Title V legislation (Section 505(a)(1)) requires the state, as part of the Application, to prepare and transmit a comprehensive statewide Needs Assessment every five years that identifies (consistent with the health status goals and national health objectives) the need for:

1. Preventive and primary care services for pregnant women, mothers and infants up to age one;
2. Preventive and primary care services for children; and
3. Services for children with special health care needs.

Findings from the Five-Year Needs Assessment serve as the cornerstone for the development of a five-year Action Plan for the State MCH Block Grant. States are required to provide annual Needs Assessment updates during interim reporting years.

The three-year period covered by this Guidance will include two interim years requiring Needs Assessment Updates, and one year requiring a comprehensive Five-Year Needs Assessment Summary, as shown in Table 2 below:

Table 2: Needs Assessment Requirements and Relevant Guidance Sections

Table 3 outlines the sections required to be updated with the Five-Year Needs Assessment and the Needs Assessment Update.

Table 3: Needs Assessment Reporting Requirements

1. Five-Year Needs Assessment Summary and Annual Updates

States will submit a Five-Year Needs Assessment Summary in 2025 (during year two of the three-year period covered by this Application/Annual Report Guidance).

The mechanism for states to report on the legislatively required, comprehensive and statewide Five-Year Needs Assessment is the Needs Assessment Summary, which is submitted as part of the first year Application/Annual Report of a new five-year cycle. The state should present a concise summary (up to 20 printed pages) of the Five-Year Needs Assessment process, methodology and findings, as described below. Given that the findings inform the development of the state MCH Block Grant's five-year State Action Plan, the Needs Assessment Summary is linked to the four subsequent interim year Applications/Annual Reports. As it reflects a point-in-time, the state does not update the Five-Year Needs Assessment Summary in the interim years. Such updates are presented in the Needs Assessment Update section of the interim year Applications/Annual Reports. Each annual update, along with the original Five-Year Needs Assessment Summary, is linked to each year's Application/Annual Report across the five-year reporting cycle.

The Needs Assessment Summary is intended to emphasize only the key findings of the state's Five-Year Needs Assessment. Given the scope and comprehensive nature of the Five-Year Needs Assessment, a state's findings may exceed the required content for the Needs Assessment Summary. States may opt to develop a more detailed and complete Five-Year Needs Assessment document, which is tailored to meet their individual MCH program needs. If such a document is created by the state and made accessible on a public website, the state is encouraged to cite the URL for the website as part of its Application/Annual Report discussion. States may also choose to submit more detailed documentation on their Five-Year Needs Assessment findings as an attachment for this section.

a. Process Description (Required Every Five Years)

This description of the overall process/methodologies used by the state in conducting its Title V Five-Year Needs Assessment provides context for the interpretation of the reported findings and the priority needs subsequently identified. There are four characteristics for states to consider in moving from a solely data-driven needs assessment effort to conducting a comprehensive assessment of its priority issues and stakeholder needs. These characteristics are:

(i)  A clear leadership structure for assembling data from both public and private sources;
(ii)  Engagement of stakeholders for soliciting meaningful programmatic input;
(iii) A structured and participatory priority-setting process; and (iv) Collaborative program planning.

In describing the Five-Year Needs assessment process, states should provide a high-level summary that includes:

(i)  Goals, framework, and methodology that guided the Needs Assessment process;
(ii)  Level and extent of stakeholder involvement, including families, individuals with practical knowledge, and family-led organizations, which should include the different MCH populations in state, such as the American Indian/Alaska Native population if appropriate. This summary would include meaningful engagement of communities, persons with practical knowledge, individuals, and families, including those of CSHCN, in the needs assessment and priority needs selection processes;
(iii)  Quantitative and qualitative methods that were used to assess the strengths and needs of the MCH population in each of the five identified population health domains, MCH program capacity, and supportive partnerships/collaborations;
(iv)  Data sources utilized to inform the Needs Assessment process; and
(v)  Interface between the collection of Needs Assessment data, the finalization of the state's Title V priority needs, and the development of the state's Action Plan.

Process Description for Needs Assessment Update (Interim Year Reporting)

The changing MCH population demographics, emerging health trends, and shifting program capacity require that states routinely engage in selected steps of the Needs Assessment process. During any interim year when a state is not reporting on its Five-Year Needs Assessment, a state should reference and summarize the findings from its ongoing needs assessment activities in the Needs Assessment Update section of the Application/Annual Report. This introductory section of the needs assessment update should include a brief description of the state's ongoing needs assessment activities, which may include MCH data collection and analyses, program evaluation, key informant interviews, customer satisfaction surveys, advisory councils, and other approaches for soliciting individual feedback and conducting ongoing performance monitoring and assessment. It also should discuss the extent to which families, individuals, and other stakeholders were engaged in the needs assessment update process.

b. Findings

Findings from the comprehensive Five-Year Needs Assessment inform the Title V program's strategic planning, decision-making, and resource allocation. These findings also provide a benchmark against which states can compare and assess the progress they achieve during the five-year reporting period.

