MCH Population Domain: Crosscutting
SPM: Vision Zero: Eliminate fatalities and serious injuries caused by motor vehicle crashes
North Dakota Priority Goal: Reduce serious motor vehicle injuries and fatalities to North Dakotans younger than 21 years of age
FY2026 Annual Plan Narrative (October 1, 2025-September 30, 2026)
The North Dakota Department of Health and Human Services (NDDHHS) and the North Dakota Department of Transportation (NDDOT) recognize the significant impact of motor vehicle crashes on children in North Dakota, making the reduction of serious motor vehicle injuries and fatalities to North Dakotans younger than 21 years of age a priority. Both agencies, in collaboration with the North Dakota Highway Patrol, are dedicated to implementing Vision Zero strategies aimed at preventing these incidents. North Dakota is committed to fostering a strong safety culture to reduce traffic fatalities and serious injuries. To meet the goal of this priority, Title V staff developed two overarching objectives: (1) By September 30, 2030, Title V staff will increase partnerships with other programs to develop and implement a plan focused on teen drivers and vehicle occupant safety to support Vision Zero in achieving its goal of reducing fatalities to 75 or less; and (2) By September 30, 2030, Title V staff, in collaboration with partners, will implement at least 80% of the recommendations identified from the North Dakota Occupant Protection Program Assessment created in 2025. These objectives are discussed in more detail below. For further information about Vision Zero, please visit https://visionzero.nd.gov/.
Motor vehicle crashes remain a leading cause of injury and death among children in North Dakota. According to the NDDOT from 2020 to 2024, the state recorded a death rate of 3.2 per 100,000 children under 18 years of age, with 234 injuries per 100,000 attributed to vehicle crashes during the same period. The severity of these injuries, as categorized by law enforcement crash reports, is as follows:
- Suspected serious injury: 17.6 per 100,000 population
- Suspected minor injury: 132.1 per 100,000 population
- Possible injury: 85.2 per 100,000 population
When analyzing the data by age group for the years 2020-2024:
- Children aged 0-13 experienced a death rate of 1.3 per 100,000 and an injury rate of 89 per 100,000.
- Children aged 14-17 had a fatality rate of 1.7 per 100,000 and an injury rate of 145 per 100,000.
The Governors Highway Safety Administration emphasizes that young drivers frequently partake in risky behaviors due to a lack of experience and maturity. This increases their likelihood of speeding, consuming alcohol, and neglecting to wear seat belts—factors that significantly contribute to a higher fatality rate. In North Dakota, in 2023, a crash involving a teen driver occurred every four hours, and a teen lost their life in a crash every 52 days. Although teens represent only 6% of licensed drivers, they are involved in nearly 20% of all crashes. Furthermore, drivers aged 14-19 were responsible for 6% of fatal crashes, with 45 teens having lost their lives in vehicle accidents over the past five years.
Recognizing the significant impact of motor vehicle crashes on North Dakota’s youth, Title V staff are dedicated to supporting existing initiatives aimed at enhancing the safety of young drivers and vehicle occupants. To achieve priority one, efforts will focus on active participation in committees that work towards improving young driver safety. Once involved
in these committees, the objective will be to identify and explore additional strategies to reduce motor vehicle fatalities and serious injuries among young people. This will involve collaboration with partners to gather insights, provide financial support as needed, and implement solutions to address existing gaps in prevention efforts. An Evidence-Based Strategy Measure (ESM) has been established with the goal of achieving a 10% reduction in serious injuries and fatalities among teens involved in motor vehicle crashes. Additionally, Title V staff will seek to identify a project that can be supplemented through networking with committee members. Potential partners for initiating this strategy include the Young Drivers Sub-Committee, Vision Zero Coordinators, and Driver Education Teachers. Partnerships and collaboration are essential, as various stakeholders across the state work with youth to achieve shared outcomes in promoting safety.
Next, to achieve the second priority, Title V staff, in collaboration with their partners, will develop and implement strategies to enhance Child Passenger Safety (CPS) programming, specifically targeting childcare providers, foster care providers, and grandparents. Staff will work closely with department employees to identify the most effective approaches for training individuals responsible for transporting children, in accordance with CPS best practices. Potential partners that will be involved in this initiative include the Foster Care program, Early Childhood, Early Head Start, the NDDOT, CPS Advisory Committee, and agencies that work closely with grandparents.
