When did you first begin to work in Title V? What was different then? What’s changed? What are you excited about as we look to the future of Title V?
Assistant Division Chief
Maternal, Child & Adolescent Health/Office of Family Planning
California Department of Public Health
I began working in Title V (TV) programs in 1998 quite by accident. I was looking for a new challenge that would allow me to use my administrative experience to make a difference in a children’s health program. At that point, as far I knew, “TV” was an abbreviation for television. I quickly learned the details of TV and fell in love with its mission.
I’m not sure what was different then, all I know is being involved in TV made a difference in my life. I always felt strongly about the importance of providing health and family services to all mothers and children when suddenly in 2001 my six-year-old son Scott was diagnosed with Type 1 diabetes. At that point I became a consumer of TV services. It made the work even more meaningful and I believe more effective.
Over the 12 years I’ve been involved with TV there have been better times and worse times. The key is the dedication of the folks doing the work. I’m always impressed with the folks who sit next to me everyday to do the hard TV work. They are always looking for opportunities, even when the entry point to an opportunity is narrow. The folks who are attracted to the TV work are always inspiring. They are the real strength of TV.
I’m excited about continuing to work with the inspiring people doing the TV work. They never fail to inspire me, even when I disagree with an idea or approach. Their passion is my inspiration.
Loretta J Fuddy, ACSW, MPH
Chief, Family Health Services Division
Hawaii State Department of Health
I first entered the field of Maternal and Child Health in the mid seventies. The models were ones of direct delivery of care through an interdisciplinary approach. It was common to have nursing, social work, nutrition and therapist consultants on staff. Over the past 35 years I have seen the emphasis from the bureau change. The eighties ushered in the era of decreasing the direct service approach with greater emphasis on creating systems of care especially in perinatal health. Regionalization of perinatal health care moved the Hawaii Department of Health to close its Maternity & Infant Care and Children and Youth Projects and contract services with private health care entities. The closure of state operated clinics also helped to initiate community-based services and the development of several community health centers. Fiscally, the eighties introduced the Title V MCH Block Grant; although it had little impact on how Hawaii expended its funds, it resulted in changes to the reporting format.
Systems building and coordination continued throughout the nineties with a greater emphasis on community planning, data and measurement. New opportunities were available through discretionary grants to improve the early identification of childhood disorders and the prevention of injury. There was a focus on improving cultural competencies. For Children with Special Health Needs the emphasis was and continues to be on the promotion of medical home, family centered community-based and coordinated care.
The new century ushered in the promotion of best practice with the funding of programs like Healthy Start and the greater use of advanced technology like Tandem Mass Spectrometry for the identification of metabolic disorders. We began to also recognize the power of data; how to translate data into information to drive policy formation and legislation to improve the health of women and children. The core public health functions of needs assessment, policy development, and assurance of health care influenced greater partnerships among other departmental programs and private health care providers.
As a public heath social worker, what excites me about this decade is the focus on the root causes of illness and the social determinants of health. There is an acknowledgement that public health alone cannot successfully address many of society’s complex health problems, without working with human services, mental health, educational, labor and housing institutions. The life cycle approach calls for cross systems integration, and approaches that address women’s health issues before pregnancy and provision a system of care beginning in infancy and all stages of development through adulthood. The prevention of chronic disease is critical to the containment of health care cost. While the challenges are many there are many promising opportunities for success when Title V and the field of Maternal and Child Health utilize the strategies already mentioned and we leverage improvements through health care reform, health technology and communications.
Jane Borst, RN, MA
Chief, Bureau of Family Health
Iowa Department of Public Health
In many respects, Title V hasn’t changed much in the past two decades; in other ways, Title V has changed dramatically. It’s such a dichotomy. The vision and mission of Title V remains the same - challenging and inspirational. My daily work is still guided by a common goal of improving the health of all mothers and children. At the same time, recalling what state and local Title V programs spent their time on when I first started working in Title V is like watching the History Channel. The ways in which we work to accomplish our overarching goal has evolved in ways I never imagined when I started working in Iowa’s Title V program 17 years ago. While there have been many important changes that shape our work today, a couple stand out.
