In Hawaii, the Family Health Services Division (FHSD) serves as the state Title V MCH agency. FHSD is committed to improving the health of women, infants, children, including those with special healthcare needs and families. FHSD works to promote health and well-being using a life course and multi-generational approach to address social determinants of health and health equity.

Because the Department of Health is the only public health agency in the state, FHSD is the only MCH agency and provides all levels of service delivery: direct, enabling, and infrastructure building for all counties. Most service contracts for county/community providers are executed through FHSD central program offices located on Oahu in consultation/coordination with county staff. However, during the pandemic, FHSD county nurse managers have been able to partner with local community organizations to procure services to address emerging needs using both federal and state funds. The sharing of procurement duties with county offices, albeit limited, effectively addressed critical administrative vacancies in the central office and helped to distribute the increase in COVID-related relief funding to rural communities.

Together, FHSD programs work to ensure statewide services delivery, as well as infrastructure for data collection, needs assessment, surveillance, planning and evaluation, systems and policy development, and the provision of workforce training and technical assistance to assure quality of care.

FHSD includes three branches—Maternal and Child Health (MCH); Children with Special Health Needs (CSHN); and Women, Infants, and Children (WIC) Services—and several offices and programs at the division level.

At the division-level, FHSD oversees the following programs:

• Title V MCH Block Grant Program/State Systems Development Initiative
• Early Childhood Comprehensive Systems (ECCS)
• Oral Health Program
• Pediatric Mental Health Care Access Grant
• Pregnancy Risk Assessment Monitoring System (PRAMS)
• Office of Primary Care and Rural Health, including the Primary Care Office (PCO), State Office of Rural Health, Medicaid Rural Hospital Flexibility Program, and Small Rural Hospital Improvement Program

The Maternal and Child Health Branch (MCHB) administers a statewide system of services to reduce health disparities for women, children, and families of Hawaii. MCHB programs provide core public health services that establish and maintain public and private partnerships to share information; support program planning; workforce training; and collaborate to promote policies that improve outcomes for women, children, and families. Services include reproductive health and interconception care; child and youth wellness; violence prevention programs (child abuse and neglect, sexual assault, domestic violence); home visiting services; fatality reviews; and family supports. Some of the programs include: The Parent Line, Safe Sleep, Child Death Review, and Maternal Mortality Review. The branch has over 35 community provider contracts for women’s health, violence prevention, and family support services.

The Children with Special Health Needs Branch (CSHNB) works to improve access for children and youth with special healthcare needs to a coordinated system of family-centered healthcare services and to improve their outcomes. This is addressed through systems development, assessment, assurance, education, collaborative partnerships, and supporting families to meet their health and developmental needs. Programs include:

• Children and Youth with Special Health Needs Section: Children with Special Health Needs, Early Childhood, Hiʻilei Developmental Screening, and Childhood Lead Poisoning Prevention
• Genomics Section: Genetics, Birth Defects, Newborn Hearing Screening, and Newborn Metabolic Screening
• Early Intervention Section (EIS): Mandated early intervention services provided through three state-operated programs and 15 purchase of service programs. The Hawaii Early Intervention Coordinating Council, established under HRS §321-353, advises and assists EIS in the performance of its responsibilities under Part C of the Individuals with Disabilities Education Act (IDEA).

The Women, Infants, and Children (WIC) Special Supplemental Nutrition Program is a $29 million United States Department of Agriculture (USDA) Food and Nutrition Service (FNS) federally funded, short-term intervention program. USDA FNS provides federal grants to states for supplemental foods, healthcare referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women and for infants and children up to age 5 who are found to be at nutritional risk. The WIC Branch of FHSD administers the USDA FNS WIC program for the State of Hawaii.

COVID Impacts on Staff: The pandemic resulted in unrelenting and unprecedented changes in all aspects of work and personal life. Staff continue to be challenged to find time to pause, assess, understand current conditions, and respond to the needs of both staff and populations served. FHSD continues to support selfcare, promote resiliency, and honor those who retire or choose to leave FHSD. Given the consequences of the pandemic, this report reflects the continued changes and innovations that occurred as the state transitions into an endemic phase.

FHSD Vision/Mission: For several years, FHSD intended to update its mission statement and organizational documents in conjunction with the updating of the DOH strategic plan. In October 2020, consultation was conducted with Karen Treiweiller, MCH consultant and former Colorado Title V director, to assist with this effort. However, both the department and FHSD plans were delayed due to COVID. FHSD hopes to proceed with updates in the future as the department starts with new administrative leadership.

Title V Role: To meet the objectives in the Title V 5-year plan, FHSD program leadership roles are varied including:

• Provide or assure services that address system gaps or critical needs
• Convene stakeholders to address priority issues
• Fund staff, services, and activities
• Partner in collaboratives and coalitions
• Provide or broker technical assistance and workforce training
• Secure and share data to help inform planning and policy development including data on health disparities
• Promote innovative and evidence-based or -informed practices
• Support efforts to develop coordinated, comprehensive, and family-centered systems of care, especially for children and youth with special healthcare needs.