In 2025, the NDDOT partnered with the National Highway Traffic Safety Administration (NHTSA) to conduct an Occupant Protection (OP) Assessment within the state. The objective of this assessment was to provide a comprehensive review of North Dakota's statewide OP program by identifying programmatic strengths, accomplishments, challenges, and recommendations for improvement. This assessment serves as a vital tool for planning, developing, and implementing OP programs and for making informed decisions regarding the prioritization of initiatives and the optimal use of available resources. The assessment is conducted by a team of five individuals with demonstrated subject matter expertise in occupant protection. Recommendations for enhancing occupant protection for children have been proposed and will be integrated into this plan over the next five years to strengthen CPS programming. The specific recommendations that will be implemented are outlined below.
The first step will involve the statewide adoption and use of the National Digital Care Seat Check Form (NDCF) by all certified CPS Technicians. This initiative aims to enhance data collection and analysis, which will be instrumental in driving outreach and messaging efforts. By improving the quality of data collection, staff will provide reliable evidence to support future initiatives. Title V staff will conduct training on NDCF data for all North Dakota CPS Technicians. Furthermore, staff will analyze and share the findings with stakeholders and the public to ensure transparency and foster collaboration.
To enhance law enforcement officers' confidence and better prepare them for identifying the proper use of child restraints during enforcement stops, staff will develop a reference guide outlining the most common errors associated with child restraint usage. Additionally, it is crucial to utilize standardized CPS materials to train both new and current law enforcement officers. These materials will emphasize the correct use of child restraints and seat belts for children, equipping officers with the necessary knowledge for effective traffic stops and accurate completion of crash reports. The dissemination of these materials will be facilitated by coordinating CPS presentations with law enforcement academies, ensuring that officers receive comprehensive training on this critical aspect of child safety.
Lastly, enhancing the CPS website by creating a dynamic, interactive experience for the public is a key recommendation that will be initiated. In addition to the existing educational resources, updates will include the incorporation of active links to current state and local resources, as well as opportunities for programs to promote various information, upcoming activities, and events.
Given that young adults, not only in North Dakota, but across the nation, are at an increased risk of injury or death from motor vehicle crashes, it is imperative to implement effective prevention strategies aimed at reducing or preventing teen driver crashes.
MCH Population Domain: Crosscutting
SPM: State Mandates: Implement North Dakota State Mandates for the Maternal and Child Health Population
North Dakota Priority Goal: To implement all North Dakota state mandates delegated to the North Dakota Department of Health Title V/Maternal and Child Health Programs.
FY2026 Annual Plan Narrative (October 1, 2025-September 30, 2026)
Priorities are frequently shaped by state mandates, which typically reflect the evolving needs expressed within the state over time. The incorporation of these mandates exemplifies a successful federal-state partnership that honors the unique priorities of each state. North Dakota has established several mandates aimed at improving the health of the maternal and child health (MCH) population, which guide Title V work efforts and necessitate the allocation of significant resources for effective implementation. A comprehensive list of these mandates can be found in Section V of the Supporting Documents, Title V-MCH State Mandates, and further details are discussed below.
Responsibilities of the North Dakota Department of Health and Human Services (NDDHHS) are addressed in North Dakota Century Code (N.D.C.C.), Chapter 23-01. The State Health Officer (SHO) of the NDDHHS is responsible for the administration of programs carried out with allotments made to the state by Title V. The NDDHHS functions in compliance with Chapter 28-32, Administrative Agencies Practice Act, N.D.C.C. Programs funded by the federal-state Title V MCH Block Grant include: Children with Special Health Care Needs (CSHCN), child/teen passenger safety, injury/violence prevention, newborn screening, MCH epidemiology, obesity prevention, nutrition, breastfeeding, school health/nursing and infant and child death services (sudden infant death syndrome).
