III.E Five-year State Action Plan

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

Overview of Oregon’s Title V Program Purpose and Design

Oregon’s Title V program relies on shared leadership between the Oregon Health Authority (OHA) Public Health Division’s Maternal and Child Section, its Adolescent and School Health program, and the Oregon Center for Children and Youth with Special Health Needs at Oregon Health and Science University. A leadership team consisting of the Title V MCH Director (Cate Wilcox), Title V CYSHCN Director (Ben Hoffman), Title V Adolescent Health Director (Rosalyn Liu), Title V CYSHCN Assessment and Evaluation Manager (Alison Martin), Title V Coordinator (Nurit Fischler) and the MCH Assessment and Evaluation Manager (John Putz) meet twice monthly to address Title V program and policy issues and ensure alignment across the agencies.

OHA MCAH Program Purpose and Design

Partnership and leadership roles

Within the MCAH Title V program, each Title V priority has a designated state lead who oversees state level program and policy work and provides technical assistance and oversight to the local level Title V grantees (public health and tribal) working on that priority (see Supporting Document #5). MCAH Title V also has a designated tribal liaison who supports/oversees the work of the tribal Title V grantees. The state priority leads from MCH, Adolescent Health, and OCCYSHN, Title V coordinator, Title V research analyst and Title V tribal liaison meet monthly to coordinate work across populations and domains.  The Title V coordinator also serves as the MCH Policy Lead, ensuring that system and policy work for Title V and other MCH programs (MIECHV, Early Hearing Detection and Intervention, Oral Health, etc.) are coordinated and integrated.

The Title V leadership team and priority leads participate in external and internal work teams and committees to provide MCAH leadership and ensure that Title V work is represented by appropriate subject matter experts and integrated into related work within the agency, across state agencies, and with external partners. Key policy and system development initiatives which Title V MCAH staff either convene or contribute to include the: Governor’s Children’s Cabinet, Health Aspects of Kindergarten Readiness metrics work group, Reach Out & Read Advisory Committee, Act Early Advisory Committee, Childhood Obesity CoIIN, Raise UP Oregon Agency Implementation Coordination Team, Braided CCO Equity funding team, OHA Health Disparities Advisory Committee, CCO Metrics and Scoring Committee, Oregon Pediatric Improvement Project, March of Dimes Perinatal Collaborative, State Health Improvement Plan committees (adversity and trauma, institutional bias, economic drivers of health and behavioral health), Trauma Informed Oregon Advisory Board, OHA Trauma Informed Policy Committee, Regional Kindergarten Readiness Network, Preschool Development Grant Needs Assessment Coordinating Committee, Oregon Safe Kids, Shared Risk and Protective Factors Work Group, Child Maltreatment Prevention Interagency Agreement group; Maternal Mortality Review Committee, State Child Fatality Review Team, and Domestic Violence Fatality Review Team.  Adolescent Health staff provide expertise and leadership to: Confederation of Oregon School Administrators Workgroup on Social Determinants of Health, Oregon Department of Education Safe and Effective Schools Working Group, Student Health Systems Division and Oregon School Activities Association workgroup on student athletes, Oregon Pediatric Improvement Project, and the Healthy Kids Learn Better Coalition.

Program Framework and Strategic Approach

The MCH Section strategic plan, and the Adolescent & School Health strategic plan (Supporting Document #4), as well as the OHA Performance Management System, PHD strategic plan and PH Modernization provide a framework for how the Title V program addresses MCAH priorities in Oregon. 

The Mission of the MCH Section is to foster the foundations of lifelong health: safe and responsive environments; resilient and connected families and communities; and nutrition and healthy development.  The lenses that the section uses in all its work include life course science, health equity, social determinants, trauma and resilience, and multi-generational impact. The work is focused in four key areas: policy and systems; workforce capacity and effectiveness; assessment, surveillance and epidemiology; and community & family capacity. Each area has a goal and several strategic priorities (see graphic below and Supporting Document #4 for complete plan), and Title V’s work is integrated across all of these. The graphic below illustrates this framework.

