comprehensive profile of doulas and birth workers in Minnesota. For the purposes of this survey, a doula or birth worker is defined as someone who provides continuous physical, emotional, and informational support to a birthing person before, during, and after childbirth to help them achieve the healthiest, most satisfying experience possible. The goal of this work is to develop a better understanding of doulas and birth workers in the state, identify barriers to becoming or practicing as a doula and gaps in service, and opportunities to improve access by building on strengths of the doula and birth worker workforce. In FFY2024, MDH and the contractor will compile, analyze, and create a summary report of the final survey results.

Maternal Care Access Coordinator

To help improve health equity in pregnancy and postpartum outcomes, MDH hired a Maternal Care Access Coordinator to develop a strategic plan and to develop and implement policies, activities, and programs, with community input, aimed at expanding access to prenatal care, doula, and midwifery services by working with internal and external partners and stakeholders. In FFY2024, the Maternal Care Access Coordinator will finalize the review of frameworks created by community doulas involved with Ramsey County’s Birth Equity Community Council’s policy committee that aims to improve the doula reimbursement and certification process in Minnesota. Community input and assessment will be developed and implemented to reflect the suggestions outlined by the community doulas and other partners for improving the process and expand organizations for required training for birth doulas. Additionally, the Maternal Care Access Coordinator will assess the access to midwife services for communities experiencing the highest rates of disparate pregnancy outcomes. This information will be used to inform cross-sector collaborations with internal and external stakeholders working to advance policies and systems changes to remove barriers to access for doula and midwife services such as trainings, certification, and reimbursement.

2. Increase Access to Family Planning with Special Attention to Youth, Rural Areas, and Communities of Color and American Indians

MDH will continue to oversee the Family Planning Special Projects (FPSP) grants program which provides low-income, high-risk people pre-pregnancy family planning services and fact-based sexual health information. Title V staff will also continue to strengthen their connection and work to streamline referrals with Minnesota Family Planning Program (MFPP) administered by the Department of Human Services (DHS). This health care program covers family planning services, diagnosis and treatment of sexually transmitted infections and transportation services to and from health care providers for these services. One of the main goals of MFPP is to reduce the number of unintended births, thereby reducing costs to Minnesota’s publicly funded health care programs. 

D.  Additional Related Activities

1. State Level Activities
   1. Maintain Ongoing Partnership and Engagement with the Center for Health Equity at the Minnesota Department of Health

MDH has established a Center for Health Equity (CHE), which is an active part of strategy, education, and programming for the department. More information on the CHE can be found in the Overview of the State. Additionally, MDH formed the Health Equity Advisory and Leadership (HEAL) Council to address Minnesota’s disparities in health status – particularly those persistent disparities across various ethnic, racial, and regional groups. The HEAL Council represents the voices of many communities most severely impacted by health inequities across the state, including racial and ethnic minority groups, rural Minnesotans, Minnesotans with disabilities, American Indians, LGBTQ community members, and refugees and immigrants. The council assists MDH in carrying out the efforts outlined in the department’s strategic plan and its Advancing Health Equity report, including advising on specific MDH policies and programs. The council also assists MDH in developing strong performance measures related to advancing health equity. The CFH Division and Title V Program will remain engaged with the HEAL Council and work of the CHE, including the MCH Director who sits on an internal advisory body to the CHE.

Domain: Cross-Cutting/Systems Building

Planning for October 2023-September 2024

Objective

By 2025, at least 75% of Division staff will have completed the Tribal State Relations Training

State Performance Measure

(SPM 6) Percent of Division staff who have completed the Tribal State Relations Training.

Structural and systemic racism plays an integral role in perpetuating poor health outcomes among American Indian women, children, and families, who experience the greatest health disparities in Minnesota. These disparities are caused by historical and ongoing trauma, racism, and colonial practices and policies that create barriers to opportunity and thriving. For example, into the 20th century Anishinaabe and Dakota peoples were continuing to experience displacement, broken treaties, and exploitation of their land by the United States and Minnesota State governments, often through violence and coercion, including genocide. These practices over the last several centuries created and continue to maintain the disparities seen in American Indian MCH populations in Minnesota today – and Tribal leaders across the state have told us they are concerned that the structures and policies within MDH do not address the cultural context of providing services in American Indian communities.

To address this concern, Title V staff will promote and support efforts for at least 75% of Division staff to complete the Tribal State Relations Training. During the 2021 legislative session, Minnesota enacted Minnesota Statute 10.65 Government-to-Government Relationship with Tribal Governments. One of the requirements under M.S. 10.65 is that state employees whose work has tribal implications attend Tribal-State Relations Training (TSRT), a course designed to educate state agency staff about American Indian tribal governments, histories, cultures, and traditions and to empower state employees to work effectively with American Indians and Tribal Governments. Participants learn that each Tribal Nation in our state is unique and that it is important to become knowledgeable about the history, culture, and governance of the Tribe as well as the role of agency’s Tribal liaison(s) to authentically and effectively partner with tribes.

As of June 2023, 35.7% of Division staff have completed the TSRT.  Minnesota will continue tracking the number of Division staff who complete the TSRT – our target for the FFY2024 is that there is a 20% increase in the number Division staff who complete the TSRT.

Community-Identified Priority Need: American Indian Family Health

For more information on the impact and importance of American Indian family health on the lives of people living in Minnesota, see the Cross-Cutting/Systems Building: American Indian Family Health 2022 Annual Report.

Strategies and Activities

A.  Strategy A: Increase Access to Culturally Specific Health Services

1. State Level Activities
   1.            Collaborate with Partners to Support Training of American Indian Doulas and Community Health Workers

Minnesota plans to collaborate with partners to explore how Family Home Visiting (FHV) and other MDH resources can better support the training of American Indian doulas and other birth workers, Indigenous breastfeeding experts, and community health workers (CHWs). FHV will use the knowledge of current grantees and other partners serving Indigenous populations to identify collaboration opportunities, locate resources, and support training. We will also continue to communicate with MN Department of Human Services – MN’s state Medicaid agency – to define and help develop billing infrastructure for doulas and CHWs working with pregnant and parenting families. In FFY2024, MDH will continue nascent work to expand doula and midwifery access in the state, including Indigenous birth workers. This work is described further in the Women’s Health section.

