Introduction to Title V: Maternal & Child Health Block Grant Massachusetts Home Visiting Initiative A Department of Public Health led state agency collaborative www.mass.gov/dph/homevisiting Introduction to Title V: Maternal & Child Health Block Grant and the Home Visiting Connection

Massachusetts Home Visiting Initiative Purpose: Learn about the federal legislation that funds many programs and activities for mothers, babies and children with special healthcare needs. Learn how Massachusetts leverages these dollars to improve the health and well being of Massachusetts families. See how Massachusetts priorities are captured by federal and state performance measures, documenting the success of the programs and services provided to our residents. The Massachusetts’ Home Visitors play an important role - supported through Title V federal dollars, leveraging additional state-funded services, addressing the health and well being of Massachusetts families. You assess and connect moms, babies, families to better health and a more promising future through the Massachusetts Home Visiting Initiative. Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative What is Title V? Enacted in 1935 as a part of the Social Security Act, the Title V Maternal and Child Health Program is the Nation’s oldest Federal-State partnership. For over 75 years, the Federal Title V Maternal and Child Health program has provided a foundation for ensuring the health of the Nation’s mothers, women, children and youth, including children and youth with special health care needs, and their families. Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative Specifically, the Title V Maternal and Child Health Program seeks to: Assure access to quality care, especially for those with low-incomes or limited availability of care; Reduce infant mortality; Provide and ensure access to comprehensive prenatal and postnatal care to women (especially low-income and at risk pregnant women); Increase the number of children receiving health assessments and follow-up diagnostic and treatment services; Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative Title V Maternal and Child Health Program seeks to: (continued) Provide and ensure access to preventive and child care services as well as rehabilitative services for certain children Implement family-centered, community-based, systems of coordinated care for children with special healthcare needs Provide toll-free hotlines and assistance in applying for services to pregnant women with infants and children who are eligible for Title XIX (Medicaid). Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative How the states receive federal funding: State Maternal and Child Health agencies apply for and receive a formula grant each year. In addition to the submission of a yearly application and annual report, State Title V programs are also required to conduct a state-wide, comprehensive Needs Assessment every five years. States and jurisdictions use their Title V funds to design and implement a wide range of Maternal and Child Health and Children with Special Health Care Needs activities that address national and state needs. Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative Unique in its design & scope, the Maternal & Child Health Block Grant: Focuses exclusively on the entire maternal and child health population Encompasses infrastructure, population-based, enabling, and direct services for the maternal and child health population Requires a unique partnership arrangement between federal, state and local entities Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative How the dollars get spent: Massachusetts received approximately $11.3 million dollars for FY 2012 from the federal government from the Title V Maternal and Child Health Block Grant . Massachusetts provided approximately 45.1 million dollars this current fiscal year. This “match” resulted in 56.4 million dollars being available for maternal and child health programs across the state. $11,338,388 20% Federal $611,612 1% Other $45,116,366 79% State  Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative In FY 11, Title V services were provided directly to: Pregnant Women 17,525 Infants < 1 year 59,420  Children 1 - 22 years 423,272 Children with Special Healthcare Needs 125,023 Others 88,904  FY11 Totals 714,144 Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative How the dollars get spent: States must match every $4 of Federal Title V money that they receive by at least $3 of State and/or local money. This “match” results in more than $6 billion being available annually for maternal and child health programs at the state and local levels. At least 30 percent of federal Title V funds are earmarked for preventive and primary care services for children. At least 30 percent are earmarked for services for children with special health care needs. States and jurisdictions may spend no more than 10 percent of Federal Title V funds on their administrative costs. The level of expenditure for each State’s and jurisdiction’s maternal and child health programs must be no less than the amount provided in 1989. Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative Unique in its design and scope, the Maternal and Child Health Block Grant to States program: Requires each state to work collaboratively with other organizations to conduct a State-wide, comprehensive Needs Assessment every 5 years (Massachusetts Title V Needs Assessment); Based on the findings of the Needs Assessment, requires each State to identify State priorities to comprehensively address the needs of the MCH population and guide the use of the Maternal and Child Health Block Grant funds; and May serve as the payer of last resort for direct services for the maternal and child health population that are not covered by any other program. Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative How Title V funded programs are evaluated: States and jurisdictions report annually on their program activities and their performance relative to 18 National Performance Measures, 9 Health Systems Capacity Indicators, 6 National Outcome Measures and 12 Heath Status Indicators. In addition, each State develops between 7 and 10 State Performance measures to address identified priorities and unique needs to the extent that these needs are not addressed by the National measures. States may develop optional Outcome Measures to track critical health issues. Federal efforts have centered on the development of a client-based data system to more accurately capture the direct, enabling and population-based services that are provided by States: TVIS Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative Title V Information System or TVIS: A web-based system that serves as the Health Resources and Services Administration’s (HRSA) portal for the submission of the State Title V Maternal and Child Health Block Grant Applications/Annual Reports and five-year Needs Assessments. Electronically captures the data submitted by States, serves as a searchable database on key financial, program and performance/indicator data and provides State-by-State, Regional and National composite data. See a ‘Snap Shot’ of Massachusetts 2010 results and 2015 goals. Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative As the Title V agency, the Bureau of Family Health and Nutrition identified 10 priorities to be addressed by Block Grant funding. Promote healthy weight Promote emotional wellness and social connectedness across lifespan Coordinate preventive oral health measures and promote universal access to affordable dental care Enhance screening for and prevention of violence and bullying Support reproductive and sexual health by improving access to education and services Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative Title V MCH Priorities: (continued) Improve the health and well being of women in their childbearing years Reduce unintentional injury and promote healthy behavior choices for adolescents Expand medical home efforts to systems building and securing access & funding for children and youth Support effective transitions from (1) early childhood to school and (2) adolescence to adulthood for CYSHCN Improve data availability, access and analytical capacity Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative National Performance Measures: National Outcome Measures: Screening & follow-up for metabolic disease CSHCN family partnership/satisfaction (Children with Special Health Care Needs) CSHCN with Medical Home CSHCN with adequate insurance CSHCN community systems ease of use Transition services for youth with SHCN Immunization Teen Births ages 15-17 Dental Sealants Motor vehicle deaths ages 10-14 Breastfeeding Newborn Hearing Screening Children without health insurance WIC child BMI over 85th percentile Smoking in last trimester Suicide deaths ages 15-19 VLBW at facilities for high risk (Very Low Birth Weight) First trimester prenatal care Infant mortality Ratio of black infant mortality to white infant mortality Neonatal mortality Post neonatal mortality Perinatal infant mortality plus infant deaths Child death rate, ages 1-14 Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative State Performance Measures: Percentage of pregnancies among women aged 18 years and older that are intended Development and implementation of social connectedness measures across the lifespan for three population groups. Percentage of females ages 18-45 years reporting binge drinking (discontinued in 2011) Percentage of women with a recent live birth reporting they have had their teeth cleaned within 1 year before, during or after pregnancy. Percentage of School Based Health Center clients for whom an assessment for intimate partner/teen dating/sexual violence was done. We took #3 off the table after the last review since we don’t have any programs specifically focused on this population that has highest rates of binge-drinking – i.e. in Massachusetts this is college students. Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative State Performance Measures: (continued) Data-driven promotion of healthy weight, physical activity and nutrition for 3 populations. Rate per 10,000 of hospitalizations due to asthma among Black, non-Hispanic and Hispanic children aged 0-4 years Rate per 100,000 of motor vehicle deaths among youth aged 15-24 years Percentage of high school students having missed a school day due to feeling unsafe at or on the way to school The percentage of high school students reporting no current use (in past 30 days) of either alcohol or illicit drugs Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative State Outcome Measure: The ratio of the Black, non-Hispanic homicide rate (per 100,000) to the White, non-Hispanic homicide rate for males ages 15 – 24 Rationale: focus on violence prevention that underscores health disparities. Black, non-Hispanic youth are 36 times more likely to die as a result of homicide compared to White, non-Hispanic youth. AP Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative Direct Services MDPH programs/services addressing MA priorities Gap-filling direct services to MCH populations: Family Planning, School-based Health Centers, Early Intervention Therapies, Preventative Oral Health Services. Enabling Services Out reach, Transportation, Massachusetts Home Visiting Initiative SSI Benefits/Public Benefits Outreach, For Families, Respite & Pedi Palliative Care, CSHCN Family Support , Teen Pregnancy Prevention, Catastrophic Illness in Children Relief Fund, MHVP Population Based Services This is not a comprehensive listing of all MDPH programs and services supported by Title V and other funding. Newborn Blood Screening, Newborn Hearing Screening, Lead Poisoning Prevention, SIDS and Bereavement Counseling, Oral Health, Injury and Violence Prevention, Poison Control System, Rape Crisis Centers, Outreach / Public Education / Information Infrastructure Services Needs Assessment, Planning, Policy Development, Coordination, Quality Assurance, Standards Development, Monitoring, Evaluation, Training, Systems of Care, ESM/EIM, MassCHIP, Healthy Weight/Nutrition & Physical Activity, Grants Management, School Health Services, Office of Health Equity, PRAMS, PELL, Health Statistics Management, Birth Defects Monitoring Program. Title V Maternal and Child Health Services: The Home Visiting Connection

Infrastructure Services Population Based Services Gap-filling direct services to MCH populations: Family Planning, School-based Health Centers, Early Intervention Therapies, Preventative Oral Health Services. Infrastructure Services Population Based Services Enabling Services Direct Services Needs Assessment, Planning, Policy Development, Coordination, Quality Assurance, Standards Development, Monitoring, Evaluation, Training, Systems of Care, ESM/EIM, MassCHIP, Healthy Weight/Nutrition & Physical Activity, Grants Management, School Health Services, Office of Heath Equity, PRAMS, PELL, Health Statistics Management, Birth Defects Monitoring Program. Newborn Blood Screening, Newborn Hearing Screening, Lead Poisoning Prevention, SIDS and Bereavement Counseling, Oral Health, Injury and Violence Prevention, Poison Control System, Rape Crisis Centers, Outreach / Public Education / Information Outreach, Transportation SSI Benefits/Public Benefits Outreach, For Families, Respite & Pedi Palliative Care, CSHCN Family Support , Teen Pregnancy Prevention, Catastrophic Illness in Children Relief Fund, MHVP The Massachusetts Home Visitor: YOU !  Provides the families with ongoing support and guidance as they learn new life strategies and build their healthy, happy family. Massachusetts Home Visitors  Assesses families to determine what resources and/or additional services will help them be healthier and more prepared to achieve their goals for a better future.  Documents milestones achieved, services provided, referrals made, validating the success of Title V and the Massachusetts Home Visiting Initiative. Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative Take Away Points: Federal legislation funds many programs and activities for mothers, babies and children with special healthcare needs. Massachusetts leverages these dollars to improve the health and well being of Massachusetts families. Massachusetts priorities are captured by federal and state performance measures, documenting the success of the programs and services provided to our residents. The Massachusetts Home Visitors play an important role - supported through Title V federal dollars, leveraging additional state-funded services, addressing the health and well being of Massachusetts families. You assess and connect moms, babies, and families to better health and a more promising future through the Massachusetts Home Visiting Initiative. Title V Maternal and Child Health Services: The Home Visiting Connection

Massachusetts Home Visiting Initiative On March 23, 2010, the President signed into law the Patient Protection and Affordable Care of 2010, legislation designed, at a minimum, to make quality affordable health care available to all Americans. Through a provision authorizing the creation of the Affordable Care Act Maternal, Infant and Early Childhood Home Visiting Program, the Act creates a new section in Title V to provide $1.5 billion over five years to states, tribes, and territories to develop and implement one or more evidence-based Maternal, Infant, and Early Childhood Home Visitation model(s). The Massachusetts Department of Public Health is the state agency designated by the Governor to apply for and administer these funds. MDPH Contacts for the Massachusetts Home Visiting Initiative: Ron Benham, Director Title V Director, CYSHCN Director Bureau of Family Health and Nutrition 250 Washington Street Boston, MA 02108 Telephone: 617-624-6060 Fax: 617-624-6062 Email: Ron.Benham@state.ma.us Karin Downs, Deputy Director MCH Director Bureau of Family Health and Nutrition 250 Washington Street Boston, MA 02108 Telephone: 617-624-6060 Fax: 617-624-6062 Email: Karin.Downs@state.ma.us Title V Maternal and Child Health Services: The Home Visiting Connection