A Comprehensive Review of State title V Performance Indicators and Needs Assessments

The federal Title V program is an important legislative provision that acknowledges the needs of the nation’s mothers and children and provides the financial mechanism to support the states and other agencies in their efforts to improve maternal and child health. Many problems faced by mothers and children throughout the country are the same across the country, but states also face unique problems and state MCH programs are in the best position to assess the needs of the population they serve, design programs to address these needs, and evaluate success. The Maternal and Children Health Bureau (MCHB) operating within the Health Resources and Services Administration (HRSA) administers the Title V program and works with the states in a partnership that acknowledges the unique abilities and concerns brought to MCH issues by each State. Title V support has evolved over time in terms of both how funds are provided to the states and how the states must account for how they use them to further the cause of women and children they serve. Change from categorical programs to block grants recognizes the needs of individual states to address their own problems. With increased flexibility in use of federal funding for program implementation comes the obligation to account for how those dollars are spent and what impact they have on the lives of the target population. The evolution of accountability has occurred over the past 25 years. A needs assessment, required every five years, was the first accountability measure to be required and mandated performance measures were second, instituted in 1997. Both the states and MCHB have worked well in partnership to implement these accountability measures and to ensure that information reported by the states is of the most value possible and not submitted in a vacuum. To this end, MCHB makes state plans and performance data available to the public via the Title V Information System. In addition, MCHB uses information submitted by the states to examine trends in needs and performance and to inform change within the Bureau to meet their overall goal to assist mothers and children by responding to state MCH needs. This project uses the wealth of information provided by states as part of the needs to examine trends in the priorities states set for addressing maternal and child health needs. Among the information that has been examined are aggregate changes in states’ priority needs, those areas where states will focus their efforts in the next 5 years, which are realigned as appropriate during each needs assessment process. Also examined are state performance measures, i.e., those unique measures developed by states in response to their identified priority needs, as well as other performance measures and indicators that are part of MCHB’s exemplary performance reporting system. Focus on needs assessment and evaluation of performance has multiple benefits. Understanding the shifting health and health care landscape for mothers and children allows states and the Bureau to plan and use their limited resources wisely. Analysis of trends and individual state performance also can provide valuable information for others as promising practices in individual states are identified.

Principal Investigator: Victoria Freeman

Funding: Maternal and Child Health Bureau, HRSA, USDHHS

Total Project Period: 09/28/11 – 09/27/13