State Title V Program Purpose Design

The Nevada Department of Health and Human Services (DHHS) oversees five Divisions, including Child and Family Services (DCFS), Health Care Financing and Policy (DHCFP/NV Medicaid), Aging and Disability Services (ADSD), Welfare and Supportive Services (DWSS), and Public and Behavioral Health (DPBH). The Nevada Title V MCH Program is part of the Maternal, Child and Adolescent Health (MCAH) Section of the Bureau of Child, Family, and Community Wellness within DPBH. The mission statement of DPBH, "It is the mission of the Division of Public and Behavioral Health to protect, promote and improve the physical and behavioral health of the people of Nevada," is the guiding directive for the Nevada Title V MCH Program.

Title V MCH staff are dedicated to improving Nevada families' health, emphasizing women, birthing people, infants, and children, including children and youth with special health care needs (CYSHCN). Title V funding from the Health Resources and Services Administration (HRSA) supports:

• health education and prevention activities,
• increasing access to health care services,
• developing, and leveraging key partnerships and collaborations, and
• planning and implementing program components reaching specific populations in collaboration with community-level partners, coalitions, non-profit organizations, and other state agencies.

National Performance Measures (NPM), Evidence-Based or- Informed Strategy Measures (ESM), and State Performance Measures influence Nevada Title V MCH priorities. Nevada's Title V MCH 2020 Needs Assessment demonstrated the need to focus on the following priorities.

• Improve preconception and interconception health among individuals of childbearing age
• Reduce substance use during pregnancy
• Promote breastfeeding
• Promote Safe-Sleep
• Increase developmental screening
• Provide a Medical Home
• Improve care coordination among adolescents
• Increase transition care for adolescents and CYSHCN

Nevada Title V MCH Program staff meet weekly to discuss programmatic updates and address the needs of partners, collaborators, and subawardees. Nevada Title V MCH also remains flexible to adapt to the changing health outcomes for Nevadans. Emerging issues require Nevada Title V MCH staff to stay abreast of evolving MCH healthcare needs. Nevada Title V MCH priorities currently address the following key issues:

COVID-19

The Nevada Health Response Center, Nevada DPBH, and the CDC are closely monitoring the outbreak of the respiratory illness caused by the 2019 novel coronavirus (COVID-19). DPBH is encouraging healthcare providers to refer to the CDC’s Health Alert Network (HAN) and DPBH Technical Bulletins and DHHS efforts inform the state COVID-19 information hub at https://nvhealthresponse.nv.gov/. The latest Nevada COVID-19 statistics and response efforts are also located at the website and kept updated through the efforts of the DHHS Office of Analytics and DPBH OPHIE office.  Local health authorities, including Southern Nevada Health District (SNHD), Washoe County Health District (WCHD), and Carson City Health and Human Services (CCHHS) are also key responders monitoring and providing information related to COVID-19.

In addition to the DHHS and DPBH efforts, Title V MCH Program staff posts MCH-specific COVID-19 resources on the program website; are engaged in COVID-in-pregnancy surveillance monitoring discussions with CDC as part of an OPHIE-led team; MIS-C efforts; share COVID-19 resources and technical bulletins to partners to support rapid information sharing; and have reached out to partners and subawardees to see how COVID-19 is affecting their efforts/activities and to assist with any technical assistance and/or adaptations or fiscal redirects as needed. MCH funded statewide clear face mask purchases for school districts and EHDI partners and supported a CHS immunization need, MCH and NHV staff were awarded pass through HRSA funds via AMCHP for a COID-19 related telehealth project for CYSHCN and prenatal care.  Fortunately, most MCH-funded partners have been able to function well and adapt to the challenges of using virtual platforms. MCH staff have adapted administrative and organizational processes to support program implementation while telecommuting. Title V MCH staff continue to facilitate a COVID-19 and MCH data presentation in concert with the Office of Analytics during the MCHAB meetings since August 2020.  MCAH staff have also discussed NOMHE-planned equity and COVID-19 toolkit distribution opportunities and shared materials from NOMHE and other quality organizations about racism and public health, health equity, health disparities and racism, and racism and pregnancy outcomes.