In addition to supporting doulas and CHWs, MDH will continue to fund other programs and services that provide culturally informed cared through the use of other disciplines.  Family Spirit, an evidence-based family home visiting model developed by and for the American Indian population, utilizes trained home visitors from the community in a peer-support model that empowers paraprofessionals to become parenting educators. 

In FFY2024, FHV staff working with tribal organizations and non-profits serving the American Indian population will produce a series of three community of practice events for these sites, with both virtual and in-person opportunities. Input from interviews and focus groups with all 11 MN Tribal Nations and a variety of urban American Indian agencies informed the content for this series.  Additionally, the series was developed using the Gathering of Native Americans (GONA) approach – a culture-based planning process for community members to gather and address community-identified issues – with tribal health and family home visiting staff to identify topics with the most detrimental effects on American Indian maternal child health in our state. Topics identified include working with families experiencing incarceration, navigating grief and loss through an Indigenous lens, and developing empowerment strategies in our communities.

2.            Support Family-Centered, Evidence-Based Programs and Practices that are Normed in the American Indian Community

Family Spirit is a family home visiting model developed by, with, and for American Indian families. It utilizes a multigenerational strengths-based approach that incorporates American Indian cultural values and an Indigenous conceptualization of health and well-being. Minnesota plans to continue supporting those organizations implementing Family Spirit, as well as all tribal home visiting programs, during FFY2024 and beyond. This includes the eight Tribal Nations offering FHV, as well as the nine non-profits in the state offering Family Spirit Home Visiting curriculum. In addition to providing funding for Family Spirit, additional opportunities are being presented for non-evidence based, but community normed, including Promising Practice Funding and Capacity Building Grant to build out programs in the community that are culturally normed. 

The FHV program is working on additional activities to develop programs that serve the American Indian population based on feedback from the community, including:

• Partnering, and sharing costs, with Johns Hopkins Center for Indigenous Health to expand the Family Spirit model to serve families with children to age five instead of requiring closure at age three – called the Family Spirit Thrive initiative.  This initiative has been advocated for by MDH after a multitude of Family Spirit implementation sites shared a need for longer support and services for families experiencing challenges. Training for the pilot study will occur in August 2023 and is open to any family home visitors working with Tribal Nations or non-profits in the state who are currently offering the Family Spirit curriculum. Our goal is to honor Indigenous values that all our relatives are included and provided the same opportunities. 
• Providing culturally specific training to provide internal training on reflective practice for Indigenous-serving programs that may not have access to trained Reflective Practice providers.  MDH staff will work with the Erikson Institute throughout FFY2024 to adapt the Facilitating Attuned Interactions (FAN) training for American Indian learners, incorporating identified and preferred Indigenous learning strategies, graphics, and other methods.  After the pilot with three FHV grantees is completed and feedback analyzed, the adapted FAN will be offered to all tribal and Indigenous-serving sites in Minnesota.
• Offering a Family Spirit/Tribal Community of Practice series in FFY2024. Tribal focus groups identified the following areas that were important to them to focus on:
  • Working with families experiencing incarceration;
  • Indigenous Perspective on grief and loss in our communities – a day-long in-person event is planned for August 2023 using a variety of Indigenous experts to walk through strategies American Indian leaders and scholars are utilizing to address historical trauma and make changes to statute, naming the trauma, and gathering to empower each other; and,
  • Empowering ourselves and our families – which will be follow up to the August event and a time to plan for further gatherings and training needs, as well as launch FAN pilot findings. 

B.  Strategy B: Mandate Cultural Proficiency, as Defined by Community

1. State Level Activities
   1. Review State Employee Tribal State Relations Training Accessibility and Impact

Minnesota acknowledges the sovereignty of the eleven federally recognized American Indian tribes within Minnesota’s geographic borders, and supports their absolute right to existence, self-governance and self-determination. Recognizing the importance and benefits of communication, consultation and informed decision-making among Minnesota state agencies and elected tribal government officials on matters that have tribal implications, Minnesota enacted Minnesota Statute 10.65 Government-to-Government Relationship with Tribal Governments during the 2021 legislative session. One of the requirements under M.S. 10.65 is that state employees whose work has tribal implications attend Tribal-State Relations Training (TSRT), a course designed to educate state agency staff about American Indian tribal governments, histories, cultures, and traditions and to empower state employees to work effectively with American Indians and Tribal Governments. Participants learn that each Tribal Nation in our state is unique and that it is important to become knowledgeable about the history, culture, and governance of the Tribe as well as the role of agency’s Tribal liaison(s) in order to authentically and effectively partner with tribes.

Successful enrollment into the training has been challenging due to several factors, including:

• the high demand for and rapidly reaching capacity of enrollment spots
• supervisor approval for staff to enroll in the TSRT
• awareness of the TSRT and relation to staff’s role at MDH

Assessing the overall impact of completing the TSRT has been a goal of Title V staff, however, due to a lack of standardized data collection and sharing processes, it has been difficult to measure and assess. Title V staff, in partnership with the Black, Indigenous, and Persons of Color (BIPOC) Community of Practice within the CFH Division and the Office of American Indian Health within MDH, will continue working to develop a more comprehensive understanding of enrollment, accessibility, and impact of the TSRT in FFY2024. 