Several mandates in N.D.C.C. address Title V CSHCN-related responsibilities within the NDDHHS. Chapter 23-01-34 includes program administration for CSHCN, including the provision of services and assistance to CSHCN and their families and the development and operation of clinics for the identification, screening, referral, and treatment of CSHCN. Chapter 23-01-41 requires the establishment and administration of an autism spectrum disorder database. Chapter 23-41 mandates administrative duties of state and county agencies, confidential birth reports for newborns with visible congenital deformities, and services for individuals with Russell Silver Syndrome. Chapter 25-17-03 mandates treatment for individuals with phenylketonuria or maple syrup urine disease through the provision of medical food and low-protein modified food products.
To meet the requirements of N.D.C.C. Chapter 14-02.1, Abortion Control Act, Section 14-02.1-02.1, Printed Information – Referral Service, the NDDHHS developed and published an Information About Pregnancy and Abortion booklet. This publication consists of objective information on specific topics to include: information and resources on various agencies and services available to assist a pregnant woman through pregnancy (provided through an on-line directory of services); anatomical information along with colored photos of development of the unborn child at two-week gestational increments; information regarding the obligations of the father; and materials that describe various surgical and drug-induced methods of abortion as well as any risk factors associated with those methods. In addition to the required information, content was also added on the harmful efforts of tobacco use during and after pregnancy. The booklet will continue to be updated on an as-needed basis to ensure that information is accurate, up-to-date, and evidence-based. The booklet, updated in March 2024, is available online at https://www.hhs.nd.gov/sites/www/files/documents/DOH%20Legacy/Information_About_Pregnancy_and_Abortion.pdf . Hard copy booklets will continue to be available upon request. During the 2023 legislative session, a bill was introduced, SB 2185, which was a bill for an act to provide for an appropriation to the Department of Health and Human Services for the development of a pregnancy and parenting resource website. Title V staff launched life.nd.gov on August 1, 2023 that provides information and links to social services, financial assistance, adoption services, pregnancy and parenting information, maternal and childbirth life services, planning guidance, care centers and agencies, and other available public and private resources for expectant families and new parents. Title V staff will continue to maintain and update the website with resources.
N.D.C.C 50-25.1-15 allows a parent or a parent’s agent (another person acting with the parent’s consent) who feels they are unable to take care of their infant, to surrender the infant without facing prosecution for abandonment. To be protected by the Baby Safe Haven Law, the child must be unharmed, under one year of age, and surrendered to an on-duty staff person or, if an infant is less than sixty days old, left in a newborn safety device, at an approved location in an unharmed condition, working for a Baby Safe Haven approved location.*There is currently no Baby Safe Haven Baby Boxes installed in North Dakota. An MCH Public Health Specialist at NDDHHS will develop and implement a public awareness campaign to provide information, public service announcements, and educational materials regarding this section to the public, including medical providers, law enforcement, and social service agencies. For additional information visit the resource page at https://www.hhs.nd.gov/cfs/safe-haven and the Baby Safe Haven training at: https://babysafehaven.pcand.org/.
N.D.C.C. Chapter 23-45, Umbilical Cord Blood Disposition, Section 23-45-02. Umbilical cord blood - Information pamphlet – Distribution, requires the NDDHHS to prepare a pamphlet that includes information on medical processes involved in the collection of umbilical cord blood; any risks of cord blood collection for both mother and baby; the current and potential future uses for the collected cord blood; the cost of cord blood donation; and options for ownership and future use of the donated material. The pamphlet must be available on the NDDHHS website and be distributed upon request at no charge. The NDDHHS elected to use and disseminate the pamphlet from the Cord Blood Registry titled Parent’s Guide to Cord Blood Banking (https://parentsguidecordblood.org/sites/default/files/uploaded-files/pgcb_brochure_usa.pdf). This pamphlet is free to patients, hospitals and other entities that choose to utilize the information. The Title V grant supports the costs associated with these unfunded, state mandates and MCH staff members have been assigned responsibility for these activities.
