State Title V Program Purpose Design
The Nevada Department of Health and Human Services (DHHS) oversees five Divisions, including Child and Family Services (DCFS), Health Care Financing and Policy (DHCFP/NV Medicaid), Aging and Disability Services (ADSD), Welfare and Supportive Services (DWSS), and Public and Behavioral Health (DPBH). The Nevada Title V MCH Program is part of the Maternal, Child and Adolescent Health (MCAH) Section of the Bureau of Child, Family, and Community Wellness within DPBH. The mission statement of DPBH, "It is the mission of the Division of Public and Behavioral Health to protect, promote and improve the physical and behavioral health of the people of Nevada," is the guiding directive for the Nevada Title V MCH Program.
Title V MCH staff are dedicated to improving Nevada families' health, emphasizing women, birthing people, infants, and children, including children and youth with special health care needs (CYSHCN). Title V funding from the Health Resources and Services Administration (HRSA) supports:
- Health education and prevention activities
- Increasing access to health care services
- Developing, and leveraging key partnerships and collaborations
- Planning and implementing program components reaching specific populations in collaboration with community-level partners, coalitions, non-profit organizations, and other state agencies
National Performance Measures (NPM), Evidence-Based or- Informed Strategy Measures (ESM), and State Performance Measures influence Nevada Title V MCH priorities. Nevada's Title V MCH 2020 Needs Assessment demonstrated the need to focus on the following priorities.
- Improve preconception and interconception health among individuals of childbearing age
- Reduce substance use during pregnancy
- Promote breastfeeding
- Promote Safe-Sleep
- Increase developmental screening
- Provide a Medical Home
- Improve care coordination among adolescents
- Increase transition care for adolescents and CYSHCN
Nevada Title V MCH Program staff meet weekly to discuss programmatic updates and address the needs of partners, collaborators, and subawardees. Nevada Title V MCH also remains flexible to adapt to the changing health outcomes for Nevadans. Emerging issues require Nevada Title V MCH staff to stay abreast of evolving MCH healthcare needs. Nevada Title V MCH priorities currently address the following key issues:
COVID-19
The Nevada Health Response Center, Nevada DPBH, and the CDC are closely monitoring the outbreak of the respiratory illness caused by the 2019 novel coronavirus (COVID-19). DPBH is encouraging healthcare providers to refer to the CDC’s Health Alert Network (HAN) and DPBH Technical Bulletins and DHHS efforts inform the state COVID-19 information hub at https://nvhealthresponse.nv.gov/. The latest Nevada COVID-19 statistics and response efforts are also located at the website and are updated through the efforts of the DHHS Office of Analytics and DPBH OPHIE. The LHAs, including SNHD, WCHD, and CCHHS are also key responders monitoring and providing information related to COVID-19.
MCH funded clear face mask purchases for school districts across the state and EHDI partners and supported a CHS immunization need. MCH and NHV staff were awarded pass through HRSA funds via AMCHP for a COVID-19 related telehealth project for CYSHCN and prenatal care. Fortunately, most MCH-funded partners have been able to function well and adapt to the challenges of using virtual platforms. MCH staff have adapted administrative and organizational processes to support program implementation while telecommuting.
Title V MCH staff continue to facilitate a COVID-19 and MCH data presentation with the DHHS Office of Analytics during MCHAB meetings. MCAH staff have also discussed NOMHE-planned equity and COVID-19 toolkit distribution opportunities and shared materials from NOMHE and other quality organizations about racism and public health, health equity, health disparities and racism, and racism and pregnancy outcomes.
Nevada PRAMS applied for and received supplemental funding to include 11 survey questions related to maternal experiences and attitudes related to COVID-19. Data collection began October 2020 and concluded September 2021. This data, once available from CDC, will be utilized to guide Title V efforts related to COVID-19 for maternal and infant populations.
MCH staff worked with UNR’s F2F partner, LHAs, and the CDC Foundation MCH-Immunizations Assignee to share information on childhood COVID-19 vaccine promotion, catch-up vaccinations, vaccination in pregnancy, ADA compliant educational webinars, and creating a sensory friendly toolkit program being distributed statewide. Numerous immunizations focused educational efforts were made possible due to partnership with MCH and MCAH programs.