The MCAH Title V program has adopted a new framework for the 2021-2025 grant cycle, illustrated in the graphic below. This framework reflects the findings of our 2020 Needs Assessment, and the Title V program’s commitment to ensure that MCAH Title V work is focused upstream, using the lenses of racial equity, social determinants, and trauma/toxic stress – as well as the multi-generation and life course approaches outlined in the graphic above. The framework below illustrates how the MCAH Title V program is addressing our three state level Title priorities - social determinants of health and equity; trauma, toxic stress, ACEs and resilience; and culturally and linguistically responsive services (CLAS) – jointly as the foundations of maternal, child and adolescent health. This framework recognizes that work on all 3 of these topics is integrally inter-connected. It also reflects the understanding that work on our 4 national priorities (well-woman care, breastfeeding, child injury prevention, and bullying prevention) must also integrate a focus on Foundations of MCAH work. The framework (see below), and the related set of strategies and activities (see supporting document 5) organize the Title V priority work into four core public health functional areas: policy and systems; workforce capacity and effectiveness; individual, family and community capacity; and assessment and evaluation. The goals of each of these areas are as follows:

• Policy and Systems: Policy, systems, resources and funding address upstream drivers of maternal, child and adolescent health, foundations of lifelong health, and family protective factors.

• Workforce Capacity & Effectiveness: Support a cross-sector workforce that serves women, children, youth and families, and delivers and links to culturally and linguistically responsive and trauma informed maternal and child health services.

• Community, Individual & Family Capacity: Communities, individuals and families have access to resources, services and built environments that promote family health, safety, protective factors, resilience, and equity.

• Assessment & Evaluation: Data on social determinants of health, trauma, and equity are monitored and shared to inform and drive policy and program decisions.

Note: Recognizing the inter-connected nature of the upstream cross-cutting/systems work, MCAH strategies and activities for our 3 state priorities will be merged under “Foundations of MCAH” and organized into the 4 key Foundations areas outlined above in the State Action Plan Narrative (Sections III.E.2.c).

Organizationally, Title V’s Adolescent Health work sits within the Adolescent & School Health Unit, with a mission of supporting the health of all youth in Oregon through evidence-based and data driven policies, practices, and programs. The Unit’s work is comprised of four program areas: policy and assessment; school-based health centers, school nursing, and youth sexual health.

Oregon’s state and local public health structure has been going through re-structuring and transformation for several years as part of Public Health Modernization. The goal of public health modernization is to ensure equitable capacity and focus on core public health functions across the state. The Title V program is working closely with Public Health Modernization, providing leadership for the MCAH community’s participation in this effort. Given the situation with the Title V pandemic over the past year, and the resulting stresses on local public health capacity, the need for equitable and consistent public health core functions is more apparent than ever. Public Health Modernization legislation passed in June 2019 allocating $25 million to enhance state and local public health modernization efforts. Legislation to allocate an additional $45 million in public health modernization funding was approved in the 2021 Legislative Session. Title V strategies and activities are built around the foundational public health capabilities and support this transformation in practice.

OCCYSHN Program Purpose and Design

OCCYSHN’s mission is to improve the health and well-being of Oregon’s children and youth with special health care needs (CYSHCN). Our vision is that all Oregon CYSHCN are supported by a system of care that is family centered, community-based, coordinated, accessible, comprehensive, continuous, and culturally sensitive and responsive. We pursue this vision within the context of Oregon’s health care transformation, and the Title V Block Grant purpose and requirements. We are located within the Institute for Development and Disability at Oregon Health & Science University (Oregon’s only academic medical center), which allows for fruitful collaboration with influential health care providers, researchers, and change-makers.

We strive to ensure that Oregon CYSHCN receives well-coordinated care in patient-centered medical homes, and that CYSCHN have an effective transition from pediatric to adult health care. Our cross-cutting state priority areas focus on health equity for CYSHCN by improving access to culturally and linguistically appropriate services, addressing the impacts of social determinants of health and equity on CYSHCN, and promoting trauma-informed care.

OCCYSHN staff are Oregon’s subject matter experts on issues affecting CYSHCN. We inform health care policy, administration, and practice with our data and evaluation expertise, our long-term experience with community-based care coordination, our relationships with health care providers and families of CYSCHN statewide, and our knowledge about Oregon’s health care systems.

