Domain: Cross-Cutting/Systems Building

Planning for October 2024-September 2025

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 (MN) 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. The MDH Title V program gains access to this data through the MN Health Access Survey (MHAS) hosted by the Health Economics program at MDH. The MN Health Access Survey is a biennial telephone and mail survey that collects information on the health of Minnesotans and how they access health insurance and health care services. The survey measures how many people in MN have health insurance and how easy it is for them to get health care.  

By FFY2025 MN aims to reduce the percentage of Minnesotans that did not get routine medical care that they needed because of cost to 5.1%

Community-Identified Priority Need: Accessible and Affordable Health Care

MN’s five-year comprehensive needs assessment identified a significant area of need in comprehensive, quality health care services, including family planning, that are available and affordable for all. Accessible and Affordable Health Care is a cross-cutting priority area for MN.

For more information on the importance of Accessible and Affordable Health Care on the lives of people living in MN see the Cross-Cutting 2023 Annual Report.

Strategies and Activities

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

MN ranks, on average, among the healthiest states in the nation. However, a closer look at the data reveals that communities of color, American Indian communities, lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities, the disability community, and rural and low-income communities experience the highest inequities in the state, and some of the highest across the nation. MN's significant and long-lasting health inequities, while partially influenced by bio-genetic factors and personal choice, are a result of structural racism and discrimination – oppression that is built into systems and policies. This first strategy aims to build off the work done at MDH to advance health equity focusing on reducing the discrimination and marginalization experienced by women, children, and families in our health care system.

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

In FFY 2025, 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. Based upon feedback received in May 2023 Health Care Homes Learning Days, Title V staff will continue to work with the MN Health Care Homes Program and the Health 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 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.

The modules were not pursued by Health Care Homes.  However, several presentations have been done utilizing the new resource that was created in partnership with CYSHN and the Center for Health Equity titled Accessibility Audit for Health Care Settings - Putting inclusive design into practice (state.mn.us). We are exploring possible partnership with LPH staff through the Statewide Health Improvement Program as a vehicle to advance accessibility in Health care across MN.

2. Address Disparities in Data Available on Minnesotans with Disabilities – Title V Led

Title V CYSHN Staff are co-leading the development of the MDH Disability Data Dashboard. The Disability Data Dashboard Project is a MDH multi-department collaboration that aims to create a publicly accessible data dashboard that communicates disability health equity related demographics, outcomes, and trends for Minnesotans with disabilities. The data dashboard, in alignment with the MN Olmstead Plan, will inform the work of MDH by better measuring and reporting on health outcomes of persons with disabilities and set benchmarks to improve the health and wellness of people with disabilities. Further, the dashboard will serve as a high-quality source of information for academic, health systems, community-based organizations (CBOs) and self-advocates to leverage data in advocacy work, targeted public health interventions, programming, and grant writing materials.

In 2025, Title V staff will continue the partnership with the Division of Health Equity, Strategy, and Innovation, formerly the MDH Center for Health Equity (CHE), to 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 MN Department of Employment and Economic Development, MN Department of Human Services, and MN 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 Division of Health Equity.

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

The second strategy aims to expand access to community-based and remote services.

State Level Activities

2. Provide Road Map/Technical Assistance to Expand Opportunities for Collaboration Between the Health Care System and Schools – Title V Supported

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 MN – Build the capacity of MN 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 MN’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 to in relation to school nursing practice specifically mental health of student.
• The School Nursing Collaborative will plan to continue to develop education and training and practice tools for the school nursing practice as well as promoting and increasing participation in NASN Every Student Counts national data collection.
• MDH and MDE school nurses will develop a plan to continue to support regional community of practice meetings for school nurses after the end of the COVID-19 CDC funding in 6/30/2024.
• MDH will continue to host monthly school health webinars, open office hours and Basecamp.
• Improve Data Sharing, Collection, and Use – MDH and MN SBHA are working collaboratively with the National SBHA, the University of MN, and the five entities overseeing SBHCs in MN 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.
• Support School Based Health Centers – In collaboration with MN 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.
• Continue to support and expand School-based Clinics.  MN currently has 29 School-Based or School Linked Health Centers (SBHC). SBHC’s partner with a local healthcare provider to provide physical and mental health services to students where they are and regardless of ability to pay, insurance coverage or immigration status.

