Title V program leadership role in addressing MCH issues

Maine’s Title V Program is located in the Maine Center for Disease Control and Prevention (Maine CDC), an office of the Maine Department of Health and Human Services. The Maine Title V Program aims to promote and improve the health and well-being of the maternal and child health population.

The Title V Program has several methods for establishing working relationships and/or partnerships with other entities. We convene planning groups and engage key stakeholders who provide services and develop policies for shared populations.

Examples of Maine’s Title V collaborative partnerships include: implementing the Maine Maternal, Fetal, and Infant Mortality Review Panel (MFIMR); participating in the Child Death and Serious Injury Review Panel; working with the Office of MaineCare Services (OMS) to improve care coordination services to children with special health care needs who are receiving services from multiple agencies within the Maine DHHS; and promoting interagency training. In addition, Title V works closely with the Women, Infant and Children (WIC) Program as well as the Tobacco and Substance Use Prevention and Control Program. External to Maine CDC Title V is enhancing a relationship with the Department of Education specific to a Preschool Development Grant and connected with the State of Kentucky to learn about and seek approval to use their safe sleep resources.

The Title V Program works closely with the Public Health Nursing (PHN) and Maine Families Home Visiting Programs. The Children with Special Health Needs (CSHN) Program collaborates with PHNs to provide consultation and education to families of an infant diagnosed with a cleft lip and/or palate. PHNs meet with the families to ensure they feel supported and understand their options. PHN also participates in the MFIMR Panel and the Domain Lead and Partners meetings.

An example of how partnerships are leveraging funding to deliver MCH services is the Center for Medicaid Services Medicaid Innovation Accelerator Program for the Maternal and Infant Health Initiative. This project links maternal and child health to value based purchasing. Maine’s project is to incentivize providers caring for pregnant women with substance abuse disorders to use the SnuggleME Guidelines (http://www.maine.gov/dhhs/SnuggleME/) to screen and refer them to treatment. The Title V program and state Medicaid provider, MaineCare, are required to partner on the project.

Other statewide partnerships include working with the Developmental Disabilities Counsel of Maine, Maine Quality Counts,Maine Medical Center (provides training for perinatal providers), Maine Parent Federation (provides supports to families on navigating the system of services), Maine Family Planning, the University of Southern Maine (provides epidemiology support to MCH programs) and the Maine Education Center for the Deaf & Hard of Hearing (provides services to families with hearing impairments).

Title V program approach to addressing MCH priorities

As part of the needs assessment process, Maine’s Title V Program collaborated with multiple stakeholders and partners to develop evidence-based action plans to address each national and state performance measure. These action plans are the framework that guides the annual work of each population domain.

Domain leads review action plans with stakeholders involved in carrying out activities quarterly and report progress toward meeting outcomes. Regular monitoring of progress allows for minor adjustments to ensure success. Annually, we convene meetings with stakeholders and partners to review and revise action plans based on prior year progress.

The Maine Title V program had a number of successes in making progress on its priorities. For example, a recent MaineCare rule change unbundled long acting reversible contraceptive (LARC) reimbursement from the labor and delivery fee. This change allowed providers to offer LARCs to new mothers before hospital discharge. We know LARCS are more accessible to post-partum women, however, we have not seen a statistically significant change in the number of women getting LARCS. We will continue to promote the voluntary use of them in an effort to make positive progress towards decreasing the number of unplanned or unwanted pregnancies.

An ongoing challenge for the Maine Title V Program is staff turnover. There are numerous vacancies across Title V funded programs. Many of these vacancies are within Public Health Nursing and 1.5 FTEs are within the Children with Special Health Needs Program. We are pleased to report that we received approval to fill many positions and programs are in the process of initiating searches.

As with many other states in the country, the number of substance-exposed infants (SEI) in Maine is a challenge and we are working on creating strategies to address this issue. An initial strategy is the creation of an SEI Surveillance workgroup. The initial focus of the workgroup is to create shared definitions allowing for data collection in a standardized manner and analyzed regularly to guide intervention and prevention efforts. The second form of engagement is through the SEI State Steering Committee and Community Level Task Forces. The purpose of these groups is to discuss prevention efforts to reduce substance use during pregnancy and create tools and resources for community providers. This group is made up of prevention staff from several Maine DHHS offices and outside providers such as prenatal and labor and delivery.

Title V support of family-centered systems of care

The Title V Program supports coordinated and family-centered services in a number of ways. All advisory boards have family members and consumers of services provided. Families/consumers are valued members assisting programs in the design and review of materials for families, medical professionals and others.

The involvement and satisfaction of families in the care of their CSHN is essential to ensuring consistent and quality care. Ensuring that families are partners in decision-making at all levels including the healthcare team and supporting parent leaders to be actively involved in policy development results in improved outcomes for children and the system of care. Families continue to be contributing members across many of the programs housed in the CSHN Program. There is family representation on the Maine Newborn Hearing Advisory Board, the Birth Defects Advisory Board and the Joint Advisory Board for Bloodspot Screening. The CSHN Director participates on the Developmental Disabilities Council. The Council includes individuals with developmental disabilities as well as family members.

The Maine Parent Federation and the Maine Autism Society have an important role on both the Statewide Act Early Autism Team and the State Agency Interdepartmental Early Learning Developmental Integration Systems Team. These teams work to improve health care quality for children ages birth to three through the expansion of developmental screening, public policy coordination, and family and community involvement.

Recognizing that the system is complex the CSHN Program contracts with two agencies to assist families as they navigate the system of services. The Maine Parent Federation (MPF) provides information, referral, one-on-one support and training to parents of children with disabilities/special health care needs and the professionals that work with them. MPF designed the Family Support Navigator Program to connect families to a network of supports, services and information at the local, state and national level. The navigators assist families with locating medical care and understanding results.

The CSHN Partners in Care Coordination Program seeks to help families navigate the system of care by linking them with other state and community level agency families, solving Medicaid or other private insurer issues, and providing a confidential ear to families.