Section III.E.2.a. State Title V Program Purpose and Design

“Empower People, Improve Lives, and Inspire Success” – these six words are the shared purpose of the approximately 2,319 employees of the North Dakota Department of Health and Human Services (NDDHHS). Effective September 1, 2022, the North Dakota Department of Health (NDDoH) and the North Dakota Department of Human Services integrated into the North Dakota Department of Health and Human Services (NDDHHS) which has enhanced partnerships between agency programs that serve similar populations. The programmatic divisions of the NDDHHS include the Divisions of Public Health (previously known as NDDoH), Medical Services (ND Medicaid), Behavioral Health, and Human Services.

As of June 2023, the Public Health Division of NDDHHS employs 345 people, with 206 full-time equivalents (FTEs) and 139 non-permanent employees. The Public Health Division includes five Sections: 1) Disease Control and Forensic Pathology, 2) Healthy and Safe Communities (which includes the Title V Program), 3) Health Response and Licensure, 4) Laboratory Services, and 5) Health Statistics and Performance.

The current vision of the NDDHHS is to make North Dakota the healthiest state in the nation, and it has identified the following goals: 1) Deliver one streamlined path to quality, equitable programs and services; 2) Continue to improve quality, effective, and efficient health and human services; and 3) Create career growth and development opportunity for team members and build a one-team culture. NDDHHS team members work to help North Dakotans of all ages enhance their well-being and quality of life by supporting equitable access to the social determinants of health, which include economic stability, housing, education, food, community, and health care. NDDHHS promotes the state’s emergency readiness and response preparedness, achieves strategic outcomes using all available resources, strengthens stakeholder engagement and collaboration and manages emerging public health challenges.

The Public Health Division’s mission is to improve the length and quality of life for all North Dakotans. To accomplish this mission, six goals, including two cross-cutting principles, help guide the work. The two cross-cutting principles are to Improve Health Equity and Use Evidence-based Practices to Make Data-Driven Decision. The Public Health Division aligns each of the cross-cutting principles to these four goals:

• Create Health and Vibrant Communities
• Enhance and Improve Systems of Care
• Strengthen Population-Based Health Interventions
• Promote Public Health Readiness & Response

The Healthy and Safe Communities Section is responsible for administering the state’s Title V program. There are four units in the Section, which all have programs and/or funding that link to maternal and child health (MCH) priorities; Health Promotion and Chronic Disease Prevention, Family Health and Wellness, Community Engagement and Special Health Services (SHS). Title V also provides a portion of funding to the vital services of information technology, contract and grant management, and epidemiological support that assist MCH staff with critical job functions. Refer to Section III.D.2. Budget and Section VI. Organizational Chart.

The Title V Director serves as the Unit Director for Special Health Services and serves as a member of the Healthy and Safe Communities Section Leadership Team; thereby, increasing leadership and visibility for MCH within the section.  

The Health Statistics and Performance (HSP) Section (formerly titled the Office of the State Epidemiologist) has also undergone restructuring, resulting in three units:

1) Special Projects and Health Analytics, 2) Surveillance and Data Management and

3) Vital Records. The MCH epidemiologist, State Systems Development Initiative (SSDI) Coordinator, Tobacco/Chronic Disease Epidemiologist, Autism Epidemiologist and the Pregnancy Risk Assessment Monitoring System (PRAMS) and Behavioral Risk Factor Surveillance Systems (BRFSS) program directors/epidemiologists are located within the HSP Section. The HSP Section provides epidemiological expertise, oversight, and enhanced data support not only to MCH programs, but to the NDDHHS and external partners. Refer to Section III.E.2.b.iii. MCH Epidemiology Workforce.   

Title V programs and priority areas set their own goals (refer to Section III.E. Five-Year State Action Plans). The overarching Title V goals were established as a result of the 2021-2025 comprehensive Five-Year Needs Assessment. The Title V Leadership Team (Title V Director, Children with Special Health Care Needs (CSHCN) Director, Family Health and Wellness Unit Director, MCH Epidemiologist and the State Systems Development Initiative (SSDI) Grant Coordinator) ensure these goals are being met. In addition to the Five-Year Needs Assessment, the 10-step conceptual framework continues to be followed for the ongoing needs assessment process.

Prevent Child Abuse North Dakota (PCAND) administers the state’s Maternal, Infant, and Early Child Home Visiting (MIECHV) Program. A partnership between PCAND and the former NDDoH was used to complete the 2020 MCH needs assessment process. PCAND and the NDDoH hosted several information-gathering partnership meetings, Work-As-One: Needs Assessment Integration, between November 2018 and December 2019. These meetings were held to learn what other agencies/programs are doing around needs assessments and explore collaborating and streamlining needs assessment processes. After having discussions with other states, North Dakota determined that the State Health Improvement Plan (SHIP) and State Health Assessment (SHA) would also be integrated into the process. In January 2020 meeting attendees were tasked with assisting in the prioritization process by providing feedback for each specific data area. The input from partners that was obtained helped the Title V Leadership Team to establish the North Dakota Title V MCH priorities that are in place today.

