State Title V Program Purpose and Design

Since its original authorization in 1935, Title V of the Social Security Act has maintained an ongoing commitment to improving the health and well-being of the nation’s mothers, infants, children, and youth, including CYSHCN, and their families.  This mission is reflected in the goals of the Title V Maternal and Child Health (MCH) Block Grant, which include: access to quality, comprehensive, family-centered care; and reduction of infant mortality and incidence of preventable disease for women, children and families, especially those with low incomes and/or limited availability of care among others.

At the state level, Nebraska Title V works to accomplish the above goals and mission, in alignment with state level priorities, by planning and implementing activities made possible through partnership and leadership.  The NE Department of Health and Human Services (NDHHS) administers the Nebraska Title V Block Grant, and thus a range of programs and services within the agency infrastructure are available for collaboration and synergy.  Leadership has emphasized cross-divisional cooperation within the Agency, and this has led to successes that directly impact the implementation of Title V activities, such as the data linkage agreement between Public Health and MLTC, expanding understanding of the social determinants of health, and working with Children and Family Services on prevention of child abuse and neglect.

Within NDHHS, Title V is overseen by two co-leads: the Title V Director and the Children and Youth with Special Health Care Needs (CYSHCN) Director.  The Unit Administrator for the Lifespan Health Services Unit within the Division of Public Health is designated as the Title V MCH Director.  The CYSHCN Director role lies with the Economic Assistance Policy Administrator II within the Division of Children and Family Services (CFS), Economic Assistance Unit (also within NDHHS).  Joint administration of a grant between two divisions under the same organization umbrella presents some logistical challenges, however this arrangement also brings significant benefits in terms of extending the reach of Title V activities, expanding the amount of available state support, and increasing the range and diversity of staff expertise available to the program. 

Through administration of Title V, Nebraska strives to utilize the characteristic flexibility of a block grant while adhering to requirements which help to demonstrate accountability.  A comprehensive Needs Assessment is conducted every five years with the assistance of stakeholders statewide to determine state priorities, which are then fit into a national framework of MCH Domains: Women/Maternal Health, Perinatal/Infant Health, Child Health, CYSHCN, and Adolescent Health (the Cross-cutting or Life-course domain was removed in the FY19 Application). 

The 10 priorities identified through the Needs Assessment represent a true life course model of maternal and child health – recognizing that early life events play an important role in shaping an individual’s health through their lifetime.  This framework of priorities makes up the Title V Action Plan, which in totality describes annual efforts to impact maternal and child health in Nebraska.  In addition to the state priorities and national performance measures which describe ultimate goals, the Plan includes strategies describing the planned activities and evidence based strategy measures (ESM) that gauge performance or progress.  Nebraska regularly monitors progress towards meeting goals and objectives by looking at successes and challenges in a collaborative way that includes data analysis, team meetings, progress reports, and evaluation.

The strategies in the action plan will not only make progress towards the identified priorities, but also strengthen the foundation for family and community health across the state.  This is due to the significant role of Title V as convener, collaborator, and partner in addressing MCH issues.  Title V activities are typically systems-level work such as engaging partners, educating providers, ensuring quality improvement, and/or developing system supports to address maternal and child health issues at the population level.  Cross-cutting activities such as promoting an equity-focus, considering access to health care from the viewpoint of social determinants of health, assessment and workforce development reflect this as well.  Because Title V has been involved in systems-level transformation for better outcomes for many years, Title V staff are widely seen as committed, knowledgeable, and passionate leaders who are well-positioned to bring about systems-level change.

Title V leadership has been demonstrated in the past in many ways, perhaps most eloquently by the ease with which Title V can bring partners to the table on various initiatives.  A history of inclusive work, transparency, and long-standing relationships built on trust mean that as new strategies are identified, implementation is generally smooth.  One example of this has been the Maternal Behavioral Health Conference.  The ability to bring engaged partners to the table during planning means that the conference has been a huge success each of the four years that it has been offered.

Title V has also demonstrated leadership in the establishment of coordinated, comprehensive, and family-centered systems of care across the state.  Working to integrate public/population/community health practice into direct care services, ensuring that family-centered care is forefront, and assisting organizations with policies to ensure culturally competent, equitable, and health-literate care are all strong goals of Nebraska Title V.  This is evident in the work with systems partners (ex: birthing hospitals, WIC agencies, NDHHS Injury Prevention, early childhood comprehensive systems, early childhood mental health, and the Behavioral Health System of Care), but also strongly evident in the partnership with the University of Nebraska Medical Center (UNMC) Munroe-Meyer Institute (MMI) and the work of Title V with others on Community Health Worker (CHW) stakeholder and workforce development.  Both of these initiatives seek to include as team members individuals who share life experience with those served, who can offer the support of a trusted peer as a member of the health care team, empower the decision-making role of individuals and consumers, and advance patient-centered and equitable outcomes.

As noted, Title V has demonstrated leadership in recognizing the impact of social determinants of health (SDoH), and encouraging health systems to accommodate those potential barriers – most recently by utilizing Community Health Workers (CHW).  Community Health Workers have untapped potential as valued and respected members of effective integrated health care teams in clinical and community settings, helping achieve population level outcomes.  Title V recognizes this potential, and through strategies identified in the 2020 action plan will be working to help build a community-level workforce equipped to reach all members of diverse communities.  This will create a comprehensive and interconnected healthcare navigation system that works together with community partners and clients in order to provide services and appropriate referrals in an equitable way.  

As Title V is a public health program at its core, activities within the Block Grant remain primarily typical public health functions.  Adhering to the Essential Public Health Services provides Nebraska Title V with a foundation of evidence-based practices, an implementation and evaluation framework, and processes to document and describe work conducted under the Block Grant.  NDHHS Division of Public Health achieved national accreditation through the Public Health Accreditation Board in 2016, and is working to maintain that important status.  Title V has demonstrated the benefits of this public health expertise and capacity in many ways, including sample policy development for birthing hospitals around safe sleep and Abusive Head Trauma (AHT) practices; assuring a competent workforce by providing various training, technical assistance and support to the NE public health infrastructure; and monitoring and assessing the health status of the maternal and child health population in the state.