N.D.C.C. Chapters 23-01-03.1 and 25-17 mandate that North Dakota have a newborn screening program. The Newborn Screening and Follow-up Program (NBSFP) is currently housed within Special Health Services (SHS) in the Public Health Division of NDDHHS. Newborn screening (NBS) is performed shortly after birth to identify newborns who may have a potentially life-altering and/or life-threatening disorder that could cause serious illness, disability, or death if not identified and treated early. Newborn screening has three parts: blood spot, hearing, and heart screening. Blood spot and heart screening are included within this mandated section. Hearing screening is not mandated in North Dakota. The national Advisory Committee on Heritable Disorders in Newborn and Children (ACHDNC) provides recommendations to state newborn screening programs which disorders should be included on their state panel. The disorders included in the recommendations supported by ACHDNC are known as the Recommended Uniform Screening Panel (RUSP). Currently, North Dakota screens for 32 of the 37 core conditions that are included on the RUSP (blood spot, hearing and heart screening are included as core conditions). As new conditions are added to the RUSP, the North Dakota Newborn Screening Advisory Committee reviews them and determines the feasibility of adding them to the state screening panel. The feasibility of screening is dependent on several factors that may include the program’s readiness to: 1) approve the screening; 2) conduct laboratory screening; 3) conduct short and long-term follow-up; 4) provide information technology support; 5) access a medical specialist specific to the disorder; 6) educate providers and community; and 7) fully implement statewide newborn screening. The approving authority for the NBSFP to add a new disorder in North Dakota is the SHO. In the next fiscal year, the NBSFP will work with the NBS Advisory Committee to review the five core conditions North Dakota is currently not screening for to address program readiness and feasibility.
The North Dakota NBSPFP is mandated to provide education and plans to continue providing annual in-person training to midwives, birthing facilities and various clinics throughout North Dakota. The North Dakota NBSFP is planning to develop educational materials targeted at parents, the general public as well as providers. The NBSFP will continue to seek innovative ways to involve partners and the families served via virtual platforms.
The screening and follow-up of newborns is performed in collaboration with the University of Iowa State Hygienic Laboratory and the University of Iowa Hospitals and Clinics, as well as SHS. Intermediate and long-term follow-up after NBS continues to be addressed in SHS by:
- Providing follow-up contacts, resource information and care coordination for children with abnormal newborn screening results.
- Providing financial support for metabolic disorder clinics that result in coordinated disease management.
- Providing no-cost or at-cost medical food and care coordination for newborns and individuals with phenylketonuria (PKU) and maple syrup urine disease (MSUD).
- Providing diagnostic and treatment services for children birth to age 21 who meet medical and financial eligibility criteria.
Along with the follow-up calls for babies with abnormal newborn screening results, SHS assists families with referrals for services, care coordination, and support. Information is provided regarding the SHS Financial Coverage program as well as other state-wide resources (e.g., WIC, North Dakota Medicaid, Early Intervention) to assist the family in meeting their needs, and to provide them support and direction during a time that can be very stressful and overwhelming. After a child is diagnosed with a condition through newborn screening, the baby enters the long-term follow-up program until the age of six and the family is contacted on a quarterly basis for the first year of their child’s life and annually thereafter. This ongoing communication with the family helps to ensure the child remains healthy and the family has access to all the resources that they find valuable such as insurance, medication, transportation, and community supports. Collaboration with specialty care providers who see patients with a critical congenital heart disease or conditions identified through blood spot screening will continue through their Newborn Screening Advisory Committee and ongoing communication with the program.
The NBSFP works closely with the North Dakota Early Hearing, Detection and Intervention (EHDI) program which is based out of the North Dakota Center for Persons with Disabilities (NDCPD) at Minot State University. The NDCPD is the NDDHHS bona fide agent that applies for funding opportunities relating to EHDI. The NBSFP Director is the State EHDI Coordinator and is the liaison between the state and EHDI program. The NBSFP and EHDI programs provide education and trainings to birthing facilities and various clinics throughout the state. This collaboration benefits both programs, the families that are served and the health care professionals providing the services directly to families. This partnership will continue and the NBSFP will include EHDI and hearing screening on the development of any educational resources geared to the public or providers.
Financial eligibility for the SHS Financial Coverage program is legislatively mandated at 185% of the federal poverty level. All current NBS conditions are approved medical conditions for SHS coverage. Title V supports staff in managing the NBSFP, including a program director, long-term follow-up coordinator, and administrative support. In addition, Title V funds support contracts for a Medical Director and metabolic disorder clinic. A portion of Title V funds and state funds will continue to support medical consultation and genetic counseling services for children with abnormal newborn screening results.