In 2023, MN legislation established funding to support existing and emerging school-based clinics. In 2024 MDH established a SBHC program that awarded funding to six grantees through a competitive RFP process. The MN SBH Alliance is also a grantee of MDH and provides technical assistance and support for all MN SBHC’s.  

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

Many people have difficulty navigating the health care system to get the care they need. Specific communities, such as people with disabilities and their families, people with limited English proficiency, people living in rural areas, and communities that have been historically discriminated against, require more unique approaches to accessing quality care than strategies that may be effective for the majority. Understanding that some populations may need different approaches in communication and outreach, it is important to leverage existing, trusted networks (such as Community Health Workers and other cultural brokers) to empower patients and families with information and tools needed to be engaged in their health care. The following activities seek to utilize these trusted health advocates as partners in MN’s efforts to improve quality of health care and person-centered practices in communities.

State Level Activities

1. Increase the Availability and Use of Non-Traditional Birth Workers – Title V Led

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 FFY2025, 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 MN. 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 – Title V Connected

MDH will continue to oversee the Sexual and Reproductive Health Services (SRHS) (SRHS) grants program which provides low-income, high-risk people pre-pregnancy family planning services and fact-based sexual health information. During this time, staff will support a total of 35 grantees funded through the original 2023-2027 grant request for proposal (RFP) and the additional $6.353 million SRHS funding expansion from the MN 2023 legislative session. Title V staff will also continue to strengthen their connection and work to streamline referrals with MN Family Planning Program (MFPP) administered by MN 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 MN’s publicly funded health care programs.

Domain: Cross-Cutting/Systems Building

Planning for October 2024-September 2025

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 (MN). 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 MN 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 MN 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 continue to promote and support efforts for Division staff to complete the Tribal State Relations Training, 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. For FY2025 our goal is at least 75% of Division staff will have completed the Tribal State Relations Training.

Community-Identified Priority Need: American Indian Family Health

MN’s five-year 2020 comprehensive needs assessment identified a significant area of need to reduce disparities and support the well-being of American Indian families, making American Indian Family Health a cross-cutting/systems building priority area for the state.

For more information on the impact and importance of American Indian family health on the lives of people living in MN, see the Cross-Cutting/Systems Building: American Indian Family Health 2023 Annual Report.

Strategies and Activities

Strategy A: Increase Access to Culturally Specific Health Services

Many American Indian families struggle with a health care system that does not meet their needs. Much of MN’s health care and public health infrastructure is rooted in Western practices and beliefs that do not overlap with American Indian approaches or values. When culturally relevant care incorporating history and cultural context is available, capacity is often limited and people living in rural areas or lacking robust transportation options can struggle with geographical access. We plan to implement the following activities to make progress in closing this gap.

“[Women, children and families need] a caring, culturally supportive community to access that shares, cares, and offers opportunities for personal and professional growth that supports them as women, as mothers, and as leaders. When a woman can move beyond the struggle of basic needs, they are capable of so much more including living a full life.” – American Indian Needs Assessment Discovery Survey Respondent

State Level Activities

1. Collaborate with Partners to Support Training of American Indian Doulas and Community Health Workers – Title V Supported

MN plans to collaborate with partners to explore how FHV and other MDH resources can better support the training of American Indian doulas and other birth workers, Indigenous breastfeeding experts, and 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 DHS – MN’s state Medicaid agency – to define and help develop billing infrastructure for doulas and CHWs working with pregnant and parenting families. In FFY2025, MDH will continue nascent work to expand doula and midwifery access in the state, including Indigenous birth workers.

