Collaborating with Title V to Improve Maternal Health in Vermont

A few decades ago, the Vermont Department of Health’s (VDH) Title X Family Planning Program had an aha moment: their priority areas were strikingly similar to those of the Title V Maternal and Child Health (MCH) Block Grant team. This realization paved the way for a collaboration between the two teams that’s now woven into the fabric of VDH. 

The Title V MCH Block Grant is the only federal program of its kind devoted solely to improving public health systems for all mothers, children, and their families. The grant addresses six MCH priority areas: women/maternal health, perinatal/infant health, child health, adolescent health, children and youth with special health care needs (CYSHCN), and cross-cutting and systems building needs. 

Like many other states and territories, VDH uses Title V priority areas and national performance measures to guide the work of their Division of Family and Child Health (FCH), which includes Title X. For example, VDH’s 2025 Title V action plan has a goal to improve mental health outcomes and reduce substance use prior to pregnancy, during pregnancy, and in the postpartum period. To achieve that goal, VDH partners with Title X providers to screen for mental health and substance use issues, and provide wrap-around services and referrals for counseling and treatment.

At an operational level, the Title X and Title V teams collaborate by: 

• Sharing staff to help facilitate full integration of programming (e.g., one person manages both the Title V Block Grant and Title X program, the Title X nurse consultant also leads VDH’s Title V perinatal work)
• Leveraging Title X expertise for Title V workforce training (e.g., supporting home visiting nurses and postpartum doulas in providing contraception counseling)
• Drawing attention to Title V priority populations that might benefit from Title X services (e.g., CYSHCN before and during their transition to adulthood)
• Recognizing opportunities for Title X to align activities with Title V measures (e.g., making referrals to meet clients’ health-related social needs, like housing, food, and behavioral health support)
• Using FCH programs and other local health division resources to enhance the capacity of the small Title X team
• Identifying shared maternal health goals and measures (e.g., number of staff, community partners, and health care providers trained and equipped to provide postpartum education, screening, referrals, and follow-up)
• Having shared staff attend both the Association of Maternal and Child Health Programs (AMCHP) conference and Title X conferences to look for synergies

To enhance postpartum care, VDH has relied on the RHNTC’s High Impact Practice Set (HIPS) on postpartum services and the related measurement tool.

By combining efforts, VDH is using its limited Title V and Title X funds efficiently and effectively. VDH expects all staff, including the Title X Program Manager, to apply a broad systems lens, which allows them to see the interconnectedness of the work and the importance of intentionally building partnerships to strengthen systems and achieve greater impact.

“Sexual and reproductive health was usually ‘over here’,” says Courtney Smalt, Title X Program Manager and Title V Block Grant Coordinator. “You can do Title X in a silo but there’s an opportunity to do more.” Ilisa Stalberg, VDH Director of FCH, adds, “This [collaboration] helps to support the whole system of care and provide patients and families with a fuller experience.”

For other Title X projects interested in pursuing this type of collaboration, VDH suggests a simple next step: identify your state’s Title V director and start a conversation with them.