C.  Strategy C: Shift Power and Policies to Address Structural Racism

1. State Level Activities
   1. Develop Opportunities for Grantees to Deliver Grant Reports Via Oral and In-Person Methodology

Numerous aspects of MDH’s funding and reporting processes are based in Westernized administrative practices. One notable example of this is the requirement that program updates are to be delivered in the form of written reports. While American Indian FHV staff are more than capable of meeting this requirement, multiple American Indian grantees have communicated they appreciate having the option to provide updates through oral reports. Since September 2019, MDH piloted a program adaptation that allows for more flexibility in grant reporting and accommodates cultural differences. American Indian culture is rooted in oral communication more so than written communication; this is a small gesture Minnesota can make to honor cultural differences and preferences for the grantees working so hard to serve Minnesota’s families. When grantees are given the option to provide updates orally, they can share stories of participants’ progress and challenges within the program rather than answering prescribed questions. They are also able to engage in a conversation with grant managers that allows for more nuance and detail. These conversations are best held in-person, which provides vital opportunities to build trust and relationships and improve technical assistance strategies. In FFY2024, Title V staff will explore adapting other grant programs’ reporting processes to expand capacity for oral and in-person methodology for grant reporting.

2.            Develop Request for Proposal Processes that Demonstrate a Knowledge of American Indian Communities, their Norms, and Values

In FFY2024, the CFH Division will be reconvening a Community of Practice for grant managers throughout the Division. As a part of this Community of Practice, Title V leadership aim to engage all grant managers in conversations around how RFPs and related processes can be more culturally reflexive and meet applicants where they are at. More details about these convenings will be available after the Community of Practice begins.  

D.  Additional Related Activities

1. State Level Activities
   1. Collaborate with the Office of American Indian Health to Eliminate American Indian Health Disparities

Title V staff will continue to collaborate with the Office of American Indian Health (OAIH) out of the Health Equity Bureau at MDH to review MCH and evidence-based services that serve our American Indian population. In continuing to work closely with OAIH, Title V staff aim to increase our capabilities to strengthen Tribal-State relations, provide meaningful and supportive services for each of our Tribal Nations, and work in partnership with Minnesota Tribal Nations to eliminate the health disparities experienced by our American Indian women, children, and families.

Domain: Cross-Cutting/Systems Building

Planning for October 2023-September 2024

Objective

By 2025, decrease the proportion of Minnesota adolescents who report staying in a shelter, somewhere not intended as a place to live, or someone else’s home because you had no other place to stay in the past 12 months by 15%.

State Performance Measure

(SPM 3) Proportion of Minnesota adolescents who report staying in a shelter, somewhere not intended as a place to live, or someone else’s home because you had no other place to stay in the past 12 months.

Nearly half of the state’s homeless population is comprised of homeless children and youth aged 24 and younger with approximately one third being children aged 17 or younger (with their parents). There is no one reason for why youth experience homelessness - some are homeless because despite family employment, they cannot afford rent and end up living on the street. Youth experiencing homelessness have a higher risk of being in a gang, using heroin, feeling depressed, attempting suicide, or experiencing trauma and violence than their housed counterparts.

Minnesota’s goal for FY2024 is that 2.5% or less of Minnesota adolescents report staying in a shelter, somewhere not intended as a place to live, or someone else’s home because you had no other place to stay in the past 12 months. Since we met our goal of 15% reduction from the baseline 2019 MSS data, we recalculated our 15% reduction based off 2022 data.

Community-Identified Priority Need: Housing

For more information on the importance of housing on the lives of people living in Minnesota see the 2022 Annual Report.

Strategies and Activities

A.  Strategy A: Expand Funding Opportunities

1.  State Level Activities

1.1  Partner to Provide Housing Support for Families through Homework Starts with Home

As one of Minnesota’s partners on the Governor’s Children’s Cabinet, Minnesota Housing and Finance Agency (MHFA) has a focus on providing housing support for families through Homework Starts with Home, a grant program focused on addressing homelessness and housing instability among students and their families. Outcomes of this grant program included reducing the number of students who become homeless for the first time, reducing the number of students and families who remain homeless, and reducing the number of students that experience homelessness at all. Grants were provided to housing programs that worked in collaboration with schools and early childhood programs. Additionally, programs needed to be responsive to specific community and cultural needs. The community-based grants could be used to provide temporary rental assistance, security deposits, rental application fees, housing inspection costs, and other undesignated costs, such as moving costs for families. MDH will continue to identify opportunities to support MHFA’s Homework Starts with Home grant program through the end of FFY2024 – when grant contracts are set to end – as well as to partner with MHFA to identify additional opportunities for funding for housing supports beyond the end of the contract period.

2. Promote Continuum of Care Models to Focus on Homeless Prevention and Assistance

Family Homeless Prevention and Assistance Program (FHPAP)

The FHPAP is a MHFA program that provides supportive services and/or financial assistance to families with children and youth/unaccompanied youth who are homeless or at imminent risk of becoming homeless. Funds are intended for populations most disparately impacted and to ensure services are culturally specific to better reflect the needs of those being served. The FHPAP is intended to complement a community’s Continuum of Care and provide funding for coordinated entry, street outreach, prevention, and rapid re-housing. Funds can be used for direct assistance (rent, utilities and other expenses to address housing crisis) or services (housing navigation, case management, outreach staff, coordinated entry assessment) to households who are at or below 200 percent of the Federal Poverty Guidelines and homeless or at imminent risk of homelessness. Title V staff will continue supporting MHFA and the FHPAP to serve Minnesota communities in FFY2024.

Continuums of Care (CoC)

CoC is a regional strategic planning body to plan and implement housing and services to reduce the incidence of homelessness by assisting individuals, youth and families experiencing homelessness to access services and stable housing. The CoC includes prevention, outreach and assessment, emergency shelter, transitional housing, and permanent supportive housing or other permanent housing. There are ten CoC regions within Minnesota that establish priorities for the household type of housing units needed within their region. Annually the CoC applies to the U.S. Department of Housing and Urban Development (HUD) CoC Program for funding to address homelessness. Minnesota Continuums access $38 million annually through this process. Title V staff will continue uplifting the interconnections of MCH health, housing, and homelessness, and support the implementation of CoCs throughout Minnesota.