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

Family Spirit is a FHV 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. MN plans to continue supporting those organizations implementing Family Spirit, as well as all tribal home visiting programs, during FFY2025 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:

• FHV staff will initially collaborate with Tribal organizations and non-profits serving the American Indian population to initiate a peer-organized and led Community of Practice. Encourage these events to occur quarterly with both virtual and in-person opportunities.  FHV will initially assist in coordinating these with goal of Family Spirit sites to carry on the peer-organized and peer- led support. MDH FHV will conduct a survey to gather information from sites on what/how they would like to proceed.
• MDH FHV staff will meet with Tribal Nations and Non-Profit Home Visiting programs called Practice Connections quarterly, monthly, and as needed for technical assistance and support.    Current funding provides agencies who implement home visiting programs to decide which evidence-based home visiting model will work best in their own community Evidence-based models currently being used are Family Spirit, Nurse Family Partnership, and Parents as Teachers. 
• MDH FHV staff also provide technical assistance and support in Practice Connections for Tribal agencies that are providing traditional home visiting under the TANF funding.  Practice Connections will be offered quarterly, or more frequently as needed.  In-person visits will also be offered at a minimum of every other year, more frequently if needed.

Strategy B: Mandate Cultural Proficiency, as Defined by Community

Participants in our Strategy Team discussed the lack of awareness and understanding surrounding American Indian history and culture among non-American Indian people. From the not-so-distant past to today, American Indian communities have been forced to operate within a context of inaccurate and reductive portrayals of their history and culture. They have been forced to live within boundaries set by people who neither knew nor understood them. This misinformation persists today through policies and structures set by uninformed government leaders and employees, regardless of whether it is done intentionally. MN state employees who misunderstand American Indian history and culture perpetuate mistrust among these communities, who are directly impacted by this ignorance both personally and systemically. Unless this cycle of misinformation is interrupted, it will continue to harm American Indian communities.

Cultural and historical proficiency – as defined by American Indian communities – should be mandated for state employees that interact with or impact American Indian families. To ensure their history and culture are conveyed accurately and meaningfully, American Indians should direct the development and delivery of trainings, educational materials, and benchmarks for proficiency.

State Level Activities

1. Review State Employee Tribal State Relations Training Accessibility and Impact – Title V Led

MN acknowledges the sovereignty of the eleven federally recognized American Indian tribes within MN’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 MN state agencies and elected tribal government officials on matters that have tribal implications, MN enacted MN 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.

In FFY2025, CFH Division leadership, including the Title V MCH Director and the Title V CYSHN Director, will continue to actively encourage staff to register and attend these trainings, including new hires. In addition, the CFH C&TC program and MDH Office of American Indian Health will continue to explore the possibility creating a Tribal State Relation (TSR) for Health Care with MN tribes, MN Department of Transportation TSR program and University of MN Duluth TSR trainers.

Strategy C: Shift Power and Policies to Address Structural Racism

“The only good Indian is a dead Indian.”

 – Gen. Phillip Sheridan, 1869 at a Tribal Leadership Meeting in what is now Oklahoma

When this opinion was voiced in 1869, it was neither scandalous nor controversial. These words reflected a common prejudice that shaped the treaties between the U.S. government and tribal leadership at the time and pervades government systems to this day. Many of MN’s laws and policies are inherently biased and perpetuate structural and systemic racism. These range from macro-level policies that make it more difficult for American Indian people to be hired to micro-level standards that create obstacles to grant funding for American Indian-led public health organizations.

State Level Activities

1. Develop Request for Proposal Processes that Demonstrate a Knowledge of American Indian Communities, their Norms, and Values – Title V Supported

In April 2022, MDH released one of the largest grant applications in its history. The roughly $150 million, five-year grant will continue to fund Tribal Nations to provide evidence-based and promising practice family home visiting services.  For sites currently funded and in good standing, the grant will be non-competitive and will allow for cultural adaptations if they align with the model chosen by the community. In FFY 2025, FHV and Title V staff will continue to work closely with the Director of American Indian Health and our Health Equity and Strategy Innovation Division, formerly the Center for Health Equity, at MDH to get input to assure grant management, including relationships with grantees, are reflective of and responsive to American Indian communities, norms, and values.

Additional Related Activities

This section details efforts that are related to the cross-cutting/systems domain, but do not fall specifically within one of the strategies or they are ongoing. These activities ultimately help to improve the health and well-being of American Indian families in MN.