Congenital Syphilis

In 2018, Nevada was the top ranked state for primary and secondary syphilis rates and ranked second for congenital syphilis (CS) rates. In 2019, Nevada remained the top ranked state for primary and secondary syphilis rates, while falling to fourth for CS rates. Primary and secondary syphilis rates have been increasing in Nevada since 2012. According to the CDC, Nevada’s rate of primary and secondary syphilis per 100,000 persons, from 2012-2019 are as follows: 4.1, 7.3, 11.0, 11.7, 15.3, 19.7, 22.7, and 26.6. With this increase of syphilis cases comes a rise in CS. According to CDC, CS rates in Nevada have been rising since 2012. Nevada’s CS rates per 100,000 persons from 2012-2019 are as follows: 2.9, 5.7, 13.9, 22.0, 33.1, 57.9, 85.5, and 114.7; this represents a 34.2% increase from 2018 to 2019, and a 3855.2% increase over an eight-year span. MCAH staff are members of the CS Workgroup for Nevada and have been instrumental in CS prevention informational campaign development and resource distribution.

Teen Suicide

Teen suicide is an emerging issue in Nevada. Data from NVSS shows the adolescent suicide rate for those ages 15-19 years per 100,000 adolescents in Nevada was 15.6 for the reporting period of 2017-19; this represents an increase of 2.6% from the 2016-18 rate. Nevada’s 2017-19 teen suicide rate is higher than the U.S. rate of 11.2 suicides per 100,000 adolescents during the same reporting period. When stratifying adolescent suicide rates for those ages 15-19 years by urban/rural residence, the 2015-19 rate was 20.0 in non-metro (rural) areas compared to 14.4 and 13.1 in small/medium and large metro areas, respectively. Title V MCH will continue to be an active participant in the Healthy Tomorrows Grant with the NVPCA. The Healthy Tomorrows project is focused on creating adolescent-friendly spaces in FQHCs to increase repeat visits and a develop a patient-centered medical home for Nevada’s adolescents. Title V MCH Program funding also helped support the Nevada OSP with teen suicide prevention and systems-building projects, such as Youth Mental Health First Aid and Project AWARE, via funding for the OSP Manager and the crisis call line. Title V MCH staff also participate on the HRSA Mental Health Evaluation Committee and attend Statewide Children’s Mental Health Consortia meetings.  Title V MCH Program staff also wrote a letter of support for The Foundation for Positively Kids in their application to the Healthy Tomorrows Program grant.

Substance Use During Pregnancy and Substance Exposed Infants

Close monitoring of substance use during pregnancy and substance exposed infants will continue to be a priority for DPBH and Nevada’s Title V MCH Program. According to data from NVSS, the percent of women who smoked during pregnancy was 3.5% in 2019; a decrease from 5.4% in 2010, or a change of 35.2%. NVSS data also reflects a modest decline in the use of substances during pregnancy, as the percentage of women who reported smoking, alcohol use, and/or drug use decreased from 5.5% in 2016 to 5.3% in 2019. MCAH will continue to work on state efforts regarding CARA and the Infant Plan of Safe Care including education, training, OMNI work group participation, and increasing awareness. Nevada PRAMS staff make inquiries about substance use before, during, and after pregnancy and provide self-reported data in addition to vital statistics and hospital inpatient data to inform Title V MCH efforts/activities. To enhance other substance use prevention efforts, PRAMS data will be presented to both the OMNI and PRISM learning communities.

Title V MCH Program staff are also core members of the Nevada ASTHO OMNI NAS-related efforts in Nevada and also participate in the AMCHP PRISM efforts.  MCH funds will support Infant Plan of Care material translation and distribution and the MCH Director will present on CARA referral pathways at a Project ECHO webinar in August and co presented at the Nevada Health Conference on Infant Plans of Care. 