The Needs Assessment Summary should highlight the state’s noted MCH strengths/needs in three main areas:

(i) MCH Population Health and Wellbeing
(ii) Title V Program Capacity
(iii) Title V Program Partnerships, Collaboration and Coordination.

i. MCH Population Health and Wellbeing

The state should clearly describe the health and wellbeing of the MCH population within each of the five population health domains (i.e., Women/Maternal Health, Perinatal/Infant Health, Child Health, Adolescent Health, and CSHCN), based on the quantitative and qualitative analyses conducted. Specific discussion points should include:

1. A summary of the noted strengths and needs in the overall MCH population and in specific MCH sub-population groups;
2. A concise description of the state's successes, challenges, and gaps related to major morbidity, mortality, health risks, or wellness for each of the five population health domains. At a minimum, the discussion should include the major health issues reflected in the state's priority needs relative to the MCH population as a whole or specific sub-populations when stratified by age, income, geography, frontier/rural/urban status, or other relevant characteristics; and
3. An analysis of current MCH Block Grant efforts in addressing the needs of its MCH population to determine areas of success and areas in which new or enhanced strategies/activities are needed.

ii. Title V Program Capacity

A state's assessment of its Title V program capacity should examine current resources, staffing, and organizational structure, state agency coordination, and family partnerships. States should summarize the findings from their Five-Year Needs Assessment relative to each of these categories in the following sections.

a. Impact of Organizational Structure

In this section, the state should reflect on the impact of Title V's location and organizational structure within the State Health Department, as described in the Overview of the State, on its ability to respond to the findings of the needs assessment. This section should address strengths, opportunities, and challenges associated with Title V's organizational placement, including their impact on Title V's ability to partner with and/or leverage the resources of other state programs and agencies to respond to MCH needs.

b. Impact of Agency Capacity

In this section, the state should reflect on Title V's capacity, including the impact of this capacity on Title V's ability to respond to the findings of the needs assessment. This section should address strengths, opportunities, and challenges associated with Title V's capacity to respond to MCH needs.

In summarizing the state Title V program capacity, the state should describe the state Title V agency's capacity to promote and protect the health of all mothers and children, including CSHCN. Included in this description should be a discussion of the steps taken by the MCH and CSHCN programs to ensure a statewide system of services that reflects the components of comprehensive, community-based and family-centered care. The state should also describe the extent to which the Title V program collaborates with other state agencies, health services entities, and private organizations to support health services delivery at the community level.

Specifically, the state’s summary on Title V program capacity should include the following:

(1)  A description of the state's Title V capacity to provide and assure services within each of the five population health domains.
(2)  An expanded discussion on the state's capacity for serving CSHCN, which includes the Title V program's ability to provide rehabilitation services for blind and disabled individuals under the age of 16 receiving benefits under Title XVI (the Supplemental Security Income Program), to the extent that medical assistance for such services is not provided under Title XIX (Medicaid). If applicable, states may describe their capacity to serve CSHCN and their families by referencing the Blueprint for Change: A National Framework for a System of Services for CSCHN.

c. Title V Workforce Capacity and Workforce Development

State Title V program efforts to implement the core public health functions (assessment, policy development, and assurance) and to assure accountability through ongoing performance measurement and monitoring require an adequately sized and skilled workforce. Form 7, Title V Program Workforce, provides data on the Title V workforce composition. In this section, states should include narrative that augments the Form 7 workforce data and addresses the following:

(1)  The capacity of the Title V workforce to address Title V priorities;
(2)  Strengths and needs of the Title V workforce (including the epidemiology workforce), including developing a workforce that reflects the population served;
(3)  Unique skillsets or composition of Title V staff that facilitate efforts to address Title V priorities;
(4) Impact of organizational changes (e.g., organizational restructuring, integration/collaboration with the Title V program, shifts in staffing, emerging demands for new skillsets and training) on the Title V workforce capacity, and planned areas for continued development or change.