Federally, the MCH Block Grant enables the state to address the following on behalf of CSHCN and their families: 1) to provide and promote family-centered, community-based, coordinated care (including care coordination services) for children with special health care needs and to facilitate the development of community-based systems of services for such children and their families, and 2) to provide rehabilitation services for blind and disabled individuals under the age of 16 receiving benefits under title XVI, to the extent medical assistance for such services is not provided under title XIX. Specifics regarding the SHS role in providing rehabilitation services is described below.
North Dakota is a 209(b) state, which means Supplemental Security Income (SSI) beneficiaries under 16 years of age are not automatically eligible for North Dakota Medicaid. If assets are an issue affecting North Dakota Medicaid eligibility, children eligible for SSI can be covered under the children and family coverage groups where asset testing is not required. The state CSHCN program pays for or provides rehabilitative services for eligible children that are served by Title V to the extent services are not provided by North Dakota Medicaid. State CSHCN program staff conduct outreach, information and referral activities targeted to the SSI population. On a monthly basis, Disability Determination Services provides referrals electronically to the state CSHCN program. In response, state CSHCN staff provide a direct mailing to families notifying them about potential programs that could be of assistance. This assures that children are consistently being referred to the Title V program and that families receive information about program benefits and needed services.
The Title V and CSHCN Directors assure compliance for these state mandates and oversee staff assigned to carry out the roles and responsibilities related to the mandates. Title V staff share program accomplishments and challenges at bi-monthly Title V meetings. These meetings serve as an avenue for program updates, sharing and collaboration.
MCH Population Domain: Crosscutting
SPM: Access to Services: Improve access to health-related services to improve the health and well-being of the MCH population
North Dakota Priority Goal: Increase awareness and the utilization of statewide services or resources.
FY2026 Annual Plan Narrative (October 1, 2025-September 30, 2026)
Raising awareness of available services and resources across the state is crucial for ensuring their effective utilization, which is why this was selected as one of North Dakota's cross-cutting priorities for the 2025–2030 grant cycle. Two overarching objectives were established to initiate this priority: (1) By September 30, 2030, Title V will improve collaboration with North Dakota Medicaid to increase access to services for high-risk populations; and (2) By September 30, 2030, Title V will expand access to essential healthcare services through partnerships. Each of these objectives are discussed further below.
To achieve the first objective, by September 30, 2030, Title V will improve collaboration with North Dakota Medicaid to increase access to services for high-risk populations. Title V staff will identify various methods to increase access to Medicaid-eligible health services for infants within the first 15 months of life. This initiative aligns with Medicaid quality measures and aims to improve maternal and infant health outcomes. One Medicaid service for infants includes well-baby visits, also known as Early Periodic Screening, Diagnosis, and Treatment (EPSDT) services. These visits are vital from birth to 15 months, when infants are particularly vulnerable, and provide critical opportunities to monitor development, administer immunizations, and identify emerging health or social needs. The American Academy of Pediatrics (AAP) and Bright Futures recommend nine or more well-child visits by the time a child turns 15 months of age, and two or more well-child visits for children between 15 and 30 months of age. Well-child visits should include a health history, physical exam, immunizations, vision and hearing screening, developmental/behavioral assessment, oral health risk assessment, and parenting education on a wide range of topics. (https://www.medicaid.gov/medicaid/quality-of-care/downloads/2022-child-chartpack.pdf). These visits are especially important for families facing barriers to preventive care. North Dakota’s recent Medicaid postpartum extension to 12 months provides continuity for mothers to access healthcare while supporting their infants’ medical needs. (https://www.hhs.nd.gov/humanservices/medicaid/about/newmom). The continuous coverage helps with early identification and management of health issues and chronic conditions, which can affect bonding between mother and baby and her ability to care for her child. Additionally, it can potentially improve maternal and infant outcomes, reduce emergency department visits, and increase follow-up care. (https://aspe.hhs.gov/sites/default/files/documents/31c91a9fb03bfb5048ef508ec6e9f991/ASPE-Postpartum-Utilization-Brief-Final.pd)
An Evidence-based Strategy Measure (ESM) has been established to monitor progress over time regarding the number of well-baby visits completed for Medicaid-enrolled infants aged 0 to 15 months. Data will be analyzed across various demographic variables to facilitate the introduction of additional activities aimed at addressing potential disparities identified through these variables.