B.  Strategy B: Person-Centered Approach/Services

1. State Level Activities
   1. Increase Access to Safe and Affordable Housing for Clients who are Pregnant or Parenting Infants

Family Home Visiting

Family home visitors are a resource for routinely screening for clients and families who are experiencing homelessness. Family home visitors at the state and community levels will continue to provide referral and support services to community resources to help find stable housing for families who were pregnant or parenting infants and/or young children. 

Positive Alternatives Grant Program (PA)

Established by the Minnesota State Legislature in 2005, the PA grant program provides funds to nonprofit organizations promoting healthy pregnancy outcomes by assisting low-income pregnant and parenting women in initiating and maintaining family stability and self-sufficiency. Twenty-seven PA grantees throughout Minnesota provide individual support services and work in collaboration with community resources to promote self-reliance and family stability. All services are provided at no cost to the client. 

Since inadequate housing is recognized as a barrier to healthy pregnancy and birth outcomes, all 27 PA grantees provide every client with a housing assessment along with housing assistance or community referrals for clients in need. PA grantees have provided long-term residential housing including wrap around services for client support and self-sufficiency, rental assistance funds for clients needing stable and safe housing, and financial assistance for housing and related living expenses.

The Minnesota State Legislature eliminated the PA grant program, and all grants will end on June 30, 2023. However, there are many new opportunities to provide safe and affordable housing to children and families passed during the recent legislative session. Future reports will provide more details as the programs and grants are established.  

2. Sustain Cross-Sector Collaborations to End Homelessness for Pregnant People and Infants

In 2019-2022, MDH implemented the Calling All Sectors (CAS) grant from the Robert Wood Johnson Foundation, which focused on the impact of homelessness on infant mortality rates, particularly in Black/African American and American Indian populations. The ultimate goal of CAS is to end homelessness for pregnant people and infants through a multi-sectoral collaboration. The CAS team, including over 60 state, county, city, and community partners, mapped the path of pregnant/postpartum people experiencing homelessness to understand how to align and streamline services and supports for these special populations. A sustainability assessment report was developed and will be used to inform strategies and activities moving forward, particularly for the 60+ CAS partners and beyond to integrate within their various professional spaces. With shifting staff roles and transitions of staff (out of COVID-19 response roles, moving to new roles, retiring, and other staff turnover), as the grant ended in June 2022, CAS sustainability plan work was put on hold for most of FFY2023. However, in FFY2024, Title V staff will re-engage with the CAS sustainability plan and develop strategies for incorporating it into MDH work, as well as its connection to the MICH Justice Plan.  

C.  Strategy C: Create/Innovate Housing

1. State Level Activities
   1. Provide Adequate, Dignified Shelter Options for Children and Families

MDH, as the state health department, has begun re-evaluating what it means and what our role is to improve and innovate the provision of adequate, dignified shelter options for children and families. Part of this work has been developing and strengthening partnerships between MDH and the Minnesota Housing and Finance Agency – the state housing department – in effort to learn more about the current and ongoing housing and homelessness landscape in Minnesota, as well as to engage in conversations, strategic development, and policy change around the interrelated linkages of MCH populations, housing, and homelessness. Title V will continue this engagement and support through FFY2024 and beyond, including specific attention to:

• Partnering with other government agencies and community partners to support a system of wraparound supportive services and referral pathways for people who are pregnant and/or parenting an infant and experiencing homelessness.
• Examining the Interconnection between health, homelessness, and housing to support expansion of screening, referral, funding, and other resources for safe and affordable housing that prioritizes pregnant and/or those parenting an infant and are currently or at risk of homelessness.

D.  Strategy D: Focus on Policy Change

1. State Level Activities
   1. Participate on the Minnesota Interagency Council on Homelessness (MICH)

The MICH is comprised of 11 state agencies, the Met Council, and the Governor’s Office, and is charged with leading Minnesota’s efforts to achieve housing stability for people experiencing homelessness in Minnesota. MDH is one of the 11 agencies participating on the MICH, including representation by an Assistant Commissioner of MDH. MICH developed Heading Home Together, an action plan to prevent and end homelessness, identifying what state agencies can do and is reflective of the input of people who have experienced homelessness, practitioners who work in the field, and Federal policy requirements and guidance. The focus of the Council is to prevent and end homelessness among youth and young adults unaccompanied by parents or guardians, as well as prevent and end homelessness among families with children. Title V staff will continue to participate on the MICH in FFY2024.

2. Engage in the Justice Strategic Planning led by the MICH

In May 2021, the MICH recognized homelessness as the most egregious form of housing injustice and committed to focus its next strategic plan on housing, racial, and health justice (Justice Plan). Title V staff engaged in the work of the MICH and Justice Strategic Planning during phase one and two – including participation in regular Justice Plan meetings and participation in strategic plan development activities, particularly those related to homelessness and the MCH population – and will continue this engagement.

Phase one of the Justice Plan development occurred May 2021-June 2022 – which included five working group meetings and three community conversations, in a community-driven process to develop a definition of housing, racial, and health justice for people experiencing homelessness. Phase two began in June 2022, with a commitment to the definition developed in phase one, and is focused on developing strategies to advance housing, racial, and health justice. Results from phase one that are driving strategy development include the following:

• Homelessness is prevented whenever possible, and services and supports are provided to ensure no one returns to homelessness.
• A robust crisis response geared towards housing outcomes supports people staying outside, in emergency shelters, and in community. 
• People facing homelessness have access to housing options that meet their needs and honors their choice.
• Homelessness is treated as a crucial health and public health crisis wherever it occurs.
• The state shares power with Indigenous, Black, Brown, Poor, LGBTQIA2S+ people and people who have faced homelessness to strengthen natural supports within community.

