Within the structure of the Pennsylvania (PA) maternal and child health (MCH) system of care, the Bureau of Family Health (BFH) is uniquely positioned as the leader on MCH public health issues as the administrator of the Title V Maternal and Child Health Services Block Grant (MCHSBG). Full integration of evidence-based public health, driven by the transformation of the Title V MCHSBG, has made the BFH a leader within the PA Department of Health (DOH) on the use of evidence-based practices, data driven decision-making, continuous quality improvement, client and family engagement and satisfaction activities, workforce development, and integration of principles of health equity into public health programming. The BFH utilizes the Title V federal grant, other federal grants and state funding to support program activities. The BFH is comprised of the following four divisions:

• Division of Child and Adult Health Services (DCAHS)

The Division of Child and Adult Health Services (DCAHS) provides evidence-based programming to improve health outcomes and support women, mothers, infants and children, including children with special health care needs (CSHCN). The DCAHS implements strategies from the MCHSBG action plan to address maternal health before, during and after pregnancy, infant mortality, child safety and injury prevention, adolescent health and LBGTQ services. The DCAHS also manages federal grants which provide teen pregnancy prevention, lead hazard control services and support the prevention of childhood lead poisoning.

• Division of Community Systems Development and Outreach (CSDO)

The Division of Community Systems Development and Outreach (CSDO) works in partnership with family, caregivers and stakeholders to improve health outcomes for individuals and families through systems change. CSDO supports evidence-based programming for CSHCN, including the home visiting Community to Home program and the Specialty Care Program addressing spina bifida, cystic fibrosis, hemophilia, sickle cell, Cooley’s Anemia, epilepsy, and orthopedic and neurological conditions. CSDO works to support and build family-centered systems by partnering with organizations such as the Parent Education, Advocacy and Leadership Center as well as Federally Qualified Health Centers and community-based organizations. Families are linked to needed resources through CSDO’s Special Kids Network Helpline and CSDO houses the state’s Traumatic Brain Injury (TBI) programs, which include those for acquired brain injury, concussion awareness, return to learn, and TBIs related to opioid use/misuse. CSDO also houses an adolescent health program promoting positive relationship behavior among young men, and an innovative program using telehealth to diagnose young children with Autism Spectrum Disorder.

• Division of Newborn Screening and Genetics (NSG)

The Division of Newborn Screening and Genetics (NSG) is responsible for ensuring all infants born in Pennsylvania receive a dried blood spot screening, critical congenital heart defects screening and hearing screening. NSG staff provide follow-up services to ensure that each newborn receives the three newborn screens and any newborn with an abnormal screening result receives a referral for confirmatory testing and diagnosis. The Division also oversees grant agreements with metabolic, cystic fibrosis, hematology treatment centers and the metabolic formula program and is responsible for the Department’s breastfeeding education, awareness and support activities. In addition, the Division administers a neonatal abstinence program (NAS) which receives NAS case reports that will be submitted to the Opioid Command Center and will be used to implement a long-term follow-up program.

• Division of Bureau Operations (DBO)

The Division of Bureau Operations (DBO) provides support to BFH staff by managing the reporting requirements of the Title V MCHSBG and through leadership and technical support to the Bureau and grantees on client satisfaction, client engagement, cultural humility, health equity and staff/workforce development. DBO also supports several surveillance programs including Child Death Review, Sudden Unexpected Infant Death/Sudden Death in the Young Case Registry and the PA Pregnancy Risk Assessment Monitoring System (PA PRAMS). Other grant programs administered by DBO include the Technology Assisted Children’s Home Program (TACHP), Charcot-Marie-Tooth disease, Tourette Syndrome Support program, and State Systems Development Initiative (SSDI).

These four divisions work with over 45 partners in the form of grantees, advisory boards, Medicaid bureaus, advisory and advocacy groups to execute programming across the six MCH population domains. The BFH serves as convener and a point of contact for MCH issues across the state as the representative of the Title V MCHSBG work. While key internal DOH partners, such as the Bureau of Women, Infants and Children (WIC) and the Bureau of Health Promotion and Risk Reduction address niche health issues within the MCH population such as nutrition, obesity, physical activity, oral health and breast and cervical cancer screening, the BFH has the singular ability to address the public health issues facing the MCH population from a broad perspective across the life course. As such, the life-course theory is the guiding roadmap for the implementation of programs with the use of Title V, state and other federal funds. Understanding the key risk and protective factors that influence a person’s health across the lifespan enables the BFH to design, plan, and implement programming at multiple critical life stages simultaneously, thereby giving current and future generations the best chance at improved health.

Key to the application of life-course theory to MCH population health is an understanding of the services and systems that shape the health of the most vulnerable of the MCH population, particularly the role of Medicaid in the provision of direct service, especially for CSHCN. While the BFH does continue to support gap-filling direct services for vulnerable and uninsured populations, the BFH has been working toward shifting the role of Title V away from direct service provision to focus on the provision of enabling services and the maintenance and enhancement of public health services and systems through a combination of Title V, state and other federal funding streams. Integral to the BFH’s systems-level work is the implementation of the core public health functions of assessment, assurance and policy development. The BFH is committed to ongoing assessment of the health status of the MCH populations in PA in order to identify and address emerging issues. In addition to continually evaluating the efficacy of Title V programming the BFH is also working to assure a competent workforce that is capable of researching innovative, evidence-based strategies that may drive improvement in health outcomes. The BFH also plays a role in linking communities to needed information and resources so that they can drive change in policy and practice at the local level.

As such, while ensuring access to health insurance and high quality, appropriate, and culturally sensitive care remains an important facet of the work of Title V, the BFH is increasingly applying a lens of health equity to expand work to address the social determinants of health across the life-course which are linked to maternal and child health outcomes. The BFH has taken steps to implement evidence-based practices among populations at higher risk of adverse outcomes, such as those with low breastfeeding rates, high infant mortality rates, and among LGBTQ youth. In order to further those efforts and foster development of system-level strategies for each of the MCH population domains, the BFH’s focus on health equity was intentionally woven into each of the new priorities driving the 2021-2025 action plan. Additionally, a concerted effort is being made to increase workforce development around addressing health disparities and health equity to increase the BFH’s capacity to mitigate the impact of social, environmental, and economic determinants of health including the effects of discrimination and racism, sexism, classism, and heterosexism.