According to North Dakota’s 2023 Medicaid data, out of 8,141 infants enrolled in Medicaid, 3,875 (47.5%) had completed a well-baby visit. The objective is to increase the percentage of Medicaid-enrolled infants who have received a well-baby visit from 47.5% to 60% by the year 2030, achieving an annual increase of 2.48%.
In year one, the first priority will be carried out with a focus on two primary activities. First, the team will establish a task force in collaboration with Medicaid and relevant Maternal and Child Health (MCH) partners, aimed at identifying and addressing gaps in access to MCH services for Medicaid-enrolled individuals. Additionally, home visiting initiatives will be prioritized during this first year, as they have demonstrated significant reach and impact across North Dakota.
There are several organizations that are successfully completing home visiting programs that Title V has partnered with but would like to strengthen relationships in order to improve service delivery and eliminate silos. Although these are not currently funded by Title V, common goals exist. For example, the Maternal and Child Health Home Visiting (MIECHV) program is administered by Families FlourishND (https://www.pcand.org/miechv). In Fiscal Year 2023, the North Dakota MIECHV program showcased strong performance and positive outcomes. The program successfully served 161 households and completed 2,192 home visits across both rural counties (Grant, Mercer, Rolette) and non-rural counties (Burleigh and Morton). Key outcomes included 98.9% of enrolled children had family members who participated in reading, storytelling, or singing with them daily, and 90.2% of caregivers were screened for depression within three months of enrollment or delivery (https://mchb.hrsa.gov/). North Dakota’s home visiting programs employ evidence-based models such as the Nurse-Family Partnership (NFP) and Parents as Teachers (PAT) (https://www.nursefamilypartnership.org/wp-content/uploads/2017/07/ND_2024-State-Profile-1.pdf). The NFP program specifically reported notable results including 85% of babies were born at term, 92% of mothers initiated breastfeeding, 96% of clients aged 18 or older were employed by 24 months, and 63% of babies received all recommended immunizations by 24 months (https://www.nursefamilypartnership.org/wp-content/uploads/2017/07/ND_2024-State-Profile-1.pdf).
Despite ongoing collaboration among organizations providing MCH services, access to these services varies significantly across the state. This variability is often reflective of county-level differences, with some individuals more readily accessing certain services than others. The rural nature of North Dakota’s landscape, characterized by limited infrastructure and service availability, is a critical factor. Additionally, discrepancies in service implementation across regions contribute to disparities in access. While the Title V MCH program has a strong history of collaboration with Medicaid, the formation of a joint task force will formalize coordination and alignment efforts. Initially, the task force will focus on identifying appropriate partners and primarily addressing service gaps related to home visiting. The North Dakota Home Visiting Coalition, along with individual home visiting programs, will play a vital role in this initiative. Some of the home visiting programs that the Title V MCH program will collaborate with include NFP and PAT, which are funded by the MIECHV grant program. Healthy Families North Dakota (HFND) is another evidence-based home visiting program designed to enhance maternal and child health, promote early childhood development, and improve family economic stability. HFND has already agreed to join the task force and has reviewed this plan.
Additionally, family home visiting represents an area where referral and financial support gaps may exist, and the task force could identify opportunities for improvement. In the second year and beyond, strategies can be developed to address these gaps. Working closely with stakeholders involved in program communications may be an initial step in this process. The task force will evaluate whether home visiting programs have effectively integrated messaging in channels that reach the target populations. Additionally, entry into services will be mapped to ensure that all eligible individuals are effectively reached through targeted messaging and appropriately referred to available home visiting programs.