In response to the psychological impacts of COVID-19 on school age children, Title V MCH as part of the Maternal, Child, and Adolescent Health Section created a mental health action plan to outline approaches to address social, emotional, and behavioral health during a pandemic for elementary and middle school children. This plan synthesized ongoing mental health efforts by agencies and partners throughout the state and provided both national and state recommendations that would be helpful in supporting positive mental health outcomes for children and youth.
Congenital Syphilis
In 2018, Nevada was the top ranked state for primary and secondary syphilis rates and ranked second for congenital syphilis (CS) rates. In 2019, Nevada remained the top ranked state for primary and secondary syphilis rates, while falling to fourth for CS rates. These rankings remained the same for 2020. Primary and secondary syphilis rates have been increasing in Nevada since 2012, with some stabilization occurring in 2020. According to the CDC, Nevada’s rate of primary and secondary syphilis per 100,000 persons from 2012-2020 are as follows: 4.1, 7.3, 11.0, 11.7, 15.3, 19.7, 22.7, 26.6, and 24.9. With this increase of syphilis cases follows a rise in CS. According to CDC, CS rates in Nevada have been rising since 2012. Nevada’s CS rates per 100,000 persons from 2012-2020 are as follows: 2.9, 5.7, 13.9, 22.0, 33.1, 57.9, 85.5, 114.7, and 131.2; this represents a 14.4% increase from 2019 to 2020, and a 4,424% increase over a nine-year span. MCAH staff are members of the CS Workgroup for Nevada and have been instrumental in CS prevention informational campaign development and resource distribution.
Teen Suicide
Teen suicide is an emerging issue in Nevada. Data from NVSS shows the adolescent suicide rate for those ages 15-19 years per 100,000 adolescents in Nevada was 15.6 for the reporting period of 2017-19; this represents an increase of 2.6% from the 2016-18 rate. Nevada’s 2017-19 teen suicide rate is higher than the U.S. rate of 11.2 suicides per 100,000 adolescents during the same reporting period. When stratifying adolescent suicide rates for those ages 15-19 years by urban/rural residence, the 2015-19 rate was 20 in non-metro (rural) areas compared to 14.4 and 13.1 in small/medium and large metro areas, respectively.
Title V MCH will continue to be an active participant in the Healthy Tomorrows Grant with the NVPCA. The Healthy Tomorrows project is focused on creating adolescent-friendly spaces in FQHCs to increase repeat visits and a develop a patient-centered medical home for Nevada’s adolescents. Title V MCH Program funding also helped support the Nevada OSP with teen suicide prevention and systems-building projects, such as Youth Mental Health First Aid and Project AWARE, via funding for the OSP Manager and the crisis call line. Title V MCH staff also participate on the HRSA Mental Health Evaluation Committee and attend Statewide Children’s Mental Health Consortia meetings. Title V MCH Program staff also wrote a letter of support for The Foundation for Positively Kids in their application to the Healthy Tomorrows Program grant. The MCH Director participated in ASTHO’s SPACECAT initiative with SAPTA, OSP, and CASAT partners to focus on ACES and suicide efforts. The AHW Coordinator and MCH Manager participate on a multi-department mental health focused workgroup. MCAH staff participate in LEAHP activities focused on SEL and comprehensive reproductive health information.
Substance Use During Pregnancy and Substance Exposed Infants
Close monitoring of substance use during pregnancy and substance exposed infants will continue to be a priority for DPBH and Nevada’s Title V MCH Program. According to data from NVSS, the percent of women who smoked during pregnancy was 3.6% in 2020; a decrease from 5.4% in 2010, or a change of 33.3%. NVSS data also reflects a modest decline in the use of substances during pregnancy, as the percentage of women who reported smoking, alcohol use, and/or drug use decreased from 5.5% in 2016 to 5.3% in 2019. MCAH will continue to work on state efforts regarding CARA and the Infant Plan of Safe Care including education, training, OMNI/Perinatal Health Initiative work group participation, and increasing awareness. Nevada PRAMS staff make inquiries about substance use before, during, and after pregnancy and provide self-reported data in addition to vital statistics and hospital inpatient data to inform Title V MCH efforts/activities. To enhance other substance use prevention efforts, PRAMS data was presented to both the OMNI and Promoting Innovation in State/Territorial Maternal and Child Health Policymaking (PRISM) learning communities.