MICH and the Justice Plan working group aim to have developed a set of strategies based on these results by the beginning of FFY2024 to then begin action planning in FFY2024. Title V staff will remain closely connected to this work as it relates to homelessness and the MCH population.

3. Prioritize the Interconnection between Health, Homelessness, and Housing to Drive Policy and Systems Change

Homelessness and health are interconnected, and MDH recognizes that homelessness and housing instability significantly impact community and MCH population health, MDH created a homeless-specific senior-level position. The Senior Advisor on Health, Homelessness, and Housing was hired in Spring 2022, and to the best knowledge of MDH and the CDC, the Senior Advisor on Health, Homelessness, and Housing is the first position of its kind at a state health department. This position will continue to work with state and local partners on public health and homelessness, including as a lead in the MICH work around the Justice Strategic Plan. Title V staff will work closely with this staff member with a focus on the interconnections between homelessness, housing, and MCH population health.

In FFY2024, Title V staff will work with the MDH Senior Advisor on Health, Homelessness, and Housing to explore opportunities to increase access to and funding for safe and affordable housing for clients who are pregnant or parenting infants and develop information and resources for housing programs and a comprehensive guide to services. 

4. Partner with the Minnesota Department of Health’s Senior Advisor on Health, Homelessness, and Housing to Engage in Strategic Development and Policy Advocacy

Title V staff will partner with the MDH Senior Advisor on Health, Homelessness, and Housing, and other partners to explore opportunities engage in policy change to reduce housing disparities such as increasing efforts to access emergency assistance that can be used for housing and advocating for improved housing policy at local, state, and federal level.  For example, policies targeted may include changing leasing restrictions and instituting rent caps – housing restrictions that impact the whole family system of and influence disparities within Minnesota’s MCH populations. 

5. Partner with the Minnesota Department of Education (MDE) to Improve and Expand Housing and Homelessness Screening for Students and their Families

Title V staff will partner with MDE to better understand how school districts currently screen students for housing needs and provide housing resources to their families. Additionally, this partnership will explore how to expand access to grants such as Homework Starts with Home – a grant program focused on addressing homelessness and housing instability among Minnesota students and their families. 

Domain: Cross-Cutting/Systems Building

Planning for October 2023-September 2024

Objective

By 2025, increase the percentage of adolescents reporting positive mental well-being by 10%.

State Performance Measure

(SPM 4) Percent of Minnesota Adolescents who report having positive mental well-being, fulfilling relationships, contributing to community, and being resilient. 

With so many factors that make-up mental well-being it is difficult to succinctly answer questions about population mental well-being with existing data. There are multiple composite measures of mental well-being proposed in the research and many commonly agreed upon components of mental well-being.37 Ten components of mental well-being are captured in the Minnesota Student Survey: positive identity, social competency, personal growth, empowerment, social integration, educational engagement, and positive family, community, teacher, and peer relationships. Positive mental well-being is measured by combining multiple components of well-being to create an overall well-being score. We are choosing this measure because of how richly it captures the multi-factorial nature of mental well-being.

By FY2024 Minnesota aims to increase the percentage of Minnesota Adolescents who report having positive mental well-being to 39.7%.

Community-Identified Priority Need: Mental Well-Being

For more information on the importance of Mental Well-Being on the lives of people living in Minnesota see the 2022 Annual Report.

Strategies and Activities

A.  Strategy A: Help communities build capacity and resilience

1.  State Level Activities

1.1  Implement the MN Thrives Outreach Plan

Minnesota Thrives is an interactive and collectively sourced database to provide communities with a meaningful list of mental health promotion strategies, opportunities to connect and learn from others doing this work, and a comprehensive picture of current activities and gaps to support mental well-being. MN Thrives is highlighted at every monthly Mental Well-being and Resilience Learning Community, spotlighting two or more examples and sharing an update on the progress toward the goal of having 1,000 entries added to the database.

A key purpose of MN Thrives is to be an online platform for community leaders to share information about projects and initiatives aimed at promoting mental health and well-being to increase access, awareness, and support for their community members. MDH develop strategies to actively connect communities and promote the resources shared in MN Thrives through an outreach plan. MDH will continue to implement the outreach plan to promote utilization of MN Thrives across Minnesota’s communities. Additionally, MDH will engage in the following MN Thrives activities:

• Continue to post monthly MN Thrives spotlights to the Mental Wellbeing and Resilience Learning Community to raise awareness, encouragement engagement, and spotlight initiatives in MN Thrives that are innovative mental wellbeing strategies. These newsletters include information about MN Thrives, links to sign up and submit an entry into MN Thrives, and a link to refer other projects or initiatives that would be a good fit for the database.
• Continue to promote MN Thrives through individual contact and group presentations across a variety of spaces and opportunities.
• Develop an icon or logo for participating organizations to post or share, as a mechanism to promote MN thrives.
• Host themed gathering spaces to highlight and connect communities and organizations working on a similar topic (e.g., social connectedness and belonging).
• Continue to highlight MN Thrives examples with the learning community and post a monthly “spotlight” article that goes more in depth about existing initiatives that are included in MN Thrives.

1.2  Build Support for Expanding Community-Based Program Models Statewide

The Mental well-being and Resilience Learning Community (MWRLC) has highlighted many examples of community-based mental well-being strategies in Minnesota each month since 2017. Though several programs have garnered significant community interest, local leaders have identified a need for additional training and financial support to make these available and sustainable. With increased awareness of the models among key leaders, we can better identify opportunities to incorporate these into existing grants or programs.

In FFY2023, MDH supported a legislative proposal that was included in the Governor’s budget which would support training on models that have been promoted through the MWBRLC. While the proposal was not passed, there was significant community support for the proposal, and MDH will consider proposing a similar effort in the future. 