The second activity aimed at achieving this objective will involve initiating a review of baseline data around the following areas: well baby visits in the first 15 months of life, common services referred to or denied for families (such as the Women, Infants, and Children (WIC) program), and breastfeeding rates among Medicaid-enrolled infants. These three factors are critical for supporting healthy child development and strengthening family stability. WIC referrals serve as a vital gateway to supplemental nutrition, breastfeeding support, and nutrition education. The program plays a significant role in preventing early childhood hunger and ensuring adequate nutrition during periods of rapid growth and brain development. According to the United States Department of Agriculture (USDA), a substantial portion of WIC-eligible Medicaid enrollees nationwide are not participating in the program: 65% of Medicaid beneficiaries aged 1 through 4 and upwards of 86% of pregnant Medicaid enrollees do not participate in WIC (https://www.fns.usda.gov/research/wic/eligibility-and-program-reach-estimates-2021). Similarly, North Dakota’s 2022 Pregnancy Risk Assessment Monitoring System (PRAMS) data show similar trends with 85.7% of mothers reporting not participating in WIC. In terms of breastfeeding, the Centers for Disease Control (CDC) reported that in 2021, 83.5% of mothers in North Dakota ever breastfed, with fewer breastfeeding at 6 and 12 months (61% and 41.8% respectively). In addition, 53.6% breastfed exclusively at 3 months and 31.4% at 6 months (https://www.cdc.gov/breastfeeding-data/about/rates-by-state.html). The American College of Obstetricians and Gynecologists (ACOG) recommends exclusive breastfeeding for the first 6 months of life, with continued breastfeeding while complementary foods are introduced during the infant’s first year of life (https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/02/breastfeeding-challenges). Furthermore, matching Medicaid enrollee data with WIC enrollee data also allows state and local WIC agencies to conduct targeted WIC outreach directly to eligible families who are not enrolled.
Breastfeeding, likewise, is closely tied to improved immune function, cognitive development, and a reduced risk of chronic illnesses. However, for many Medicaid-enrolled families, consistent breastfeeding support remains limited, often due to a lack of lactation services or messaging that does not reflect cultural norms or preferences. Seeing how few mothers are able to initiate but not sustain exclusive breastfeeding, the Title V MCH program and Medicaid will explore ways to improve WIC enrollment rates while promoting breastfeeding through programs like the Infant Friendly Workplace program and continuous coverage of lactation support.
The second overarching objective, Title V will expand access to essential healthcare services through partnerships, will be initiated by two key strategies. First, Title V staff will actively participate in various collaboratives, coalitions, and boards dedicated to addressing priorities outlined in the State Health Implementation Plan (SHIP). North Dakota’s 2024–2029 SHIP serves as a five-year strategic framework aimed at improving the health and well-being of residents across the state. Developed through comprehensive data analysis and collaboration with an array of partners, the SHIP acts as a unifying guide for public health efforts. It facilitates the alignment of efforts across government agencies, healthcare systems, nonprofits, and community organizations, while also informing how resources are allocated, programs are developed, and policies are shaped to ensure meaningful impact. The plan outlines four statewide priorities: strengthening the workforce, cultivating wellness, expanding access and connection, and building community resilience (https://www.hhs.nd.gov/sites/www/files/documents/DOH%20Legacy/Systems%20and%20Performance/ND%20State%20Health%20Improvement%20Plan%202024-2029.pdf). The Title V MCH program focus on well-child visits, referrals like WIC, breastfeeding, and oral health directly supports the SHIP’s third priority by ensuring that families are connected to high-quality care early in life.
To bring this plan into action, the state established the Multi-Partner Health Collaborative (MPHC). The MPHC is a statewide public-private coalition that will support outreach and service integration. The MPHC’s goal groups, which include community, tribal, and healthcare partners, help drive shared priorities under North Dakota’s SHIP. The North Dakota Department of Health and Human Services (NDDHHS) will provide operational support, including staffing and progress tracking through data dashboards.
Research demonstrates that cross-sector collaboration among public health, healthcare, and social service organizations, working in partnership with communities, is a highly effective strategy to improve health outcomes and ensure everyone has the chance to live their healthiest lives. These collaborations not only strengthen the capacity of partner organizations by fostering new skills, improving productivity, and building stronger relationships, but they can also result in broader public health outcomes such as reduced mortality, improved disease management, and higher immunization rates (https://phaboard.org/).
