āTitle V Program Background
āThe mission of the California Department of Public Health (CDPH) is to advance the health and well-being of people and communities in California. The Maternal, Child, and Adolescent Health Division (MCAH) is one of three divisions under the Center for Family Health (CFH) in CDPH. MCAH administers the Title V Maternal and Child Health Services Block Grant Program.
CDPH/MCAH supports 61 Local MCAH Programs, based in 58 counties and three cities, which differ widely by population, geography, and socioeconomic factors. Californiaās counties include major metropolitan areas as well as rural and frontier counties; glāāobal centers for agriculture, the arts, culture, technology, and innovation; geography ranging from coastal areas and mountains to the desert; nine National Parks; an international border; and countless other unique characteristics. Local MCAH programs play a critical role in the collaborative development of priorities and strategies that drive the MCAH mission. CDPH/MCAH also strengthens the capacity of Local Health Jurisdictions (LHJs), communities, and Community-Based Organizations (CBOs) and leverages the MCAH infrastructure provided by Title V to improve the health and well-being of women, infants, children, and adolescents throughout the state. CDPH/MCAH programs and initiatives serve California's diverse populations and regions, providing resources, information, and data on physical, emotional, mental, and social health.
In addition to Local MCAH programs, Title V supports a variety of other programs such as the Black Infant Health Program (BIH) and the Adolescent Family Life Program. CDPH/MCAH funds and supports partnerships with state and local agencies, CBOs, and universities to drive programmatic efforts that improve the health of the MCAH population. CDPH/MCAH also collaborates with partners across the state on topics including oral health, trauma and violence prevention, infectious and genetic diseases, nutrition support, adolescent sexual health, maternal and perinatal quality of care, developmental screening, and others. CDPH/MCAH recognizes the integral role that families play in the health of mothers, infants, children, and adolescents and engages in ongoing efforts to increase family involvement as an important aspect of its Title V work.
Health Equity: A Core Focus
āAchieving health and well-being for all Californians means acknowledging and addressing health disparities. CDPH/MCAH recognizes that systemic inequities based on race/ethnicity, gender, sexual orientation and gender identity, and disability, along with poverty, trauma, geography, and other social and environmental factors, have an interconnected impact on physical and mental well-being. CDPH/MCAH utilizes a health equity lens throughout its Title V Programs and will continue to expand this focus in the future. CDPH/MCAH programs connect families to economic, social, and physical supports and services that can help mitigate the impact of discrimination and poverty on their physical and mental/emotional health. CDPH/MCAH recognizes the need to listen to and learn from its population for program development and improvement, and to ensure that their needs are addressed.
CDPH/MCAH is committed to exploring and addressing both the causes and the effects of structural injustices on mothers, infants, children, and adolescents within Californiaās communities. As one example, between 2018-2020, the pregnancy-related mortality ratio for Black women and birthing people was three to four times greater than the mortality raāātios for Asian, Hispanic/Latino, and White persons. CDPH/MCAH has undertaken several efforts, including expansion of the BIH program and establishment of the Perinatal Equity Initiative, to reduce racial health disparities in birth outcomes among Black women and birthing people. New State General Funds, distributed in 2020 and 2023, were allocated to improve and expand the BIH program. This expansion included changes such as offering one-on-one case management for participants who are unable to attend group sessions, and support for a public education campaign to increase awareness of inequities and poorer birthing outcomes for Black women and birthing people. To highlight these inequities, CDPH released the āCentering Black Mothers Reportā in 2023, describing how social policies, structural racism, and community and neighborhood conditions impact the health of Black birthing people and babies.
CDPH has an active Office of Health Equity, and our staff participate in the departmentās racial equity initiative. A Health Equity Liaison position has been filled within CFH to help embed racial and health equity into policies, programs, and services. While CDPH/MCAH has made significant strides in health equity, a great deal of work is still left to do. CDPH/MCAH reflects some of the core planned activities for 2021-2025 and will continue to explore and work with community partners to do more to address racial and health equity.
Impacts on the MCAH Workforceā
As California continues to emerge from the COVID-19 crisis, CDPH/MCAH has worked to redesign and recalibrate programs and initiatives, especially those disproportionately impacted. The CDPH/MCAH response to the pandemic's secondary effects on the MCAH population includes assessing these impacts on families in the state. Notable population burdens resulting from the pandemic include increased mental health issues; loss of social support and connection; increased risk of preterm births, stillbirth, and other pregnancy complications; increased violence, childhood adversity, and trauma; disrupted access to health care, social services, and education; and increased economic hardships such as food insecurity and employment loss. CDPH/MCAH also continues to monitor other secondary impacts of the pandemic on California families.
Over the past couple of years, CDPH/MCAH has received a series of new funding from the State General Fund that has enabled the division to undergo a significant expansion. Large funding increases include the following: the BIH Program ($18 million), the California Home Visiting Program (CHVP) ($37.5 million), the Future of Public Health (FoPH) ($2.9 million) and SB 65 ā The CA Momnibus Act ($5.5 million). The CHVP State General Fund expansion will support increased evidence-based home visiting services with funding available to every LHJ which applies. The increased BIH Program funding will support the expansion of the BIH evidence-informed model over the next five years to maximize reach. The new FoPH funding supports a significant expansion of emergency preparedness and mental and behavioral health efforts. The new SB 65 funding will support enhanced maternal mortality investigations and severe maternal morbidity deliberations. At the same time, this important expansion is impacting the existing CDPH/MCAH workforce as it works toward filling many new positions.
Public health and health care are facing a crisis-level workforce shortage, leading to difficulties with filling vacancies both at the state and local level. These difficulties have affected MCAH programs, as well as all the other sectors that serve MCAH populations, including education, childcare, early intervention, and others. This is an ongoing issue that will require statewide efforts to address.ā