The state also should describe its plans for strengthening the MCH workforce and advancing a future MCH workforce vision (e.g., types of personnel and skillsets needed), including discussion of the following:

(1)  Recruitment and retention of a qualified Title V staff, including those with lived experience;
(2)  Assessment of training and professional development needs for new and seasoned Title V staff and family leaders;
(3)  Engagement of the Title V workforce in training the next generation of MCH professionals (including activities with MCHB-funded training programs, internships, other universities);
(4)  One innovation/example of a key partnership that enhances capacity of the Title V workforce to meet its goals (i.e., partnerships with academic institutions, other training providers, student internships, family-led organizations, community organizations, etc.)

In addition to this narrative discussion of the state's MCH workforce activities, a state completes Form 7 to compare, organize, and annually monitor its MCH workforce data and training information.

d. State Systems Development Initiative (SSDI) (Annual Update Required)

The purpose of SSDI is to improve MCH outcomes by increasing state capacity to collect, analyze, and use reliable data for state Title V policy and program development. SSDI funds support expansion of data linkages of key MCH datasets for analysis; improved access to and analysis of health data; and translation of data into action at the state/jurisdictional level. The SSDI program assures foundational MCH data capacity support for the Title V MCH Block Grant program. SSDI provides the flexibility to shift focus, including addressing MCH data capacity needs during an emergency and as emerging issues or threats arise, such as COVID-19. Data are central to state/jurisdictional reporting on their Title V MCH Block Grant assessment, planning, implementation, and evaluation efforts, in the Title V MCH Block Grant Application/Annual Report.

States that receive SSDI funding should provide a narrative update that describes the state's progress in completing its SSDI work plan that aligns with the four goals of the SSDI program, as described below:

(1)  Strengthen capacity to collect, analyze, and use reliable data for the Title V MCH Block Grant to assure data-driven programming;
(2)  Strengthen access to, and linkage of, key MCH datasets to inform MCH Block Grant programming and policy development, and assure and strengthen information exchange and data interoperability;
(3)  Enhance the development, integration, and tracking of health outcomes and social determinants of health (SDoH) metrics to inform Title V programming; and
(4)  Develop and enhance capacity for timely MCH data collection, analysis, reporting, and visualization to inform rapid state program and policy action related to emergencies and emerging issues/threats, such as COVID-19.

States also should address the following items as part of the narrative discussion:

(1)  The contributions of the SSDI grant in building and supporting accessible, timely, and linked MCH data systems, as documented on Form 12; and (2) A description of key SSDI products or resource materials that were developed to support State Title V program efforts in addressing its identified MCH priority needs, conducting the Five-Year Needs Assessment, implementing the Five-Year State Action Plan, and advancing data-driven MCH programming.

Since the purpose of SSDI is to build and support MCH data capacity for State Title V programs, SSDI program successes are largely demonstrated in the state's MCH Block Grant Application/Annual Report. As such, this SSDI narrative section is designed to serve as the annual progress report for the state's SSDI grant.

If a state does not receive SSDI funding, a statement should be entered in this section to indicate that the state is not an SSDI grant recipient.

e. Other Data Capacity

In this section, states should describe Title V data capacity efforts funded by sources other than SSDI, which support up-to-date MCH data and information systems. This description should highlight the state's MCH epidemiological and data enhancement activities and how they support Title V program activities, such as the Five-Year Needs Assessment, annual MCH Block Grant performance measure reporting/monitoring, and data-driven programming. Such efforts may include, but are not limited to, activities such as the ones listed in the SSDI section above but not funded by SSDI, the state's partnership and collaboration in implementing national surveys and monitoring systems, the availability/accessibility of state and local MCH data information systems, the collection and tracking of real-time data, creation of data review boards, provision and sharing of data with other state/local and external partners, and advances in information technology that facilitates automated data analyses and reporting. States should also describe key challenges they face in their efforts to improve the use of MCH data.

iii. Title V Program Partnerships, Collaboration, and Coordination

In this section, states should describe partnerships with other federal, state, and local entities, both public and private, to enhance state Title V capacity to meet the needs of the MCH population, including CSHCN, and to address the priorities identified through the Five-Year Needs Assessment. This section should include descriptions of partnerships and stakeholder engagement in programmatic decisions, as well as relationships that expand the capacity and reach of the state Title V program.