State Level Activities

1. Collaborate with the Office of American Indian Health to Eliminate American Indian Health Disparities – Title V Led

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 MN Tribal Nations to eliminate the health disparities experienced by our American Indian women, children, and families. To do so, we hope to continue learning about and adjusting to how our tribal and urban American Indian communities engage with MDH and what barriers exist in strengthening these relationships, particularly in our Title V work.

Domain: Cross-Cutting/Systems Building

Planning for October 2024-September 2025

Objective

By 2025, decrease the proportion of Minnesota (MN) 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 MN 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.

MN’s goal for FY2025 is that 2.5% or less of MN 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

MN’s five-year 2020 comprehensive needs assessment identified a significant area of need in increasing safe, affordable, and stable housing for all people in MN, making housing is a cross-cutting/systems building health priority area for the state.

For more information on the importance of housing on the lives of people living in MN see the 2023 Annual Report.

Strategies and Activities

Strategy A: Expand Funding Opportunities

State Level Activities

1. Promote Continuum of Care Models to Focus on Homeless Prevention and Assistance - Title V Connected

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 MN communities in FFY 2025.

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 MN 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. MN 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 MN.

Strategy B: Person-Centered Approach/Services

State Level Activities

1. Increase Access to Safe and Affordable Housing for Clients who are Pregnant or Parenting Infants - Title V Connected

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. 

Strategy C: Create/Innovate Housing

State Level Activities

A.  Provide Adequate, Dignified Shelter Options for Children and Families - Title V Connected

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 MN Housing and Finance Agency – the state housing department – in effort to learn more about the current and ongoing housing and homelessness landscape in MN, 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 in FFY2025 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.

Strategy D: Focus on Policy Change

State Level Activities

1. Participate on the MN Interagency Council on Homelessness (MICH) and the Crossroads to Justice Strategic Planning- Title V Connected

The MICH is comprised of 13 state agencies, the Met Council, and the Governor’s Office, and is charged with leading MN’s efforts to achieve housing stability for people experiencing homelessness in MN. MDH is one of the 13 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. 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 – resulting in the Crossroads to Justice Strategic Plan. See activity two of this strategy for more information about the Crossroads to Justice Strategic Plan. Title V staff will continue to participate in the MICH activities in FFY2025.

2. Prioritize the Interconnection between Health, Homelessness, and Housing to Drive Policy and Systems Change - Title V Supported

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 continue work closely with this staff member with a focus on the interconnections between homelessness, housing, and MCH population health.

In FFY2025, Title V staff will work with the MDH Senior Advisor on Health, Homelessness, and Housing to explore opportunities to develop information and resources for Title V grantees and the general public to increase awareness and understanding of the interconnections between homelessness, housing, and MCH population health. This includes developing facts sheets and webinars on addressing housing and homelessness in MCH populations using Title V resources.

Domain: Cross-Cutting/Systems Building

Planning for October 2024-September 2025

Objective

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

State Performance Measure

(SPM 4) Percent of Minnesota (MN) 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 MN 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 FFY2025 MN aims to increase the percentage of MN Adolescents who report having positive mental well-being to 40.4%.

Community-Identified Priority Need: Mental Well-Being

MN’s five-year 2020 comprehensive needs assessment identified a significant area of need in ensuring all people living in MN have the opportunity and skills to manage day-to-day stress, have meaningful relationships and contribute to their family and community, including building resilience in those who experience childhood trauma. Mental Well Being was selected as a cross-cutting/systems building priority area for MN.

For more information on the importance of Mental Well-Being on the lives of people living in MN see the 2023 Annual Report.

Strategies and Activities

Strategy A: Help communities build capacity and resilience

This first strategy builds the understanding that local communities have the power to shape mental well-being across socio-ecological domains and across the lifespan but need the capacity to address these needs. This includes information and resources, and support from the state where needed. As communities in MN continue to learn about trauma and resilience, this strategy is about developing shared knowledge across communities and resources for communities to improve mental well-being. In addition, this will help establish effective support roles for state institutions in community resilience work. 