In FFY2024, MDH will do the following:

• Continue to host the MWRLC highlighting a range of strategies across communities in Minnesota.
• Identify opportunities to actively support and connect those interested in advancing a strategy to key groups.
• Continue to elevate initiatives that promote connection to nature. For example, MDH will be sponsoring a cohort of people to get trained in forest therapy, and will work with the learning community to support and promote the community resources that flow from this new community capacity, as well as promote the opportunity for other communities to build similar strategies. 
• Continue to look for funding to support this work, including coordination with the MDH Center for Health equity to explore and identify opportunities. 
• Convene stakeholders to identify steps to build infrastructure and supports for community led care. For example, what are the minimum expectations for referring community members to higher levels of care when needed, and how can this work be sustained financially. 

1.3  Partner with Key Stakeholders to Help Communities Assess Needs and Gaps for Mental Well-Being and Resilience Strategies using a Comprehensive Public Health Approach

Communities need to have a deep understanding of what a comprehensive public health approach looks like, and what they currently have available. Title V staff aim to support this through engagement in the following activities in FFY2024:

• Leverage existing partnerships between the U of M Extension (UMN), additional MDH sections and programs (Statewide Health Improvement Partnership (SHIP), Injury and Violence Prevention (IVPS), Suicide Prevention, and Public Health Practice), and Local Public Health to design and test a community process or tools that can help them decide what actions are needed to promote mental well-being. The workgroup will partner with other MDH community data initiatives to align efforts where feasible, especially those working on quantitative assessment processes. Partners, with support from Title V staff, will assess current systems and community-based strategies for mental health promotion and primary prevention and identify interest and opportunity for new strategies to be utilized. 
• Partner with the UMN Extension and Center of Excellence in Public Health to expand the mental health socio-ecological model in efforts to help guide community planning around mental health and well-being.
• Partner with the Brooklyn Bridge Alliance for Youth to work in community with Black youth and families to identify local policy changes that will impact Black Youth mental health. *See additional details in Strategy C, Activity 1 below.

B.  Strategy B: Implement a Public Health Communications Campaign on Mental Well-Being across the Lifespan

1.  State Level Activities

1.1  Expand Understanding of Key Research and Current Strategies to Support Social connectedness and Other Factors that Influence Mental Well-Being

During FFY2024, MDH staff will continue to develop and promote content on social connectedness and other selected strategies to promote mental well-being, highlighting research, data sources, key talking points, and examples of community strategies to address the issue. These resources will be shared broadly and use examples of strategies highlighted in the MN Thrives database and the Mental Well-Being and Resilience Learning Community. We will partner with internal and external stakeholders to share these resources and to identify policy and environmental changes that promote social connectedness.  

MDH has also volunteered to co-chair the Suicide Prevention Taskforce’s Committee on Mental Health and Wellbeing. This committee will help oversee the raising awareness of recommendations and resources across the state to promote mental health and wellbeing across the life span in Minnesota’s communities.

Additionally, MDH has started to craft a web page specifically to promote adolescent mental health. This web page will share information and resources about social connectedness and adolescent development that is critical to mental health – it is estimated to be completed and published in FFY2024.  

1.2  Partner with the Preschool Development Grant (PDG) staff on Shaping a Trauma-Informed Toolkit and Training Modules

While the active work on the trauma-informed toolkit was completed in FFY2022, MDH and PDG staff will continue to look for opportunities to share the toolkit with early childhood providers seeking mental health supports. Because this is a free resource that will continue to be hosted on the web, it can continue to be shared indefinitely. MDH is also looking for opportunities for new funding to build onto the toolkit and enhance it with more content in order to avoid duplication.

MDH is also exploring an extended partnership with the Minnesota Association for Children’s Mental Health to build out the toolkit to reach primary care providers with resources about trauma and resilience, using proposed federal funds designed to improve systems that serve young children.

1.3  Identify Opportunities to Develop and Implement Formal Marketing Campaigns on Mental Well-Being, Trauma, and Resilience

Professional anti-stigma campaigns have been effective at raising awareness about mental illness, as well as how to start conversations about mental health to encourage help seeking behaviors. To build toward a comprehensive marketing and communications plan, MDH staff will engage in the following activities during FFY2024: 

• Partner with Preschool Development Grant staff and the advisory council for the trauma-informed toolkit to communicate about available resources with different audiences (e.g. parents, jails, early childhood providers, etc.). 
• Support the development of a marketing campaign around healthy relationships with technology for populations across the lifespan. 
• Support communications about the benefits of nature for mental well-being in partnership with the MN Department of Natural Resources, in support of the Children’s Outdoor Bill of Rights. 
• Identify opportunities to promote Child and Teen Check-ups (C&TC) well visits, the state’s version of the Early and Periodic Screening, Diagnostic and Treatment service, as well as incorporating other well-being resources and natural supports in clinical settings. 
• Partner with C&TC to promote county level outreach to juvenile justice systems and support organizations to educate on the importance of preventive care screenings for youth in community based juvenile justice settings and promote the importance of prompt reinstatement of Medicaid and C&TC services when youth are discharged from secure settings.
• Partner with C&TC to incorporate information on the 2022 American Academy of Pediatrics (AAP) Bright Futures recommendation to include suicide risk assessment questions into depression screening protocol in clinics into our Best Practices training.
• Promote key resources to support mental well-being including the trauma-informed toolkit, resources developed by Live More Screen Less regarding a balanced relationships with technology, and efforts to promote access to nature, including the Department of Natural Resource’s Children’s Outdoor Bill of Rights.
• Continue engagement in the MN State Fair Mental Health Awareness event.