OCCYSHN brings a systems-based perspective to pursuing our priorities. We view health care systems, and the context in which they operate, as the primary locus of intervention to influence the infrastructure serving CYSCHN and their families. Our leadership role in improving systems of care for CYSHCN requires effective partnerships with the people, programs and institutions that make up those systems. (See Critical Partnerships lists for NPMs 11 and 12.) OCCYSHN convenes and participates in cross-systems, interagency collaborations on behalf of CYSCHN to strengthen systems of care. We are committed to integrating family members of CYSHCN into all efforts to improve the systems that serve them.

OCCYSHN’s work is organized into three primary units: Family Involvement; Systems and Workforce Development; and Assessment and Evaluation. The Family Involvement Program ensures that family members of CYSHCN are supported, that their voices are heard, and that they have an active role in designing and implementing policies and programs that affect them. The Systems and Workforce Development unit partners with local public health authorities around the state on programs and projects aimed at coordinating care for CYSHCN and improving local systems of care. The Assessment and Evaluation unit conducts surveillance, needs assessment, and program evaluation research for OCCYSHN. Our programs and projects (see list below, with links for more information) combine the expertise of our work units to address our priorities and advance policy goals.

OCCYSHN’s strategies to address national and state priorities were developed using 2015 and 2020 needs assessment results, reported experience of stakeholders about systems serving CYSHCN, and evidence-based/informed resources such as the Standards for Systems of Care for CYSHCN (AMCHP & NASHP, 2017; NASHP, 2020). We integrate learnings from technical assistance into our work, and we bring over thirty years of experience working with community and state partners to improve systems of care for Oregon CYSHCN.

OCCYSHN embraces innovative approaches to advancing our priorities. We use on-line platforms to build learning communities, engage family members of CYSHCN in care coordination, and share information between families, first responders, and emergency departments in emergency situations. We are exploring the intersection of legal issues and health care systems as they impact CYSHCN. We conducted some of the first studies in the nation on the health care experiences of CYSHCN from families of color. As we implement our block grant strategies, we will continue to fine-tune our efforts and explore new approaches to improving Oregon’s health systems infrastructure to improve the health and well-being of CYSHCN and their families.

OCCYSHN Programs and Projects

• Advocacy: OCCSYHN participates on committees, workgroups, and collaborations that impact CYSHCN. We also provide data and expertise to inform administrators and policymakers.
• Assessment and Evaluation collects, analyzes, and disseminates data about issues and interventions for Oregon's CYSHCN.
• CaCoon is a home-visiting public health nursing program. Nurses across the state work with families to coordinate care for CYSHCN.
• Community-Based Autism ID Teams use local medical-educational teams to establish a single, valid, and timely evaluation for autism spectrum disorders. Teams determine both educational eligibility for autism services and a medical diagnosis for children up to age five, and refer families to appropriate services.
• Community Health Worker Project: OCCYSHN developed an online course for community health workers.  The training addresses the particular needs of CYSHCN and their families. Community health workers often provide culturally and linguistically congruent services, thereby advancing health equity.
• Family Involvement is a partnership between families and professionals. The Family Involvement Program empowers families of CYSHCN, and increases opportunities for those families to inform health care practice and policy.
• HERO Kids Registry (launching 2022) will be a voluntary, no-cost registry where families can provide vital information about their child, which will be made available to emergency responders and emergency departments.
• Learning Communities use video conferencing technology to discuss practice situations involving caring for CYSHCN. Participants teach and learn from each other about coordinating care for CYSHCN, and strengthen local systems of care.
• Policy Project: This collaboration between OCCYSHN and the Oregon Law Center improves systems of care by addressing legal challenges faced by families of CYSHCN.
• Medical Complexity Project: The MCHB-funded Children with Medical Complexity Collaborative Improvement and Innovation Network (CMC CoIIN) improves the quality of life for children with medical complexity, the wellbeing of their families, and the cost-effectiveness of their care, through innovative care and payment models.
• Shared Care Planning is a process for coordinating care across health, education, and community service systems. OCCYSHN contracts with partners around Oregon to implement shared care planning for CYSHCN in their communities.
• Zetosch Funds come to OCCYSHN from the Oregon Community Foundation. Funds are designated for purchasing educational equipment for Oregon CYSCHN in low-income families. Implementation requires that OCCYSHN collaborate with health, education, and service providers statewide.