State Level Activities

1. Build Support for Expanding Community-Based Program Models Statewide – Title V Supported

The Mental well-being and Resilience Learning Community (MWRLC) has highlighted many examples of community-based mental well-being strategies in MN 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 FFY2025, MDH will do the following:

• Continue to host the MWRLC highlighting a range of well-being strategies across communities in MN.
• Identify opportunities to actively support and connect those interested in advancing or scaling one of the identified strategies.
• Continue to elevate initiatives that promote connection to nature. Including, opportunities to connect certified forest therapy guides, 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 the highlighted initiatives. 
• Convene stakeholders to identify steps to build infrastructure and support for community led care. For example, defining the minimum expectations for referring community members to higher levels of care when needed, and strategies to sustain this type of community programming. 

2. Partner with Key Stakeholders to Develop Shared Objectives and Maintain the MN Community Resilience Learning Cohort – Title V Supported

 An overarching goal for mental health promotion efforts in MN is to advance a public health approach to mental health, especially a policy approach. For communities to invest in population level mental health promotion, they must embrace a broader definition of mental health that includes everyone, that recognizes that we all have mental health.  Understanding the range of individual, family and community factors that can promote mental well-being, especially the impact of policies on our collective mental well-being can also support investment in a public health approach to mental health.  Finally, communities often need to know what resources they already have, before finalizing priority action steps. Title V staff aim to support this through engagement in the following activities in FFY2025:

• 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.
• Evaluate and communicate about the community process implemented for the BYMH grant and explore opportunities to scale this model to other communities. 
• Continue to engage state and community leaders to discuss community level protective factors and policies that promote mental health.
• Continue to partner with 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 tools that could help communities process or prioritize them to decide what actions are needed to promote mental well-being health promotion strategies. The workgroup will partner with other MDH community data initiatives to align efforts where feasible, especially those working on quantitative assessment processes (e.g., community health improvement planning). 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 finalize the literature review for the societal level of the expand the mental health socio-ecological model, and develop a summary to help in efforts to help guide community leaders prioritize or elevate the strategies identified through the literature review.   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.

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

This strategy is aimed at increasing awareness of key factors and strategies to promote mental well-being to influence individual and family behavior, as well as build public support for mental health promotion activities. Expanded awareness about mental well-being, and a public health approach to mental well-being, is important for local leaders as well as the public. 

State Level Activities

1. Expand Understanding of Key Research and Current Strategies to Support Social connectedness and Other Factors that Influence Mental Well-Being – Title V Supported

During FFY2025, 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 will leverage national resources, including those from the Surgeon General 5 for 5 Connection Challenge to promote social connectedness through the May Mental Health month toolkit, online, and at public events where MDH hosts a table.

Title V staff will continue 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 MN’s communities, including attention to social connectedness

2. Identify Opportunities to Develop and Implement Formal Marketing Campaigns on Mental Well-Being, Trauma, and Resilience – Title V Supported

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 continue to work with partners to amplify mental well-being messages in FFY2025 by:

• Promoting the trauma-informed toolkit to communicate about available resources with different audiences (e.g. parents, jails, early childhood providers, etc.).
• Promoting the implementation of a campaign and training around healthy relationships with technology especially for children and adolescents, including promoting resources developed by Live More Screen Less
• 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.
• Continue engagement in the MN State Fair Mental Health Awareness event.

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

This strategy builds on the understanding that policies at every level share the conditions for mental well-being and are essential for population change. The aim is to build state and community capacity to identify, prioritize, and implement policies that promote mental well-being.  

State Level Activities 

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

Reimagine Black Youth Mental Health Initiative – Title V Supported

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 four goals:

• Shift the narrative from deficit to well-being for mental health.
• Strengthen the ecosystem, the environments that support Black youth.
• Change the conditions and policies that perpetuate harm to Black youth.
• Model an authentic Black youth and community-driven policy change process.

