Virginia’s Title V Purpose and Design

Virginia’s Title V Program provides collaborative public health leadership that supports and strengthens systems for the health and well-being of Virginia’s children, families, and communities.  Virginia’s Title V organizes and sustains a portfolio of programs aligned with the findings from the MCH five-year needs assessment.  Title V contextualizes and convenes a shared vision around the MCH priorities, ensuring that national and state performance measures are widely known and accepted as performance indicators for all MCH programming within the state, regardless of the source of funding. Title V serves as hub, bridging and synthesizing relationships for common purpose.

THE OFFICE OF FAMILY HEALTH SERVICES (OFHS) houses four divisions, all of which partner closely to ensure successful implementation and oversight of Title V-funded programs.

The Division of Child and Family Health (DCFH) houses both the Title V and CYSHCN directors who serve as the state level administrators of the Title V MCH Block Grant, ensuring that the responsibilities set forth by HRSA’s Maternal and Child Health Bureau are met.  The Reproductive Health Unit includes programs dedicated to Title V populations and priorities, including the Title X Family Planning Program, the Contraceptive Access Network, the Virginia Contraceptive Access Initiative, the Adolescent Health Program, Resource Mothers, the Doula Certification Program and Task Force, and the Pregnancy Loss Services Initiative.  DCFH has a robust Newborn screening and followup program, which includes birth defects surveillance, CMV follow-up, and Early Hearting Detection & Intervention (EHDI) programs. The Maternal Infant Health Consultant focuses on maternal mental health and substance use/abuse, and partners with statewide stakeholders to address the maternal and infant morbidity and mortality.  MIECHV, Healthy Start, the Early Childhood Comprehensive Systems (ECCS) grant, Virginia Mental Health Access Program for children (VMAP) comprise the infant health program as School Health are also in DCFH. 

The Division of Population Health Data (DPHD) provides deliberative epidemiological support across all DCFH Title V-funded programs.  The MCH Epidemiology team supports the MCH Block Grant, SSDI Grant, Title X/Family Planning, Oral Health Workforce, Newborn Screening, Sickle Cell programs, and CYSHCN.   PRAMS, YRBS, and BRFSS are also housed in DHPD, as well as Overdose Data to Action, Rape Prevention and Education, Firearm Injury Surveillance, Chronic Disease and Tobacco surveillance, all of which influence Title V programmatic planning and implementation.

The Division of Prevention and Health Promotion houses the Injury Prevention Team, which supports Title V efforts regarding safe sleep, child safety, and suicide and violence prevention. Additionally, the Oral Health team supports statewide efforts to increase dental visits for pregnant women, and children and adolescents, including CYSHCN. 

The Division of Community Nutrition, the home for Virginia’s WIC program, partners at the local level where local health districts implement Title V programs in collaboration with their WIC programs.  Additionally, the Statewide Breastfeeding Coordinator is located in this division, and is a key collaborator with Title V.

Virginia’s Title V Family Delegate is the Director of the Center for Family Involvement and Associate Director of Partnership for People with Disabilities, which is located in Virginia Commonwealth University. This critical partnership ensures strong connectivity for Virginia’s CYSHCN program as well as shapes and informs Title V’s programmatic family centeredness.

Virginia’s 35 Local Health Districts (LHDs) engage in MCH activities – providing services through home visiting programs, prenatal care, family planning services, WIC, and immunization clinics.  The LHDs provide the true synergistic interaction between Title V administration and the community.

Together, these programs, partnered with key internal, external, community, state, and federal stakeholders, implement Virginia’s Title V program, ensuring programmatic success across all six domains.  Core programs identified for the current five-year cycle are:

Virginia’s Framework for Improving Outcomes for MCH Populations

Virginia’s Title V Program acknowledges that although the state is often at or above the national average for key measures of maternal and child health, there are profound and avoidable health disparities and inequities across the state’s MCH population.  The qualitative and quantitative approach to the 2020 Needs Assessment determined the directional focus for the next five years, identifying ten broadly defined priority needs that are visible in all six MCH domains.  Approaching these ten priority needs individually and collectively across domains reflects a true commitment to Virginia’s women, mothers, infants, children, youth, and CYSHCN populations.  This approach provides stronger collaboration across VDH Office of Family Health Services, and 35 local health districts governed under the Office of Community Health Services (CHS), recognizing that the life-course perspective approach is not completely linear in nature, and the populations served by Title V should be approached through coordinated, comprehensive systems.

Virginia’s Title V Program incorporates the following principles into efforts to improve systems for Virginia’s women, children and families:

• Trauma-informed:  Understanding the significant role that trauma plays in the lives of the MCH population, while also acknowledging community resiliency and capacity.
• Social ecological model: Considering the complex interplay between individual, relationship, community, and societal factors.
• Data-driven:  Making strategic decisions based on data analysis and interpretation, acknowledging that within certain spaces where no data exists, community or individual knowledge or experience bears considerable weight.
• Evidence-based and informed practices: Using the best evidence possible to shape practices or programs.
• Family and community driven: Building not only on the strengths of the child and the family, but also on the strengths of the community in which the family resides.

Virginia’s strategy for ensuring Title V Maternal and Child Health Block Grant funding is utilized with intention, effectiveness and efficiency includes:

• Data-informed program planning & implementation:  Needs assessments conducted with both qualitative and quantitative methodology remain the driver for priority and gap identification and work plan development.  Virginia’s robust MCH epidemiology team drives, guides and supports all programmatic efforts through their ability to analyze data and identify trends, build and guide programmatic efforts through evaluation, and partner and exchange data as needed.
• Partnership-based, collaborative approach:  Title V partners with organizations that work directly with communities at the community, local and state levels.  These agencies, which includes the local health districts, are well positioned within the communities they serve, providing MCH services across all the population domains.
• Advancing core commitments to family/community partnerships and racial equity:  Through both evidence-based and community-developed practices, Virginia’s Title V program demonstrates its value and commitment to all populations, especially those who have been historically marginalized.  The Title V Program seeks to understand the lived experiences of those we seek to serve, understand the rich landscape of their health priorities and challenges, and ground our decisions and resource allocations in evidence.  By hearing, recognizing, and implementing those voices, Title V Program further shores up the commitment to the health and wellbeing that each Virginian deserves.