New Hampshire (NH) Title V is located within two distinct areas of the Department of Health and Human Services (DHHS). The Maternal and Child Health Section (MCH) resides in the Bureau of Population Health and Community Health Services within the Division of Public Health Services . The Bureau of Special Medical Services (SMS) sits within the Division of Long Term Supports and Services. MCH consists of 28 positions, 13 of which are funded all or in part by Title V; SMS has 18 positions, 12 of which are Title V funded. MCH currently has seven programmatic units, Infant Surveillance, Data/Decision Support, Quality Improvement and Clinical Services, Home Visiting, Women’s Health, Early Childhood Systems and Injury Prevention; SMS has three programmatic units, Family Support (CYSHCN and individuals with IDD), Part C Early Intervention and CYSHCN Services.

Five of the eight state action plan priorities highlight access to services. Title V looks upon itself as the “enhancer” or “enabler” of access to quality health care services for the MCH population, including CYSHCN. Title V funding decisions are made based on gap assessments founded on discussions of the state’s health care system and the needs assessment process, which looks at health outcomes.

Title V leads by calling attention to emerging issues, thinking strategically, facilitating analysis, and educating on best practices. Title V looks for gaps and tries to fill them, in alignment with priority areas. For example, using its surveillance of babies born in the state, MCH was the first entity to alert others to the rising incidence of babies born with neonatal abstinence syndrome. Within the context of the current opioid misuse problem, MCH has partnered on many response activities including co-leading the development of a Plan of Safe Care for drug affected newborns, facilitation of a surveillance system on opioid caused deaths and overdoses and the addition of opioid misuse questions on the NH PRAMS survey. MCH’s surveillance of suicide as part of the National Violent Death Reporting System and its participation as leadership in the state’s Suicide Prevention Council are two ways of addressing this issue as the rates in all age groups has risen.

Title V has the role of convener as well as participant in many statewide groups. Title V staff members inaugurated and currently facilitate several advisory committees (Newborn Screening, Birth Conditions, PRAMS, NVDRS and Early Hearing Screening), mortality review groups (Maternal Mortality, SUID, SDY and Child Fatality) as well as workgroups such as the Communications Subcommittee of the NH Suicide Prevention Council; the NH Home Visiting Task Force and the NH Council on Autism Spectrum Disorders.

Using Title V, MCH supports 13 community health centers (CHCs) in their mission to provide accessible and affordable comprehensive primary care services for some 126,250 individuals and 2,468 pregnant women in 2018.[1] A 2016 study of Medicaid claims confirms total cost of care for patients in Federally Qualified Health Centers (11 of the 13 CHCs) was 24% lower than in non-centers.[2] Most funding is currently used for quality improvement projects such as getting adolescents into annual care; increasing the number of pregnant women and the homeless receiving tobacco cessation services; and increasing the usage of highly effective contraceptive methods. Funds also go to enabling services such as case management, transportation and interpretation services.

Title V funds are also braided with those from the Division of Children, Youth and Families and the Division of Housing and Economic Security to support the eight Comprehensive Family Support Services Program agencies, which provide home visiting  and parenting education for families with children under 21.

Title V funds in whole or part the following positions in MCH: Child Health Nurse Consultant, Program Analyst, Data Scientist/SSDI Director, Birth Conditions Program Coordinator, Infant Surveillance Program Coordinator and Pediatric Mental Health Care/Access Program Coordinator positions. The Title V components of the two new latter positions include a broad spectrum of activities, ranging from facilitating safe sleep projects, involvement with developmental screening initiatives and telehealth programming. The QI/QA Nurse Consultant position oversees the evaluation of all programming with specific recommendations and required actions to meet the goals of the Title V National and State Performance Measures.

MCH utilizes part of its Title V funding for an epidemiologist from the University of New Hampshire, who has worked with Title V for close to two decades, conducting analyses of state and national data sets related to maternal and child health.

Title V funds a portion of the Injury Prevention Program Manager and the Injury Surveillance Coordinator who seek to reduce morbidity and mortality due to intentional and unintentional injuries and oversee the contracts with the Brain Injury Association, the NH Coalition for Domestic and Sexual Violence, the Injury Prevention Center and the Northern New England Poison Center.

Title V funds SMS through a combination of ‘in-house’ positions and seven external contracts. These contracts primarily focus on systems access, infrastructure development and improvement and a small percentage for direct services. The support to the system of care includes statewide programming for a Child Development Clinic Network which consists of an autism clinic and four locations for interdisciplinary diagnostic evaluation services to children 0-6 years of age suspected of or at risk for altered developmental progress; an interdisciplinary clinic for neuro-motor disabilities and a new Complex Care Network that incorporates interdisciplinary clinics and specialty consultation to providers serving CYSHCN that is child specific or that addresses more general questions and a Nutrition and Feeding/Swallowing Consultation Network which offers community-based consultation and intervention services utilizing a home visiting framework. SMS also funds two contracts with NH Family Voices; the first supports and enhances the programming of and its mission to assist families with CYSHCN to navigate the system of care, maintain a virtual resource center on their website, assist family advisories/councils and provide a comprehensive lending library; the second is to support statewide efforts to enhance and improve access to medical homes for all children including CYSHCN.

SMS works creatively with other DHHS agencies by ‘braiding’ funding to work on collaborative efforts including an effort with DHHS’s Bureau of Developmental Services for a contract that enhances access for CYSHCN to psychiatry services, limited to one-time direct assessment, consultation, and short-term condition/medication management. Another example is the work taking place related to Developmental Screening. Title V funds one staff member in SMS committed to working to enhance developmental screening (who is also a CDC Learn the Signs: Act Early Ambassador). This staff member has been identified as the lead for Watch Me Grow (WMG) activities within DHHS. WMG is coordinated by a steering committee, which includes representatives from state agencies and public and private organizations, to foster a comprehensive developmental screening, referral, evaluation, diagnosis, treatment and services system.

[1] NH MCH UDS tables, 2018.

[2] Nocon, et al. (2016) Health Care Use and Spending for Medicaid Enrollees in Federally Qualified Health Centers versus Other Primary Care Settings. American Journal of Public Health: 106 (11).