The Reimagine Black Youth Mental Health Initiative is set to continue through FFY2025. Additionally, MDH will continue to support implementation of the demonstration project and increase focus on the evaluation, and sustainability. This will include working with state agency partners to explore opportunities to sustainability and scale 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:

• Black youth safety
• Addressing historical trauma among Black families
• Black affinity spaces
• Increasing Black school leadership and teachers, and
• Expanding Black history and cultural education opportunities.

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

Additionally, in FFY2025, 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, MN Public Health Law Network, MDH Healthy MN 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 MN 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 identify important and relevant policies. For example, we will continue to partner with the University of MN 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 MN SHIP, Department of Natural Resources, and MN Department of Education, to inform strategies that support local policy action.

2. Identify Public Health-Focused Recommendations for the State Mental Health Advisory Council Report – Title V Supported

In FFY2025, MDH staff will continue participating on the State Mental Health Advisory Council, Family Systems and Prevention Workgroup, and School Mental Health workgroup. The State Mental Health Advisory Council does not submit a report to the Governor during odd years.  The workgroups will continue to identify opportunities to advance previous 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. 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 2026 State Mental Health Advisory Council Report.

3. Promote Policy, System, and Practice Changes to Support Children of Incarcerated Parents – Title V Supported

An estimated 16% of youth in MN have an incarcerated or previously incarcerated parent, making parental incarceration the second most frequently reported ACE for this population (MSS, 2022). Youth with an incarcerated parent have increased risk of poor mental health and illness, substance use, and poor academic outcomes. During FFY2025, MN will continue to grow the Model Jail Practices Learning Community, through a federal Department of Justice grant and the state legislature, to promote policy, system, and practice changes that support children of incarcerated parents.  The initiative will connect with at least fifteen counties in MN through a range of activities including:

• Bi-monthly training for jails on model practices
• Quarterly learning community meetings to facilitate quality improvements and share relevant resources.
• 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. This will include training for these systems and opportunities to build connections with partnering jails.
• Coordinate training in evidence parenting programming for jail and community partners.

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.

Additional Related Activities

State Level Activities

1. Develop an Internal CFH Division Mental Health Workplan – Title V Supported

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 MN’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 developed an initial plan for the division. 

In FFY2025 MDH will continue to review the plan and reconcile it with available state and federal funding, including legislative proposals. MDH will continue to identify opportunities to align efforts within and across divisions.

Domain: Cross-Cutting/Systems Building

Planning for October 2024-September 2025

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 FFY2025 is 68.5% 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

Minnesota’s (MN) five-year 2020 comprehensive needs assessment identified a significant area of need in supporting parents and caregivers socially and emotionally with family-focused activities, policies, and education. Parent and Caregiver Support is a cross-cutting priority area for the state.

For more information on the importance of Parent and Caregiver Support on the lives of people living in MN see the Cross-Cutting 2023 Annual Report.

Strategies and Activities

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

The first strategy aims to work toward redesigning policies and programs at the state level so that the system is set up in a manner where families are better able to receive needed support. This includes promoting family home visiting (FHV)services as a part of a comprehensive early childhood system and advocating for policies that support the well-being of parents and caregivers beyond the early childhood stage. 

State Level Activities

1. Coordinate between Title V and FHV initiatives to Serve More Families through FHV - Title V Supported

A major activity aimed at helping promote a comprehensive system that supports families is 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 connect to community resources that help stabilize and empower families.

 

A 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 MN’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 FFY2025, 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.  MDH-FHV staff will conduct subrecipient monitoring activities including fiscal monitoring, site visits, and regularly scheduled opportunities for communication and technical assistance for LIAs. Title V and FHV staff will work internally to improve relationships and better understand Local Public Health's implementation of FHV by braiding a variety of funding sources (MIECHV, TANF, Title V, state funding). Our goal is to provide improved guidance and recommendations to Local Public Health agencies for the optimal use of these funding streams. Starting in 2024, a family home visiting (FHV) subcommittee will be formed within the existing Maternal Child Health Task force (which also includes CYSHN, IMOM, Infant and Early Childhood, and Child and Adolescent subcommittees). The purpose of the MCH Task Force is to advise the Commissioner of Health on the health care services/needs of maternal and child health populations in MN, the use of funds for maternal and child health and children with special health needs administered through MDH and the priorities and goals for maternal and child health activities.
• 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.   Title V and FHV staff will work closely with the MDH Center for Health Equity to improve support and collaborative approaches in our work with non-profits and tribal nations focused specifically on serving American Indian families and communities of color.
• 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). One such example of this collaboration is the development of a training presentation by a local public health agency, CYSHN, MDE, and FHV staff specific to implementing FHV with families with children with special health care needs. MDH-FHV staff will also implement enhancements to the grant management process that seeks input from counties, tribes, and non-profit LIAs. Providing data reports to monitor fidelity, progress towards meeting MIECHV benchmarks, and identifying areas for technical assistance and CQI will continue to be a strong focus.

