While many of the problems faced by the maternal and child health population (which includes mothers, women, children, adolescents, children and youth with special health care needs and their families) throughout the country are the same, each State and jurisdiction faces unique challenges. As a Federal-State partnership, Title V acknowledges the uniqueness of each State and jurisdictional maternal and child health program and the differing needs of their individual populations. State and jurisdictional Maternal and Child Health programs are best positioned to assess the needs of the population they serve, to design programs that address their specific needs, and to evaluate the success of their program efforts in meeting these needs. The Title V Federal-State partnership seeks to blend the needs of the Nation’s maternal and child health population as a group with the unique needs of mothers, women, children, adolescents, children and youth with special health care needs, and families who live in different States.
Title V support has evolved over time in terms of both how funds are provided to the States and jurisdictions and how each State and jurisdiction uses its allocated funds to meet the needs of the maternal and child health population they serve. In recognition of the need for States and jurisdictions to have some flexibility in designing and implementing maternal and child health programs that address their individual strengths and challenges, Title V was converted from several categorical programs to a block grant program in 1981. With this increase in flexibility came an obligation for better accountability in how States and jurisdictions use their Title V funds to impact the lives of the target populations. Requiring States and jurisdictions to conduct a Needs Assessment as part of the Title V Maternal and Child Health Block Grant program was the first of several accountability measures instituted. This requirement was followed by the addition of National program performance measures in 1997.
Title V legislation requires each State and jurisdiction to conduct a State-wide, comprehensive Needs Assessment every five (5) years. States and jurisdictions report on their findings in the Title V Maternal and Child Health Block Grant Application that they submit with the Needs Assessment document. For interim years, States and jurisdictions report on their progress in operationalizing the Needs Assessment findings and other ongoing Needs Assessment efforts in the annual Title V Maternal and Child Health Block Grant Application. Specific to Needs Assessment, States and jurisdictions describe the need for:
In the applications for each fiscal year, States and jurisdictions also include the following elements:
The conceptual framework for the Title V Needs Assessment process is depicted in the figure below. Reflected in the ten identified steps is the expectation of the Maternal and Child Health Bureau that the Needs Assessments conducted by the 59 States and jurisdictions will result in two ultimate goals: (1) Improved outcomes for maternal and child health populations; and (2) Strengthened partnerships. Partnerships should include, but are not limited to, collaboration efforts with the Federal Maternal and Child Health Bureau, State Department of Health, other agencies and organizations within each State and jurisdiction that have an interest in the well-being of the maternal and child health population, families, practitioners, and the community.
Figure – State Title V Maternal and Child Health Needs Assessment Framework
Engaging stakeholders and strengthening partnerships is a continuous and ongoing activity. Effective coalitions can help the State/jurisdiction realistically assess needs and identify desired outcomes and mandates, assess strengths and examine capacity, select priorities, seek resources, set performance objectives, develop an action plan, allocate resources, and monitor progress for impact on outcomes.
Assess Needs and Identify Desired Outcomes and Mandates
States and jurisdictions assess the needs of their maternal and child health population groups using Title V indicators, performance measures and other quantitative and qualitative data that are available in the State. The anticipated outcome is to identify the community/system needs and desired outcomes by specific maternal and child health population groups. In addition, the State identifies legislative, political, community-driven, financial, or other internal and external mandates that they will be required to implement, regardless of what the Needs Assessment reveals.
Examine Strengths and Capacity
States and jurisdiction examine their program’s capacity to engage in various activities, including the conduct of the 5-year Needs Assessment and the collection of annual performance data, and to provide services by each level of the Maternal and Child Health Bureau Pyramid. These levels include direct health care services, enabling services, population-based services, and infrastructure-building services. The anticipated outcome is for each State and jurisdiction to develop a better understanding of the relationship of existing program/system capacity to identified strengths and needs.
Each State and jurisdiction examines the identified needs and matches them to the desired outcomes, required mandates, and level of existing capacity. Based on the results of this process, the State/jurisdiction selects its most important, or highest priority, maternal and child health strengths and needs to receive targeted efforts for improvement and/or continuation of progress. The inputs include: the Needs Assessment, the opinions of stakeholders, the examination of capacity, and the political priorities within the State. The anticipated outcome is the development of a set of priority needs unique to each individual State/jurisdiction based on the Needs Assessment findings. Mandated activities are understood to be continuing. Priority needs should include those areas in which the State believes it has a reasonable opportunity to maintain, modify, or enhance existing interventions, initiatives, or systems that have been successful, or to begin new interventions, initiatives, or systems that are expected to result in needed improvements.
Depending upon the priorities selected and the existing resources identified, the State/jurisdiction may identify a need to seek additional resources, funds, or authority from the State legislature or funding agencies in order to address priority areas.
Set Performance Objectives
The setting of performance objectives consists of two phases. First, each State/jurisdiction will select seven (7) to ten (10) State-negotiated Performance Measures to assess progress on State priorities that are not already monitored through the Title V Maternal and Child Health Block Grant program’s National Performance and Outcome Measures. Each State/jurisdiction then sets Outcome Measure targets and State and National Performance Measure targets. The anticipated outcome is the identification of State-negotiated Performance Measures and the establishment of Performance Measure targets.
Develop an Action Plan
States/jurisdictions develop an action plan which consists of identifying activities to address the priority strengths and needs based on the activities identified for each of the four Maternal and Child Health Bureau Pyramid levels (direct health care services, enabling services, population-based services, and infrastructure building services).
States and jurisdictions consider the funding of planned activities to address State priorities. Inputs include the action plan, current budgets, political priorities, and partnerships. The anticipated outcome is the development of a budget that directs available resources towards activities identified in the Action Plan as being the most important for addressing the State’s priorities.
Monitor Progress for Impacts on Outcomes
States examine the results of their efforts to see if there has been improvement. The inputs include the State Performance Measures, National Performance Measures, Outcome Measures, Health Status Indicators, Health System Capacity Indicators, performance objectives, and other quantitative and qualitative information. Potential outcomes may include altered activities and shifting of resource allocations to address current levels of performance and the availability of resources. Feedback loops between various stages of the process allow for continuous input and re-evaluation of the outputs.
Report Back to Stakeholders
Reporting on the Needs Assessment findings and the program plan that was developed aids in assuring accountability to stakeholders and partners who worked with the Maternal and Child Health staff throughout the Needs Assessment process. It also helps to assure the continued involvement of all stakeholders and partners in the ongoing Needs Assessment process.
Based on the findings of the five-year Needs Assessment, each State and jurisdictional Maternal and Child Health Block Grantee is required to specify at least seven (7), but no more than ten (10), priority needs for their population. States and jurisdictions also establish seven (7) to ten (10) State Performance Measures to address the identified priority needs to the extent that they are not addressed by the Title V Maternal and Child Health Block Grant program’s National Performance and Outcome Measures. States and jurisdictions report annually on State Performance Measures and assess their progress in achieving established performance targets for these priority areas.
In addition to serving as an important tool to States and jurisdictions in documenting the needs of their maternal and child health populations, the State and jurisdictional Needs Assessment findings also inform the Maternal and Child Health Bureau’s Title V program planning efforts. Following the submission of the Needs Assessment documents, the Bureau examines and compiles the identified Priority Needs across all 59 States and jurisdictions to determine the National maternal and child health priorities. These priorities help to inform future programmatic directions and the allocation of resources.