C.  Strategy C: Advocate for Legislative Policies that Promote Mental Well-Being for Everyone

1.  State Level Activities

1.1  Develop and Support Infrastructure for Community-Initiated Care

For the 2023 legislative session, MDH proposed state legislation that would establish a grant program for communities to implement a Community Initiated Care model for mental health and wellbeing across Minnesota. This legislation has made it into the Governor’s budget and initial omnibus bill and has a lot of support from a wide variety of stakeholders including the Governor’s Children’s' Cabinet, Ignite After School, NAMI Minnesota, Health Partners, and several additional state and national partners who are experts in the field of mental health and wellbeing. This drafted legislation would create state funds accessible for culturally relevant mental health promotion programming for communities and go a long way to establishing an infrastructure for Community Initiated Care. Unfortunately, this proposal was not funded by the Legislature, and MDH will consider future plans for this proposal.

Additionally, MDH plans to:

• Partner with key community partners to outline current efforts, as well as accepted standards of practice, referral and training expectations, and sustainable funding opportunities; and,
• Partner with MDH’s Center for Health Equity and the Governor’s Children’s Cabinet to convene leaders to help develop key administrative infrastructure such as: definitions of community-initiated care, a network for communities implementing various models, sustainable funding sources, and guidelines for implementation. 

1.2  Partner with Key Stakeholders to Identify Policies and Practices to Support Mental Well-Being

Reimagine Black Youth Mental Health Initiative

In 2022, MDH launched the Reimagine Black Youth Mental Health Initiative in collaboration with the Brooklyn Bridge Alliance for Youth– supported through a federal grant from the Office of Minority Health. This is a policy demonstration grant that engages local partners to identify, assess, implement, and evaluation specific policies that will improve Black youth mental health. The Reimagine Black Youth Mental Health Initiative has three goals:

• Improve Black youth mental health.
• Design a process that includes Black youth and communities in policy development.
• Implement a Mental Health in All Policies Approach.

The Reimagine Black Youth Mental Health Initiative is set to continue through FFY2026. In FFY2024, a state resource team on Black Youth Health and the Reimagine Black Youth Mental Health Advisory Council will collaborate to support sustainability and scaling effective practices and policies highlighted through this effort. Through the Mental Health in All Policies approach, the Advisory Council will partner with Black youth in community to identify and implement policies in the following priority policy areas:

• Employment
• Recreation
• School Policies
• City Policies
• Policing
• Healthcare.

Governor’s Children’s Cabinet, Statewide Health Improvement Partnership (SHIP) and Other Activities

Additionally, in FFY2024, MDH staff will engage in the following activities:

• Continue to participate in the Governor’s Children’s Cabinet Mental Health Action Team to share a public health perspective and cultivate promotion and prevention opportunities, including support for potential legislative proposals.
• Work with key partners, including the MDH SHIP, Center for Health Equity, Minnesota Public Health Law Network, MDH Healthy Minnesota Partnership, Local Public Health Association, and others, to assess the state landscape for mental well-being related policy initiatives, as well as stakeholders, related research, and reports that support proposed policies.
• Utilize the Minnesota Mental Well-Being and Resilience Learning Community to identify examples of relevant policies – inviting presenters to provide relevant policy examples that support their work and proposals with the learning community and partners.
• Promote and contribute to the development of tools that help isolate important and relevant policies. For example, we will continue to partner with the University of Minnesota Extension and School of Public Health to use the Social Ecological Model which was developed through this partnership. 
• Contribute to the Trust for Public Land and Child and Nature Network – Green Schoolyard Advisory Committee, in partnership with the Minnesota SHIP, Department of Natural Resources, and Minnesota Department of Education, to inform strategies that support local policy action. 

1.3  Identify Public Health-Focused Recommendations for the 2024 State Mental Health Advisory Council Report

In FFY2024, MDH staff will continue participating on the State Mental Health Advisory Council and facilitate the Family Systems and Prevention Workgroup. For the 2022 State Mental Health Advisory Council Report, the workgroup identified four proposals which were all approved by the full council and included in the recommendations to the Governor in October 2022. Recommendations included: expanding wraparound through the system of care initiative, expanding family peer support opportunities, growing family supports in schools, and building community-initiated care to support young people and families. In reviewing these proposals, MDH provided feedback with information about what was/is currently happening at MDH that aligns with each proposal. In FFY2023, a legislative proposal that aligns with one of the recommendations was advanced through MDH and included in the Governor’s budget. This proposal supported adolescent mental health community led supports. It was consistent with the community-led and promotion aspects, but only included a focus on adolescent mental health due to the current mental health crisis among adolescents. MDH will continue to support a public health perspective in the work of the State Advisory Council on Mental Health and include related recommendations to the Governor in the 2024 State Mental Health Advisory Council Report.

1.4  Promote Policy, System, and Practice Changes to Support Children of Incarcerated Parents

An estimated 13% of youth in Minnesota have an incarcerated or previously incarcerated parent, making parental incarceration one of the most frequently reported ACE for this population (MSS, 2022). Additionally, youth with an incarcerated parent have increased risk of poor mental health and illness, substance abuse, and poor academic outcomes. During FFY2024, Minnesota will engage in the following activities attempting to promote policy, system, and practice changes to support children of incarcerated parents:

• Through a federal Department of Justice grant, MDH will continue to work in partnership with the current six county jails and local partners to implement model jail policies designed to facilitate stronger relationships between children and their incarcerated parents. MDH will also continue to identify policy issues related to the systems that could work in tandem with jails to better support justice involved children and families, such as child-welfare, schools, and family home visiting. 
• Additionally, MDH will continue to work on expanding these efforts to other county jails and continue to support Family Home Visiting (FHV) and other community program investments in justice involved families, including sponsoring a Circle of Security training for FHV staff to facilitate discussion around further connections between FHV services and support for children of incarcerated parents.

D.  Additional Related Activities

1.  State Level Activities

1.1  Develop an Internal CFH Division Mental Health Workplan

In FFY2023, an internal workgroup was formed with an aim to build capacity for staff engaging in the mental health work we do as a Division with Minnesota’s communities and families, through the development of a Division Mental Health Workplan. The purpose of the workplan is to provide a framework for staff engaging in mental health work when applying to funding opportunities, engaging with communities, and developing partnerships, including other MDH Divisions and state agencies. In FFY2024, the workgroup will finalize and begin implementation of the Mental Health Workplan.