2. Advocate for Policies that Promote and Support the Well-Being of Parents/Caregivers -Title V Supported

MN will convene partners to advocate for policies that promote and support the well-being of families, including the following activities during FFY2025:

• 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 MN 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.

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

Public health professionals and family home visitors play a vital role in improving the health and well-being of families. MN intends to build capacity of public health professionals and family home visitors to help improve the mental health, well-being, and resilience of families. Since two-thirds of the block grant funding goes to LPH agencies, we intend to first focus on LPH staff who are providing services to families through family home visiting, CYSHN follow-up, and other family serving initiatives.

State Level Activities

1. Provide Training and Support the Implementation of Best Practices Amongst Public Health Professionals and Family Home Visitors - Title V Supported

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.

MDH FHV will continue to host and sponsor MECSH Foundation Training four times per year, Refresher Training two times per year, and Stop-Gap Training as needed for new MECSH home visitors that have a need to begin enrolling families into the program before they can attend the next available in-person Foundation Training. Additionally, virtual training on the PICCOLO parent-child interaction tool will be offered to family home visitors across MN beginning in 2025.

Other areas of emphasis for training public health professionals will continue to be trauma-informed care, reflective practice, intimate partner violence, depression, parental substance use, and adverse childhood experiences (ACEs). Plans are also underway for MDH-FHV to release a funding opportunity for LIAs to support their unique local training needs and priorities, with an expected award date of July 2024 with funds continuing through the end of SFY2027.

 

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 ACEs. 

2. Provide Training on Postpartum Depression Screening for Health Care Providers – Title V Supported

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 C&TC 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.

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

With our third strategy, MN aims to develop innovative ways that parents and caregivers can connect with each other, addressing the social isolation that families can feel if they do not have adequate supports in place. This strategy has especially become relevant during the COVID-19 pandemic.

State Level Activities

1. Connecting Families to Family-to-Family Support - Title V Led

During FFY2025, MDH will continue to fund family-to-family support through the Early Hearing Detection and Intervention Program – this program uses state and federal funds separate from our block grant. We will also continue work to connect LPH staff with family support organizations. LPH direct support to families through the Follow Along Program, CYSHN condition-specific follow-up, home visiting, and other programs. The direct touchpoints with families present opportunities for LPH to help link those families with other resources (like peer support) that might be beneficial for them.

Upon completion of the Environmental Scan and working with a Think Tank, CYSHN Title V Staff has intentional plans to work with family support organizations. The approach:

• Incorporates lessons learned from the initial three gatherings held on October 25 and December 6, 2023, and February 7, 2024. 
• Embraces a learning and growth mindset. This pilot phase encourages intentional, yet flexible approaches so the CYSHN Title V staff can continuously reflect on what is working and what’s not so adjustments can be made in real-time. 
• Values multiple learning approaches to account for multiple adult learning styles. 
• Strengthens relationships with family support organizations by directly engaging, leading, coordinating, and executing the proposed plan for the coming year. This will allow the Systems Transformation unit to understand the needs of family support organizations more deeply and ensure that any future requests for proposals with an external vendor will have clear responsibilities and deliverables.

The collaborative is a space for family support organizations to:

• Learn about the work of other family support organizations.
• Connect, build relationships, share knowledge, and find solutions together. 
• Build strong, vibrant partnerships with Title V, including the CYSHN section and provide input on its priorities and plans.