Evidence from a U.S.-based study by Kegler and Swan (2012) further supports this, showing that active partner involvement in coalitions contributes to community capacity-building outcomes, emphasizing the importance of broad and participatory collaboration (https://doi.org/10.1093/her/cyr083). Even in preparing this plan, the Title V MCH team consulted with multiple partners, ensuring there was co-creation of plans to improve access to essential health services. Gaps most likely lie in the spaces between services; therefore, partnership with all those who impact MCH is key to closing service gaps in entry, referral, and access to services.
North Dakota’s Title V program will partner with the Oral Health program to promote access to dental care, especially given cost and provider shortages in rural areas. North Dakotans have identified oral health as an important gap in healthcare. Oral health is deeply interconnected with overall systemic health. Research shows that poor oral health, particularly conditions like periodontal disease, can increase the risk of chronic illnesses such as diabetes, cardiovascular disease, rheumatoid arthritis, and respiratory infections. Beyond its physical implications, oral health significantly influences mental, social, and economic well-being. Untreated dental conditions can result in chronic pain, infections, difficulty eating, and poor nutrition, all of which can impact daily functioning and quality of life. In children, oral disease is associated with missed school days and hindered learning, while in adults, it contributes to reduced work productivity and increased healthcare costs. These impacts highlight the broader societal and economic burden of poor oral health. Title V staff will actively participate on the Oral Health Coalition to ensure that oral health concerns for MCH are addressed during meetings.
By braiding oral health initiatives into this MCH cross-cutting priority, North Dakota underscores the message that true health integration means no aspect of health is overlooked. Good oral health supports nutrition, self-esteem, employability, and chronic disease prevention, all of which are essential for healthy mothers and children.
Additionally, ensuring that women have access to high-quality prenatal services throughout the state is essential for providing babies with the healthiest start in life. Healthy pregnancies contribute to positive birth outcomes. By collaborating with the North Dakota Perinatal Quality Collaborative (NDPQC) and the state’s birthing facilities, maternal and newborn public health initiatives can be advanced to optimize health outcomes for mothers and newborns, irrespective of the location of birth within the state. Staff members will participate on the NDPQC on behalf of state Title V.
The second strategy for collaboration will prioritize working with North Dakota's five Tribal Nations: Standing Rock Sioux Tribe, Spirit Lake Nation, Turtle Mountain Band of Chippewa Indians, Three Affiliated Tribes of the Fort Berthold Reservation (Mandan, Hidatsa, and Arikara Nation), and Sisseton-Wahpeton Oyate. These sovereign Nations represent distinct jurisdictions with unique health systems, infrastructure, and governance structures that must be considered in all public health coordination. In year one, efforts will focus on identifying a specific systems-level healthcare access issue within at least one of these geographic regions, with targeted strategies developed to address the identified gaps.
For example, healthcare systems operating within Tribal jurisdictions for preventive and routine care often utilize different electronic health record systems compared to those utilized by regional facilities that provide higher-acuity services or specialty care. This discrepancy can create challenges in care coordination, particularly during transitions between local routine care and external services for more complex health needs, as well as ensuring continuity of care upon returning to the local system. Addressing these gaps will require enhanced collaboration across jurisdictions to improve health information sharing, referral systems, and care transitions. Effective coordination with Tribal Nations is essential for strengthening public health infrastructure in these regions and reducing systemic barriers to healthcare access within American Indian/Alaska Native (AI/AN) Jurisdictions.
In summary, the emphasis on well-baby visits is rooted in the life course perspective, which highlights the enduring benefits of early health interventions. Well-baby visits are positioned as a critical foundation for lifelong health, addressing both developmental milestones and upstream social determinants of health. By leveraging partnerships and maximizing collaboration, we can effectively identify and address gaps in health services. Participation in coalitions and collaboratives, along with close cooperation with Medicaid and programs such as home visiting, will facilitate the identification and resolution of these gaps over the next five years. With sustained investment and active partnerships, North Dakota aims to ensure that all individuals, particularly its youngest and most vulnerable residents, have access to essential health services.
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