Domain: Cross-Cutting/Systems Building

Planning for October 2023-September 2024

Objective

By 2025, increase the percentage of children, ages 0-17, living with parents who are coping very well with the demands of parenthood by 5%.

State Performance Measure

(SPM 5) Percent of children, ages 0-17, living with parents who are coping very well with the demands of parenthood.

Our target for the FY2024 is 67.8% children, ages 0-17, living with parents who are coping very well with the demands of parenthood.

Community-Identified Priority Need: Parent and Caregiver Support

For more information on the importance of Parent and Caregiver Support on the lives of people living in Minnesota see the Cross-Cutting 2022 Annual Report.

Strategies and Activities

A.  Strategy A: Advocate for the Redesign of a Network of Policies and Programs to Better Support Families

1.  State Level Activities

1.1  Coordinate between Title V and FHV initiatives to Serve More Families through FHV

A major activity aimed at helping promote a comprehensive system that supports families is Family Home Visiting (FHV). FHV helps ensure pregnant women receive adequate prenatal care, learn about healthy development in utero, in infancy, and beyond, and promotes responsive relationships. Then, as children and families develop, FHV helps ensure families with young children receive individualized social, emotional, health-related, and parenting supports, and relate to community resources that help stabilize and empower families. 

A major goal of this five-year block grant cycle is to better coordinate between the MDH Title V and FHV initiatives to ensure we are reaching the most at-risk families with home visiting services. This goal directly aligns with the goals of Minnesota’s MIECHV program grant. We have already begun to strengthen this partnership through the work we have done to combine and coordinate our Title V and MIECHV needs assessments and through the involvement of FHV Section leadership and staff in our strategy development work. Moving forward into 2024, we plan to begin work around the following activities: 

• Understanding home visiting services provided via Title V funding. Based on their annual work plans and reporting, we know that LPH agencies use Title V funding to support a portion of home visiting services. However, we would like to develop a more formal understanding of the number of families served and types of visits provided and will partner with the FHV Section to explore this further. 
• Improving coordination of services for traditionally underserved communities. We intend to participate in interagency and cross-divisional conversations to provide consultation to and collaboration with early childhood system stakeholders.  
• Assessing whether we are reaching traditionally underserved families who would benefit the most from home visiting services. Through our interagency and cross-divisional work, we will build the partnerships needed to better ensure we are reaching the most families possible. This means ensuring that FHV is available in all regions of the state, and that programs are enrolling appropriate numbers of families (including appropriate numbers of families from diverse racial/cultural groups and those with disabilities/special health needs). 

1.2  Advocate for Policies that Promote and Support the Well-Being of Parents/Caregivers

Minnesota will convene partners to advocate for policies that promote and support the well-being of families. This approach will be developed over the course of this five-year block grant cycle, and will include the following activities during FFY2024: 

• Identify and participate in statewide working groups, councils, or committees that aim to improve support for parents and caregivers. 
• Build a better understanding of the landscape around issues that impact the well-being of parents and caregivers (and therefore families), including student loan forgiveness, work flexibility, living wages, and paid parental leave. 
• Create and distribute infographics/reports on advocacy topics so they can be used by our partners when advocating for change.

Additionally, during the 2023 legislative session, a bill providing a paid family and medical leave (PFML) program for the state was passed. The program provides Minnesota workers up to 12 weeks off per year with partial pay to care for a newborn or sick family member, as well as up to 12 weeks per year to recover from personal serious illness. PFML will coincide with the new earned sick and safe time program, also signed into law during the 2023 legislative session, allowing employees to earn one hour of sick and safe time for every 30 hours worked, up to a maximum of 48 hours a year. The PFML Act will not go into effect until 2026; however, in FFY2024, Title V staff will provide support toward implementation planning and communications efforts.  

B.  Strategy B: Build Capacity of Public Health Professionals and Family Home Visitors to Help Improve the Mental Health, Well-Being, and Resilience of Families

1.  State Level Activities

1.1  Provide Training and Support the Implementation of Best Practices Amongst Public Health Professionals and Family Home Visitors

The main activity aimed at building capacity of public health professionals is providing training and supporting the implementation of best practices. By building capacity, we mean that we not only plan to provide trainings to LPH agencies but also will provide the needed technical assistance and other support to help ensure they are implementing the best practices – using a continuous quality improvement approach. We will focus on the following topic areas: trauma-informed care, Reflective Practice, intimate partner violence, depression, opioid drug use, and adverse childhood experiences (ACEs).  

1.2  Provide Training on Postpartum Depression Screening for Health Care Providers

Postpartum depression screening for any accompanying caregiver is a recommended component in all Child and Teen Checkups (C&TC) well-child visits in children up to 13 months of age. The MDH C&TC Program will continue to provide training to medical providers who perform C&TC visits on best practices in conducting postpartum depression screening. The training is also available for Head Start staff, local public health C&TC staff, and university-based post baccalaureate advanced practice nurse (nurse practitioner) training programs.  

C.  Strategy C: Build Supports for Multi-Faceted Ways for Parents/Caregivers to Connect with One Another

1.  State Level Activities

1.1  Connecting Families to Family-to-Family Support

Family-to-family support is a vital part of a comprehensive system of care. There are many different opportunities for parents to connect to family support – such as through the education, child welfare, mental health, and other family-serving systems. During FY2024 and in upcoming years, MDH will work to develop a better understanding of the different organizations providing family-to-family support, will ensure information about these resources is included in centralized resources (such as Help Me Connect), and will work with LPH agencies, tribal nations and non-profit agencies doing family home visiting, to connect more families to appropriate options for family support. 

[1] Minnesota Study of Telehealth Expansion and Payment Parity: Technical Advisory Group - MN Dept. of Health (state.mn.us)