State Title V Purpose & Design

The Title V MCH & CSHCN Program is administered as one integrated program  within the Virgin Islands Department of Health.  This allows for better and more efficient coordination of services in MCH.  The program provides health care services for mothers, infants, children, youth and adolescents and their families. The program also provides and coordinates a system of preventive and primary health care services for this population.   These services include prenatal and high-risk prenatal care clinics, postpartum care, well child care, high risk infant and pediatric clinics, care coordination and access to pediatric sub-specialty care for children and adolescents with special health care needs.  Services are provided in accordance with SSA -Title V law related to children with special health care needs.

The MCH & CSHCN Program is guided by an advisory council, which is charged with the responsibility of advising the Administrative Unit of the MCH & CSHCN Program. The Advisory Council assists in developing goals and objectives, long range program planning, identifying service gaps, locating resources, and monitoring the quality of services provided. Members of the Council include representatives from: Family Planning, Departments of Education, Human Services and Justice, Infants and Toddlers, 330-funded health centers, parents and guardians of children with special health care needs, child care providers, hospitals and faith and community-based organizations. The MCH Director, and Assistant Director are ex-officio members. The Advisory Council was revitalized in 2018 in conjunction with the well-established Maternal, Infant, and Early Childhood home visiting Advisory Board. Council members are instrumental in review of program activities and provide valuable input.

Goals & Objectives:  MCH & CSHCN goals are: (a) to assure access to comprehensive coordinated, family-centered, culturally-competent primary and preventive health care services for all women and children, especially low income and vulnerable populations, in order to promote and improve pregnancy and birth  outcomes; (b) to improve the health of children and adolescents including those with special health care needs  through comprehensive, coordinated, family-centered, culturally-competent primary and preventive care; and (c) to provide a system that eliminates barriers and health disparities and strengthens the MCH infrastructure.

Direct Care: The program assures access to preventive and primary health services for infants, young children and adolescents, including allied health and other health related services.  Specialty clinics provide pediatric specialty services that are generally unavailable or inaccessible to low-income, uninsured or underinsured families.  While the aim of the Prenatal / Perinatal Program is to prevent maternal and infant deaths and other adverse perinatal outcomes by promoting preconceptual health, assuring early entry into prenatal care, and improving perinatal care. 

Enabling Services: Issues related to access to care are addressed through provision of comprehensive primary and preventive care for children and adolescents which include access to direct medical care; referrals to support programs and services; and strengthening of Title V collaborative partnerships.  The Title V program continues to function as the safety net for families with limited resources.  The program remains committed to providing clinical preventive care and case management services for pregnant women, infants and children in low income populations.

Population-based services: The MCH & CSHCN Program offers three population-based preventive services: immunization services; the newborn hearing and loss to follow-up through the Universal Newborn Screening and Intervention Program and genetic / metabolic screening program; and the newborn hearing screening program.  Home visiting services are also provided to at risk families through the Maternal, Infant, and Early Childhood home Visiting Program.

Infrastructure building services:  The program continued activities directed at assuring the availability of the infrastructure necessary to delivery of services to the maternal/child population and to increase access to quality health care for families who lack sufficient financial resources to meet the costs of medical care.  The State Supplemental Data Initiative grant is structured to drive improvements in data systems for collection, analysis, surveillance and reporting capacity are critical to providing accurate assessments to assure these needs are met and the target population is being served. 

Children with Special Health Care Needs

For children, ages 0-21, with disabilities and chronic conditions, the program provides preventative and primary care, therapeutic and rehabilitative services. The MCH & CSHCN program  offers a system of family-centered, coordinated, community-based, culturally competent care, assuring access to child health services including medical care, case management and home visiting, screening, referrals and assistance obtaining a medical home.  Services are provided either directly through Title V or by referral to other agencies and programs that have the capability to provide medical, social, and support services to this population.  

