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), 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.
Nevada Title V MCH is dedicated to improving the health of families, with an emphasis on women, 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, and planning and implementing program components reaching target populations in collaboration with community-level partners, stakeholders, coalitions, non-profit organizations, and other state agencies.
The 2015 Title V MCH Needs Assessment helped to formulate Nevada’s priorities to improve the health for each population domain during the 2016-2020 block grant applications and reports. Nevada Title V MCH priorities are also influenced by the state’s chosen National Performance Measures (NPM), Evidence-Based or- Informed Strategy Measures (ESM), and State Performance Measures. Nevada Title V MCH priorities from the 2015 Needs Assessment were:
- Improve preconception health among adolescents and women of childbearing age
- Increase percent of infants who are ever breastfed, and percent of infants breastfed exclusively through six months
- Increase the percent pf children aged 10 through 71 months receiving developmental screening
- Increase the percent of children, adolescents and women of childbearing age who are physically active
- Increase the percent of adolescents and women of childbearing age who have access to healthcare services.
- Promote establishment of a medical home for children
- Prevent and reduce tobacco use among adolescents, pregnant women and women of childbearing age
- Increase the percent of adequately insured children
Nevada’s Title V MCH 2020 Needs Assessment demonstrated the need to retain some of these priorities as well as addressing additional priorities. Although the removed measures remain a priority, they have been adjusted to meet the evolving needs of Nevada’s MCH population. Moving forward, the priorities for Nevada’s Title V MCH Program are:
- Improve preconception and interconception health among women 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, stakeholders, 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 DHHS, Nevada DPBH, and the Centers for Disease Control and Prevention (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), DPBH Technical Bulletins, and DHHS efforts by visiting the state’s COVID-19 information hub at https://nvhealthresponse.nv.gov/. Local health authorities, including Southern Nevada Health District (SNHD), Washoe County Health District (WCHD), and Carson City Health and Human Services (CCHHS) are also key responders monitoring and providing information related to COVID-19.
The latest statistics and response efforts are located at https://nvhealthresponse.nv.gov/ and are updated regularly by the DHHS Office of Analytics and DPBH Office of Public Health Investigations and Epidemiology (OPHIE).
In addition to DHHS and DPBH efforts, Nevada Title V MCH staff have posted MCH-specific resources on the program’s website, are engaged in pregnancy surveillance monitoring discussions with CDC as part of an OPHIE-led team, have shared resources and Technical Bulletins with partners to support rapid information sharing, reached out to stakeholders and subawardees to determine how COVID-19 is affecting their efforts, and is assisting in any technical assistance and allowing reasonable adaptations or fiscal redirects for subawardees as needed. Fortunately, most MCH-funded partners have been able to function well and adapt to the challenges of using virtual platforms. Nevada Title V MCH Program staff are actively telecommuting and have adapted administrative processes to continue supporting program implementation. Nevada Title V MCH staff will facilitate a COVID-19 and MCH data presentation in concert with the Office of Analytics for the August 2020 Maternal and Child Health Advisory Board (MCHAB) meeting. MCAH staff have also discussed Nevada Office of Minority Health and Equity (NOMHE) “Equity and COVID-19 Toolkit” distribution opportunities and shared materials from NOHME and other quality sources regarding racism and public health, equity, health disparities and racism, and pregnancy outcomes and racism.
Congenital Syphilis
In 2018, Nevada ranked number one in the country for primary and secondary syphilis rates and second for congenital syphilis (CS) rates. Primary and secondary syphilis rates have been increasing in Nevada since 2012. According to the CDC, Nevada’s rate of primary and secondary syphilis per 100,000 persons, from 2012-2018 was 4.1, 7.3, 11.0, 11.7, 15.3, 19.7, and 22.7, respectively, representing an increase of 453.7%. With this increase of syphilis cases comes a rise in congenital syphilis as well.
According to CDC, CS rates in Nevada have also been rising since 2012. Nevada’s CS rate per 100,000 infants from 2012-2018 was 2.9, 5.7, 13.9, 22.0, 33.1, 57.9, and 85.5 respectively. This represents a 47.7% increase from 2017 to 2018, and a 2,848.3% increase over the seven-year span. MCH staff are members of the CS Workgroup for Nevada and have been instrumental in CS informational campaign development and resource distribution.
Teen Suicide
Teen suicide is an emerging issue in Nevada. Data from the National Vital Statistics System (NVSS) shows the adolescent suicide rate for Nevada teens ages 15 to 19 years was 15.2 per 100,000 persons for 2016-2018; this represents an increase of 12.6% from the rate recorded for 2015-2017. Nevada’s 2016-2018 rate is also higher than the U.S. rate of 11.1 per 100,000 persons for the same time period. When stratifying Nevada’s adolescent suicide rate for teens ages 15-19 years by urban/rural residence, the 2016-2018 rate was 22.1 in non-metro areas compared to 13.7 and 12.3 in small/medium and large metro areas, respectively, illustrating a concerning trend for adolescents living in rural areas.