OBRA ’89 made a significant impact on our state and local level working relationships between Medicaid and Title V. Implementation of the provisions for collaboration didn’t really start until 1993, but since then we’ve worked together to conduct state and community assessments, improve policy and programs, and assure that quality services are available to all mothers and children in our state, not just those enrolled in Medicaid. Our collective response to OBRA’89 promoted integrated service delivery at a community level. It virtually replaced a two-tiered system that provided intermittent and episodic services for children from low-income families with a continuum of care available to all children. CHIP and CHIPRA legislation reinforced our earlier work. Preventive health services became more available, and continuity of care is an emerging expectation as we work to implement medical/health homes.
The Future of Public Health (1988) provided a context for developing system level approaches to our work in Title V. Recognizing core functions for public health created support for developing MCH strategies for assessment, policy development and assurance, which moved the system even further than we might have predicted. The principles of core functions provided a common vocabulary for focusing on system level work. It took us beyond reports of “unduplicated counts of clients served.” Title V has always been about building systems of care, but in earlier years those core functions of our system were not as well recognized or valued. The Ten Essential Public Health Services to Promote Maternal and Child Health in America (1995) added labels to our system development strategies. Once Essential Services had a recognized value, Title V was able to focus on sustainable changes which continue today.
Health care reform makes this an exciting time for Title V. The Affordable Care Act Maternal, Infant and Early Childhood Home Visiting Program along with the Personal Responsibility Education Program (PREP) provide unprecedented opportunities for state Title V programs to do what we do best, which is to improve the health of all mothers and children.
Nancy Birkhimer, MPH
Population Health and Prevention Section Leader
Division of Family Health
Maine Center for Disease Control and Prevention
Maine Department of Health and Human Services
When I joined Maine Department of Health and Human Services, Division of Family Health in 1999 as the State Adolescent Health Coordinator, the position was narrowly focused on teen pregnancy and school-based health centers. Like many of my colleagues, I often felt that adolescents were not fully part of “MCH.” The National Network of State Adolescent Health Coordinators soon became a critical support system as I worked to create a wider vision of adolescent health in Maine.
More people seem to realize that youth and their families still need supports during adolescence. Some parenting skills, such as setting limits, might seem similar, but look very different for parents of teens. At one point I was told that if we could just educate the parents of two-years-olds, we wouldn’t need adolescent health programs! The emerging science of adolescent brain development has provided a “sexier” platform to talk about the needs of this population.
Positive Youth Development has moved youth from being seen as the problem to being seen as part of a solution. We are no longer talking about youth involvement, but meaningful youth engagement.
The field of young adult health is emerging. When I started, they were either lumped with adolescents or adults, and most strategies were limited to college settings. While much more work is left to be done, the broad spectrum of young adults and their needs are increasingly being recognized.
Evidence-based practices have come into the forefront of our thinking. While this is not limited to adolescent health, the research and the need for programs that “work” have definitely advanced our practices beyond the point of doing what “feels good.”
Daniel R. Bender, MHS
Title V Director
Mississippi State Department of Health
I started my MCH career with the Mississippi State Department of Health in the early 1980s working to secure grant funding for the Genetics Program, particularly newborn screening. Mississippi was the first state to mandate screening for an expanded panel of 29 disorders (up from five) and ultimately expanded the number of screened disorders to 40, including sickle cell, which is important because of Mississippi’s significant African-American population.
After becoming the Child Health Director and then the Title V Director, I witnessed the MCH Block Grant funding make possible an expansion of Title V services to more areas of our rural state. With the advent of IDEA Part C, early intervention services became available to address both the educational and the physical needs of vulnerable populations.
As I look to the future, I am excited about the opportunity to strengthen relationships with community health centers and private medicine as well as focus on infrastructure improvements. Historically, Mississippi inverts the MCH pyramid by expending the largest portion of funding on gap filling services, a byproduct of scarce state resources to address health needs. By investing in relationships with other MCH providers, it is my hope that going forward direct health care needs will continue to be met while allowing the build up of the MCH infrastructure.