Public Health Nurses provide parental counseling and education regarding growth and developmental milestones, proper nutrition practices, immunizations; service / care coordination and home visiting services to high risk children and their families. Children with special health care needs have access to a source of care that provides evaluation and treatment sources; early developmental and hearing screening; early intervention services; care coordination and family support services, and access to clinical and laboratory services.

In the past few years, program activities addressed improvement of access to services low-income, underserved or uninsured families, identification of the needs of culturally diverse groups, especially non-English speaking and other immigrant groups, and recognition of changes brought about by lack of access to adequate health insurance coverage, public or private, for a significant percentage of the population. In addition, activities for children and youth with special health care needs focused on assuring pediatric specialty and sub-specialty services to children and families, integrating data systems, continuing collaborations with private and public partnerships, and integrating community based services.

Through a series of outreach activities, the MCH & CSHCN Unit identifies children who have health problems requiring intervention, are diagnosed with disabling, or chronic medical conditions, or are at risk. A system of public health nursing, based on specified health districts, is an integral component of providing family-centered, community health services. Sources of child-find include referrals from the Queen Louise Home for Children, Early Childhood Education, Head Start, and Private Providers. Pediatricians, Nurses, Social Workers, a Physical Therapist Assistant, an Occupational Therapist, Audiologists, and Speech Pathologist are the major providers of direct services. The Infants and Toddlers Program employs Service Coordinators on each island.

Hospital newborns with biological, established, or environmental risks are referred to the Infant or Pediatric High Risk clinics based on established criteria. At one year of age, infants are re-assessed and transition to the Well Child Clinic or the Pediatric High Risk Clinic. The Infant and Pediatric High Risk Clinics offer comprehensive, coordinated, family-centered services. Screening is done for developmental delays using the ASQ Developmental Screening Tool. Social Workers complete an assessment of the family and home environment, existing support structures, and financial status. A diagnostic assessment and therapeutic plan is developed by the clinical staff. Through an appointment system, children with special health care needs are referred to the sub-specialty clinics by the primary care physician.

MCH & CSHCN Services

MCH & CSHCN remains committed to building an effective system of care through the continuance of improved access to Direct Health Services. This occurs at multiple levels of performance such as extending hours and increasing number of service delivery sites in both health service districts; extend hours for prenatal clinics to accommodate working mothers, particularly in the private sector; increase services to adolescents in all areas of primary and preventive care appropriate for this age group; and, continue to provide primary and preventive care services to mothers.

Both Enabling Services and Population Based Services require systematic, concurrent enhancement of the department’s visibility and conceptual position of local citizens.  Therefore, comprehensive awareness campaigns are being instituted for all Department of Health providers, collaborative government agencies, and community based organizations on the concept of the “medical home” for clients, within MCH.  Existing collaborative relationships, e.g., the Federally Qualified Health Centers and the VI Partners for Healthy Communities assist to increase services to infants, pregnant mothers, mothers and children in both districts. Reaching our populace with the requisite services is a collaborative effort with programs such as Immunization Program who through their mandate welcome improved immunization of all children against vaccine preventable diseases.  In addition, linkages with agencies providing services to adolescents are an ongoing activity, e.g., administering comprehensive health behavior survey as many are cooperative and committed to improved health habits for the adolescent population.

Personnel shortages continue to hinder the capacity of MCH to provide optimal care on both islands – particularly in St. Croix.  Recruitment is underway for a Pediatrician, Pediatric Nurse Practioner, a Speech Pathologist, Registered Nurses, and Certified Medical Assistants to support our clinical care.

The lack of Pediatric Specialists on island to provide the services needed for children with special health care needs limits the availability of specialty care and remains a challenge, we continue to have discussions with National organizations to facilitate bringing in specialists, as well as exploring the option of telemedicine for MCH. Quarterly pediatric neurology visits resume in 2018 for both districts.  MCH continues to partner with the local schools, Head Start and Early Head Start to ensure a coordinated system of care for families in need of services.