Nevada Title V MCH will continue to participate in the Healthy Tomorrows Grant with the Nevada Primary Care Association (NVPCA), focused on creating adolescent-friendly spaces at Federally-Qualified Health Centers (FQHCs) to increase repeat visits and create a patient-centered medical home. Title V MCH funding also helped support the Nevada Office of Suicide Prevention (OSP) with teen suicide prevention and systems-building projects, such as Youth Mental Health First Aid and Project AWARE by funding the OSP Manager’s salary and the crisis call line. Nevada Title V MCH staff participate in the HRSA Mental Health Evaluation Committee and attend the Statewide Children’s Mental Health Consortia meetings.
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 smoke during pregnancy was 4.2% in 2018. This percentage has decreased from 5.4% in 2010, representing a decrease of 22.2%. Data from the Nevada Office of Vital Records (OVR) reflects a modest decline in the use of substances during pregnancy, as the percentage of women who reported smoking, alcohol use, and drug use decreased from 5.5% in 2016 to 5.3% in 2019. MCAH will continue to work on statewide efforts such as the Comprehensive Addiction Recovery Act (CARA) project and the Infant Plan of Safe Care including education, training, work group participation, and increasing awareness. Nevada’s Pregnancy Risk Assessment Monitoring System (PRAMS) surveys inquire about substance use before, during, and after pregnancy and provides this self-reported data to inform Title V MCH efforts, in addition to the vital statistics and hospital inpatient data. Nevada Title V MCH Program staff are also core members of the Nevada ASTHO OMNI NAS efforts.
Maternal Mortality Review Committee (MMRC) and Alliance for Innovation on Maternal Health (AIM) Efforts
Governor Steve Sisolak signed Assembly Bill (AB) 169 of the 80th Nevada Legislative Session into law, establishing the Nevada MMRC and Processes and granting committee protections. The bill was codified in Nevada Revised Statues (NRS) 442.751 through 442.774, inclusive, and its creation reflected the work of a wide array of supporters and advocates in Nevada. The Committee 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 established their first MMRC and convened for their first meeting in February 2020. The MMRC will continue to meet at least twice annually to review all incidences of maternal mortality in Nevada. The Title V MCH Program will support the MMRC-related meeting travel and ancillary costs, and will consider 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). Reporting produced by the MMRC support staff will be included in the Title V MCH Block Grant reporting, and 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, State Systems Development Initiative (SSDI) Program, and Nevada Title V MCH Program. Nevada Title V MCH staff will look for opportunities to create sustained funding for the MMRC as it was passed into law without dedicated funding; currently, SSDI funds help support the MMRC administrative support staff. Nevada Title V MCH staff are also in discussions with the Nevada Rural Hospital Partnership 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 also support reducing preventable maternal mortality and SMM.
Early Childhood Continuum
Strengthening the early childhood education continuum to include public health is an emerging issue MCH will help address in Nevada. Nevada Title V MCH 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 the National Survey of Children’s Health (NSCH), Nevada experienced a decrease from 2017-2019 in the percent of children screened, dropping from 30.9% to 27.9%. Systems-level interventions are needed to address all components of child development. Nevada Title V MCH staff will work with the Early Childhood Advisory Council and Nevada Home Visiting Program to engage diverse stakeholders and leverage existing efforts to address the early childhood continuum. The MCH Director and Nevada Home Visiting (NHV) staff have been core participants of Pritzker efforts in Nevada related to strengthening the early care continuum.
State Title V Program Purpose Design Conclusion
The Nevada Title V MCH Program is a small, but enthusiastic and well-organized unit. Working with other programs within the MCAH Section, such as NHV, SSDI, PRAMS, Personal Responsibility Education Program (PREP), Sexual Risk Avoidance Education (SRAE) Program, Early Hearing Detection and Intervention (EHDI) Program, and Rape Prevention and Education (RPE) Program, the Title V MCH Program aims to address many of the key health needs of Nevada’s MCH population using evidenced-based approaches, highlighting social determinants of health, and prioritizing the importance of stakeholder collaboration. Nevada Title V MCH takes a systems-based approach to achieving the mission of DPBH and embraces intra and inter agency braided efforts. In addition to Title V MCH Block Grant priorities, program staff support the Governor’s priorities and those of DHHS to maximize MCH population health outcomes and improve the health and wellbeing of Nevada families.
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