In summarizing its partnerships and collaborations, the state should describe relationships with programs, such as the following:

(1)  Other MCHB investments, which may include Maternal Health Innovation grants; Pediatric Mental Health Care Access Grants; Family-to-Family Health Information Centers; MCHB investments related to newborn and early childhood screenings, epilepsy, genetics, blood disorders; Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Grants; Healthy Start Grants; Early Childhood Comprehensive Systems (ECCS) Grants; MCH Training programs; and MCHB investments relating to injury prevention, autism, developmental disabilities, adolescent health, workforce development, oral health, bullying, and emergency medical services for children;
(2)  Other HRSA programs (e.g., community health centers, HIV/AIDS programs, and Area Health Education Centers);
(3)  Other Federal investments (e.g., ACF, CDC, and USDA-funded programs, such as maternal mortality reviews, community health workers, immunizations, and WIC);
(4)  Local MCH programs and organizations (e.g., community-based organizations, local health departments, and urban MCH programs);
(5)  Other State programs, including other programs within the State Department of Health (e.g., chronic disease prevention and health promotion, immunization, vital records and health statistics, injury prevention, behavioral and mental health, and substance abuse);
(6)  Other governmental agencies (e.g., Medicaid, CHIP, Education, Social Services/Child Welfare, Housing, Social Security Administration, Corrections and Vocational Rehabilitation Services);
(7) Tribes, Tribal Organizations, and Urban Indian Organizations; and
(8) Public health and health professional educational programs and universities.

iv. Family and Community Partnerships

As discussed under the Guiding Principles in Part One, Section IV, family partnership is defined in the MCH Block Grant as "the intentional practice of working with families for the ultimate goal of positive outcomes in all areas through the life course. Family engagement reflects a belief in the value of the family leadership at all levels from an individual, community and policy level."

The state should provide an overarching discussion of its organizational capacity and vision for partnering with families, individuals, and family-led organizations in all aspects of their Title V Action Plan development and implementation across all population domains. Descriptions of partnership activities may include, but are not limited to, the following areas:

(1) Advisory Committees;
(2) Strategic and Program Planning;
(3) Quality Improvement;
(4) Workforce Development and Training;
(5) Block Grant Development and Review;
(6) Materials Development; and
(7) Program Outreach and Awareness

Training activities that serve to strengthen and advance family partnership in the Title V program, both in orientation and ongoing professional development, which are conducted for staff, family leaders, volunteers, contractors, and subcontractors should be discussed. The state should describe the contributions of family and community leaders to Title V program processes, such as assessment of needs/assets, program planning, MCH and CSHCN services delivery, and evaluation/monitoring/quality improvement activities. This discussion should include the state's efforts to partner with families and individuals who are representative of the MCH communities being served to ensure that their needs are properly identified and appropriately addressed.

The state should further address specific roles and responsibilities of families, individuals, and family-led organizations at the direct care, organizational and governance, and policymaking levels and describe the outcomes and impacts of its established family partnerships on Title V program policies and activities. Specific impacts of family partnership on each of the five MCH populations and on the Title V program's cross-cutting and systems building activities should be included in the appropriate MCH domain narrative discussion.

c. Identifying Priority Needs and Linking to Performance Measures (Required Every Five Years)

Consistent with Figure 3, findings from the Five-Year Needs Assessment should drive the state's identification of its seven to 10 highest MCH priority needs for the five-year reporting cycle. The selected priorities may address the defined MCH population groups and/or cross-cutting/systems building areas, and they should reflect the unique needs of the state. In addition, the identified priority needs should address areas in which a state believes that targeted interventions can result in needed improvements to its health care delivery systems. Once identified, the priority needs inform the selection of NPMs and the development of SPMs. Collectively, the NPMs and SPMs should address the state's identified priority needs.

TVIS will prepopulate the priority needs provided in the previous year. States should review their priority needs to ensure alignment within the State Action Plan where priorities are linked with the existing National Outcome Measures (NOMs), NPMs, SPMs and ESMs. States can classify priority needs as New, Continued, or Revised under the following conditions:

• New: Priority Need is added
• Revised: Description is changed for a Priority Need provided in the previous interim year
• Continued: No changes for a Priority Need provided in the previous interim year.

The TVIS will record up to 10 priority needs, but a state can include additional priorities in a field note, if desired.

The narrative discussion supplements the listing of the final priority needs by providing a rationale for how the priority needs were determined and how they link with the selected national and state performance measures. Specifically, this discussion should include:

(1) Methodologies used to rank the broad set of identified needs and the state’s process for selecting its final seven to ten priorities;

(2) Emerging issues or other frequently cited needs that were not included in the final list of priority needs and a rationale for why they were not selected;

(3) Factors that contributed to changes in the state’s priority needs since the previous five-year reporting cycle; and

(4) Relationship between the priority need and the selected national and/or state performance measures in driving improvement.