Maternal Mortality Review Committee (MMRC) and Alliance for Innovation on Maternal Health (AIM) Efforts

Governor Steve Sisolak signed Assembly Bill (AB) 169 of the 80th Nevada Legislative Session into law in June 2020, establishing a Nevada MMRC. AB169 was codified in NRS 442.751 through 442.774, inclusive, and reflected the work of a wide vary of supporters and advocates. The MMRC is required to: 1) review incidents of maternal mortality and severe maternal morbidity (SMM) in Nevada; 2) disseminate findings and recommendations concerning maternal mortality and SMM to providers of health care, medical facilities, other interested persons and the public; 3) publish timely reports consisting of data relating to maternal mortality and SMM, descriptions of incidents reviewed by the Committee, and recommendations to reduce maternal mortality and SMM in Nevada.

Nevada established the state’s first MMRC and convened the first meeting in February 2020 and convened a total of four times that year. This MMRC will continue to meet at least twice annually to review all incidences of maternal mortality in Nevada. The Title V MCH Program will be involved in supporting MMRC-related meeting travel and ancillary costs for members, and in considering possible opportunities for implementing MMRC recommendations in MCH programmatic efforts for prevention, increased awareness of the existence and recommendations of the MMRC among the public, clinicians, and policy makers, and supporting dissemination of required reports and data-driven MMRC recommendations (e.g., evidence-based practices, screenings, and patient and provider education). The 2021 legislative session added a partnership between the MMRC and the NOMHE Advisory Board in relation to recommendations of the MMRC in the biennial report to the legislature.

Reporting produced by the MMRC support staff is included in Nevada’s Title V MCH Block Grant reporting, and health equity in birth outcomes and maternal domain population health maximization will be key areas of topical intersect in priorities of the MMRC, MCAH Section, SSDI Program, and Title V MCH Program. Title V MCH Program staff will look for opportunities to create sustained funding for the MMRC as it was passed into law without dedicated funding. SSDI funds help support MMRC administrative support staff. The Title V MCH Program is in discussions with the Nevada Rural Hospital Partnership to launch Advanced Life Support in Obstetrics (ALSO), American College of Obstetricians and Gynecologists (ACOG) efforts to reduce rural maternal mortality by working with critical access hospitals.  Nevada is now an AIM State, which will help staff support activities reducing preventable maternal mortality and severe maternal morbidity (SMM), beginning with the hypertension patient safety bundle with the Nevada AIM launch June 24, 2021.

Early Childhood Continuum

Strengthening the early childhood education continuum to include public health is an emerging issue the Nevada Title V MCH Program will help address. The Title V MCH Program will continue and expand efforts to achieve the goal of NPM 6: To increase the percent of children, ages 9 to 35 months, who received a developmental screening using a parent completed screening tool. According to data from NSCH, Nevada has experienced an increase in the percent of children screened, from 27.9% during 2017-2018 to 30.6% during 2018-2019. Systems-level interventions are needed to address all components of child development. Title V MCH Program staff will continue to work with the Early Childhood Advisory Council, Pritzker initiatives, Nevada Early Intervention Services (NEIS), and NHV to engage diverse partners and leverage existing efforts to address the early childhood continuum. The MCH Director and NHV staff have been core participants in Pritzker efforts in Nevada also related to strengthening the early care continuum. Title V MCH funding replaced out of date audiological equipment.  The new audiological equipment will serve all NEIS children statewide.

State Title V Program Purpose Design Conclusion

The Nevada Title V MCH Program is a small, enthusiastic, and well-organized unit within the MCAH Section.  It works in conjunction with MCAH programs, including NHV, SSDI, PRAMS, PREP, the SRAE Program, EHDI, AIM, MMRC, AFP, RPE, and OSP. The Nevada Title V MCH Program aims to address many key health needs of Nevada's MCH population using evidence-based approaches, highlighting SDOH, and prioritizing the importance of partner collaboration. Nevada Title V MCH takes a systems-based approach to achieve the mission of DPBH and embraces intra- and inter-agency braided efforts.  In addition to Title V MCH Block Grant priorities, program staff support the Governor's priorities and those of DHHS to maximize MCH population health outcomes and improve Nevada families' health and well-being.