Title V success would not be possible without a well-functioning team and statewide partnerships. Serving as either a convener, collaborator, or partner is essential in addressing MCH issues. Key partners within each population domain were convened in June 2020 to develop the new five-year action plans and identify strategies, activities, and opportunities to braid and layer resources throughout North Dakota. Existing and new partners are convened annually to build upon existing activities and to create annual activities. Internally, the Title V Director also facilitates Title V team meetings every other month to review and discuss progress, successes and challenges relating to the five-year state action plans, collaboration and integration opportunities, and emerging issues. Title V staff, along with partners, work collaboratively to move forward and implement the strategies and activities within the action plans. All program strategies are required to utilize innovative and evidence-based or evidence-informed approaches and incorporate the core public health functions of assessment, quality improvement/assurance and policy development, especially around the areas of health equity and social determinants of health.   

North Dakota is committed to building, sustaining, and expanding partnerships that contribute to, or expand, the state Title V and CSHCN programs' capacity and reach. Title V staff actively participate and provide leadership roles on a variety of committees/coalitions that impact the MCH population. These collaborative partners help identify common strategies to address priority needs identified through the ongoing needs assessment process within each of the six population health domains and strengthen Title V efforts to promote and protect the MCH population's health. Specific partnerships are discussed in Section III.E.2.c. State Action Plan Narrative by Domain.

One of five strategic initiatives of North Dakota Governor Doug Burgum, the Main Street Initiative (MSI), gives local leaders a direct access point to a variety of resources, helping capitalize on strengths and make sound planning decisions. This initiative aims to help create vibrant cities poised to attract and retain a 21st Century Workforce, helping North Dakota compete and succeed in a global economy. The MSI focuses on three pillars of economic success: 1) A skilled workforce; 2) Smart, efficient infrastructure; and 3) Healthy, vibrant communities: https://www.nd.gov/living-nd/main-street-nd.

Governor Doug Burgum appointed Dr. Nizar Wehbi to serve as North Dakota’s State Health Officer, effective May 1, 2021. In this role, Dr Wehbi serves as a member of the Governor’s Cabinet, leads tribal health and external stakeholder engagement, serves as the health liaison to the state legislature, advises on other HHS focus areas including community engagement, health care workforce development, and emergency preparedness and response, and develops wellness strategies for North Dakota.

State MCH support for communities is addressed through contracts with local public health units, nonprofits, tribal entities, schools, and universities. In addition, CSHCN support for communities is addressed through collaborative partnerships and contracts with health systems, universities, and nonprofits that support multidisciplinary clinics, family support services, and CSHCN systems development initiatives.

The North Dakota Children's Health Insurance Program (CHIP) falls under the North Dakota Medicaid program in the Medical Services Division within NDDHHS. The state CSHCN program has close ties with the Medical Services Division and participates in scheduled meetings to discuss policy, claims payment, and North Dakota Medicaid Management Information System (MMIS) issues or updates.

North Dakota is a 209(b) state, which means Supplemental Security Income (SSI) beneficiaries under 16 years of age are not automatically eligible for North Dakota Medicaid. If assets are an issue affecting North Dakota Medicaid eligibility, children eligible for SSI can be covered under the children and family coverage groups where asset testing is not required. The state CSHCN program pays for or provides rehabilitative services for eligible children served by Title V, to the extent services are not provided by North Dakota Medicaid.

State CSHCN program staff conduct outreach, information and referral activities targeted to the SSI population. On a monthly basis, Disability Determination Services (DDS) provides referrals electronically to the state CSHCN program. In response, state CSHCN staff provide a direct mailing to families notifying them about potential programs that could be of assistance. This assures that children are consistently being referred to the Title V program and that families receive information about program benefits and needed services.

The North Dakota CSHCN program utilizes AMCHP’s National Consensus Standards for Systems of Care for Children and Youth with Special Health Care Needs as a framework for supporting coordinated, comprehensive, and family-centered systems of services at state and local levels. The SHS Director serves as the NDDHHS representative on the State Council on Developmental Disabilities and the Interagency Coordinating Council, focusing on systems that support individuals with disabilities and their families.

Annually, the state CSHCN program convenes a meeting between DDS, the local Social Security Administration office, North Dakota Medicaid, and key family organizations in the state to assure communication about any new developments that have occurred or that are expected during the year that might affect SSI eligible children. Procedures are in place between DDS and SHS to assure SSI recipients and cessations receive information about program benefits or services. DDS is located in the Human Services Division of NDDHHS.

The state CSHCN program and several of the state’s universities have developed a mutually beneficial relationship to support multidisciplinary clinic services for CSHCN. SHS multidisciplinary clinics are often used as a source of pre-service training experiences for various health disciplines. A collaborative relationship exists with the University of North Dakota (UND) Communication Disorders Department for administrative support of cleft clinics in the state's northeast region. In addition, a contract is in place with the Anne Carlson Center to support autism diagnostic clinics that are held throughout North Dakota.

A copy of the current cooperative agreement to ensure care and improve health status is in place between North Dakota Title V and North Dakota Medicaid. The most recent agreement was finalized in July 2020 and is included in Section IV. Title V - Medicaid IAA/MOU.