Title V MCH Program staff are core members of the Nevada ASTHO OMNI NAS-related efforts in Nevada and also participate in the AMCHP PRISM efforts. MCH funds will support Infant Plan of Care material translation and distribution and the MCH Director will present on CARA referral pathways at a Project ECHO webinar in August 2021 and co-presented at the Nevada Health Conference in March 2021 on Infant Plans of Care.
Maternal Mortality Review Committee and Alliance for Innovation on Maternal Health Efforts
Governor Steve Sisolak signed Assembly Bill (AB) 169 of the 80th Nevada Legislative Session into law in June 2019, establishing the Nevada MMRC. AB169 was codified in NRS 442.751 through 442.774, inclusive, and reflected the work of a wide variety of supporters and advocates. The MMRC is required to: 1) review incidents of maternal mortality and severe maternal morbidity (SMM) in Nevada; 2) disseminate findings and recommendations concerning maternal mortality and SMM to providers of health care, medical facilities, other interested persons and the public; 3) publish timely reports consisting of data relating to maternal mortality and SMM, descriptions of incidents reviewed by the Committee, and recommendations to reduce maternal mortality and SMM in Nevada.
Nevada’s MMRC convened its first meeting in February 2020 and met four times that year. The MMRC will continue to meet at least twice annually to review all incidences of maternal mortality and SMM in Nevada. The Title V MCH Program will support MMRC-related travel to meetings and ancillary costs for members; and, in considering possible opportunities for implementing MMRC recommendations in MCH programmatic efforts for prevention, increased awareness of the existence and recommendations of the MMRC among the public, clinicians, and policy makers, and supporting dissemination of required reports and data-driven MMRC recommendations (e.g., evidence-based practices, screenings, and patient and provider education). The 2021 legislative session added a partnership between the MMRC and the NOMHE Advisory Board in relation to collaborating to provide an equity lens to the recommendations of the MMRC in the biennial report to the Nevada Legislature.
Reporting produced by the MMRC support staff is included in Nevada’s Title V MCH Block Grant reporting. Health equity in birth outcomes and maternal domain population health maximization will be key areas of topical intersect in priorities of the MMRC, MCAH Section, SSDI Program, AIM, ERASE MM, and Title V MCH Program. SSDI funds help support MMRC administrative support staff.
The Title V MCH Program is in discussions with the NRHP to launch Advanced Life Support in Obstetrics (ALSO), American College of Obstetricians and Gynecologists (ACOG) efforts to reduce rural maternal mortality by working with critical access hospitals. Nevada is now an AIM State, which will help staff support activities reducing preventable maternal mortality and SMM, beginning with the hypertension patient safety bundle with the Nevada AIM which launched June 24, 2021.
Early Childhood Continuum
Strengthening the early childhood education continuum to include public health is an emerging issue the Nevada Title V MCH Program will help address. The Title V MCH Program will continue and expand efforts to achieve the goal of NPM 6: To increase the percent of children, ages 9 to 35 months, who received a developmental screening using a parent completed screening tool. According to data from NSCH, Nevada has experienced a significant decrease in the percent of children screened, from 30.6% during 2018-19 to 22.3% during 2019-20. Systems-level interventions are needed to address all components of child development. Title V MCH Program staff will continue to work with the Early Childhood Advisory Council, Pritzker initiatives, Healthy Start, ECCS, NEIS, and NHV to engage diverse partners and leverage existing efforts to address the early childhood continuum. The MCH Director and NHV staff have been core participants in Pritzker efforts in Nevada also related to strengthening the early care continuum. Title V MCH funding replaced out of date audiological equipment. The new audiological equipment serves NEIS children statewide.
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