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Massachusetts Title V—Caring for Mothers and Families in the Commonwealth

Posted By Sarah L. Stone, Friday, October 23, 2015
Updated: Friday, October 23, 2015
What do you think of when someone says “Massachusetts?” Maybe you think of the Boston Marathon, our famous chowda’ or Paul Revere’s midnight ride. Or, if you’re a maternal and child health (MCH) epidemiologist, maybe you think of our leadership in healthcare. With four medical schools and ten neonatal intensive care units—nine of which are within birthing hospitals with advanced obstetrical care units— Massachusetts is able to provide excellent clinical care to our most vulnerable infants and their mothers. Massachusetts is now recognized as having one of the lowest infant mortality rates in the country at less than 42 deaths per 10,000 live births. Yet our MCH excellence also extends beyond the hospitals, directly to the communities. The framework that supports Massachusetts as a MCH leader comes from the Title V program. Title V is a federal–state partnership that focuses on improving the health of all mothers and children. Title V is administered by the Health Resources and Services Administration (HRSA)/ Maternal and Child Health Bureau (MCHB) and has its roots in the Children’s Bureau of 1912 and Title V of the 1935 Social Security Act. Title V supports core public health functions of assessment, policy development and assurance through surveillance, education, community partnerships and outreach, policy development, linking services to those in need, and increasing MCH capacity.

The start of my CDC/CSTE Applied Epidemiology fellowship at the Massachusetts Department of Public Health coincided with the national five-year Title V block grant (TVBG) application cycle for 2016-2020 and our state’s five-year needs assessment, which is a year-long process. The statewide needs assessment entailed reviewing all current MCH programs and evaluating data from national and state surveys to create a picture of the state’s MCH needs. Beyond National Performance Measures, on which every state reports, states draft seven to ten priorities to address MCH needs for the next five years. These priorities focus on women of reproductive age, mothers and their children from birth through young adulthood, as well as children and youth with special health care needs and their families.

With so many possibilities, how were we to decide our priorities? As epidemiologists do, we started with quantitative data. We analyzed data as diverse as Vital Records, the National Survey of Children’s Health, the National Survey of Children and Youth with Special Health Care Needs, the Pregnancy Risk Assessment Monitoring System and the Massachusetts Youth Health Survey, to name just a few. But quantitative data alone were not enough. It was crucial to listen directly to the voices of the Commonwealth. Through 67 internal and external key informant interviews, we identified the most important issues for the MCH population for the next five years. We then held 14 focus groups with residents across Massachusetts, in English, Spanish and Vietnamese. These focus groups, which included pregnant and parenting teens, low-income mothers, non-English speaking families, lesbian, gay, bisexual, transgender or questioning (LGBTQ) adolescents, parents of children and youth with special health care needs, military families, fathers, and families facing housing insecurity, allowed us to hear first-hand of residents’ needs as well as their suggestions for strategies. We also considered current Title V MCH programs—were they making a difference? One Title V program, the Early Intervention Partnership Program (EIPP), a high-risk maternal and newborn screening, assessment and service system, told us of a recent event. One of the EIPP nurses was scheduled to meet with a pregnant mom for an initial visit and comprehensive assessment. The assessment began and when the nurse asked about her physical health and asked about any problematic symptoms, the mom discussed that she had started bleeding that morning. The mom was just going to wait until the next visit with her doctor to share this information. The EIPP nurse called 911 and both went to the ER. The baby was born prematurely but safely, and both mom and baby are now thriving. Without EIPP and their home visiting services, it is unlikely that this story would have had a happy ending.

We combined our qualitative information with quantitative data and used an iterative process to propose ten Massachusetts priorities (Table 1 and TVIS screenshot) that reflected our state’s needs, while also aligning with HRSA/ MCHB’s National Performance Measures. We then developed a state action plan, aligning specific objectives, strategies and evidence-based measures to each priority, detailing what we plan to achieve, and how we will do it. Finally, a full year after we began, we submitted our TVBG needs assessment and state action plan. But we aren’t done yet. States are held accountable for achieving progress on these priorities through annual reports. The action plan provides a roadmap to accountability and progress. In every annual report, we ask ourselves: Are we successfully addressing our chosen priorities? Do we see our strategies making a difference in outcomes? Do we need to revise our objectives or strategies? It is this iterative process of data evaluation and listening to residents that is key to our ability to serve the MCH population.

We have come a long way in improving the health and lives of mothers and children since the Children’s Bureau was established—a time that saw one in five children die before reaching their fifth birthday, and a maternal death rate of one mother’s death per every 150 live births. The Title V program is an integral part of that improvement, continuing to help mothers and their families achieve the best health outcomes possible.

The Maternal and Child Health Bureau (MCHB) website is accessible at and the Title V website is accessible at

Sarah Lederberg Stone, PhD, MPH is a CDC/CSTE Applied Epidemiology fellow at the Massachusetts Department of Health. If you would like to contribute to the public health field like Sarah, the Applied Epidemiology Fellowship application has just opened. If you are a CSTE member and would like to learn more about MCH, join the MCH Subcommittee.


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Megan Davies MD says...
Posted Thursday, October 29, 2015
Thanks for a nice insight into MCH. As someone not working in that field, I really enjoyed reading this blog.
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