Title V MCH Application & Needs Assessment Guide

The Title V Application Process

The Title V application process is fundamentally different from competitive grant applications. States do not submit proposals through Grants.gov or compete against other states for funding. Instead, they complete a combined application and annual report through the Title V Information System (TVIS), an online platform managed by MCHB. The combined document serves dual purposes: it reports on the prior year's performance while simultaneously applying for the coming year's funding.

This integrated approach means that your application quality is directly tied to your reporting quality. States that collect strong performance data and can demonstrate measurable progress on their selected National Performance Measures will produce stronger applications. States that struggle with data collection will find it difficult to build compelling narratives about their program impact.

TVIS: The Title V Information System

TVIS is the central platform for all Title V application and reporting activities. Every state and jurisdiction uses TVIS to submit their combined application/annual report to MCHB. The system captures:

• Executive summary: State overview, program highlights, and legislative/budget developments affecting MCH
• Needs assessment updates: Five-year comprehensive assessment plus annual updates documenting changes in MCH needs
• State action plans: Detailed strategies and activities for each selected NPM, organized by population domain
• Performance measure data: NOMs, NPMs, and ESMs with trend data, targets, and narrative interpretation
• Budget information: Federal allocation, state match, set-aside compliance, and expenditure categories
• Assurance narratives: Documentation of compliance with Title V legislative requirements

TVIS access is limited to authorized state Title V staff. MCHB assigns login credentials and provides technical support for the system. States should identify a primary TVIS coordinator and at least one backup to ensure continuity during staff transitions.

The Five-Year Needs Assessment

The statewide MCH needs assessment is the foundation of the entire Title V program. Title V legislation requires a comprehensive assessment at least every five years, with annual updates in the intervening years. The needs assessment drives everything: which populations the state prioritizes, which NPMs it selects, what strategies it implements, and how it allocates resources.

Needs Assessment Components

A comprehensive Title V needs assessment typically includes the following elements:

• Quantitative health data analysis: Vital statistics (birth and death data), PRAMS (Pregnancy Risk Assessment Monitoring System), NIS (National Immunization Survey), NSCH (National Survey of Children's Health), BRFSS (Behavioral Risk Factor Surveillance System), hospitalization data, Medicaid claims data, and state-specific surveillance systems
• Social determinants of health data: Poverty rates, unemployment, educational attainment, food insecurity, housing instability, environmental exposures, and access to transportation
• Stakeholder input: Surveys, focus groups, interviews, and town halls with families, providers, community organizations, tribal partners, public health staff, and other stakeholders across the state
• Health equity analysis: Disaggregated data examining disparities by race/ethnicity, geography (urban/rural), income, language, disability status, and other characteristics
• Capacity and resource assessment: Inventory of existing MCH programs, services, and workforce; identification of gaps in service delivery capacity and geographic coverage
• Priority identification: A structured process for ranking MCH needs and identifying the state's top priorities for the coming five-year period, documented with the criteria and methodology used

The Needs Assessment Cycle

The five-year cycle is coordinated nationally, with all states conducting their comprehensive needs assessment during the same period. The most recent cycle aligned with the federal fiscal year schedule. States typically begin planning their needs assessment 12 to 18 months before the comprehensive assessment year, conduct the assessment over 6 to 12 months, and then use the findings to select NPMs and develop state action plans for the coming five-year block.

In the years between comprehensive assessments, states submit annual needs assessment updates through TVIS. These updates document emerging issues, changes in MCH conditions, and any adjustments to state priorities. Annual updates are less intensive than the comprehensive assessment but require ongoing surveillance and stakeholder engagement.

Selecting National Performance Measures (NPMs)

One of the most consequential decisions a state makes during the needs assessment cycle is selecting its NPMs. The 18 NPMs span the six population health domains, and each state must select a minimum of 8 NPMs covering at least 5 of the 6 domains. The selected NPMs define the state's measurement focus for the entire five-year period.

The table above represents a selection of NPMs. The complete set of 18 NPMs is available through the MCHB/HRSA Title V performance framework documentation. States should select NPMs that align with their needs assessment priorities, where they have the capacity to implement evidence-based strategies, and where they can reasonably expect to move the measure within the five-year period.

Developing Evidence-based Strategy Measures (ESMs)

For each selected NPM, states must develop at least one Evidence-based/informed Strategy Measure (ESM). ESMs are state-defined measures that track the implementation of specific strategies the state is using to improve the NPM. The ESM framework creates a logic chain: the state selects an NPM based on the needs assessment, identifies evidence-based strategies to improve that NPM, and develops ESMs to track whether those strategies are being implemented as planned.

ESM Design Principles

Well-designed ESMs share several characteristics:

• Specificity: The ESM should measure a specific, concrete strategy — not a broad program area. "Number of providers completing safe sleep training" is more specific than "percent of communities with safe sleep programs."
• Measurability: The state must be able to actually collect the data needed to calculate the ESM. Avoid creating ESMs that depend on data systems you do not yet have in place.
• Evidence linkage: The ESM should logically connect to the NPM through an evidence-based theory of change. If the strategy is implemented (as measured by the ESM), there should be reasonable evidence that it will improve the outcome (as measured by the NPM).
• Actionability: The ESM should measure something the state can directly influence through Title V-funded activities. Population-level measures that are affected by many factors beyond the state's control are better suited as NOMs, not ESMs.

The MCH Evidence Center provides curated evidence reviews aligned with each NPM, helping states identify evidence-based strategies and develop corresponding ESMs. Leveraging these resources can significantly strengthen your ESM selection.

State Action Plan Structure

The state action plan is the strategic core of the TVIS application. It describes what the state will do to improve each selected NPM, organized by population health domain. For each NPM, the action plan should include:

• Needs assessment connection: How the needs assessment findings led to prioritization of this NPM
• Baseline data and targets: Current performance on the NPM, trend data, and specific improvement targets
• Strategies and activities: Detailed description of evidence-based strategies the state will implement, including who will implement them, where, and at what scale
• ESM definitions: The ESMs selected to track strategy implementation, with numerators, denominators, and data sources
• Health equity considerations: How the strategy addresses disparities within the target population

Budget Justification

The TVIS application includes a budget section that demonstrates how the state will allocate its federal Title V funds and state match across program areas. The budget must show compliance with the 30/30/10 set-asides and the match requirement. For detailed guidance on budget preparation and financial management, see the Budget & Financial Management section of this guide.

The budget justification should clearly connect resource allocation to the state action plan. MCHB reviewers look for alignment between stated priorities and budget allocations. If your needs assessment identifies adolescent health as a top priority and your action plan includes specific strategies for improving adolescent well-visits, but your budget allocates minimal resources to adolescent health programs, the disconnect will be flagged during review.

The Federal Review Process

MCHB reviews each state's TVIS submission through a structured process. While Title V is not a competitive grant, the review does assess whether the state's application meets legislative requirements and programmatic standards. The review addresses:

• Legislative compliance: Set-asides, match, MOE, and other statutory requirements are met
• Needs assessment quality: The assessment is comprehensive, uses appropriate data sources, includes meaningful stakeholder engagement, and identifies priority populations
• NPM and ESM alignment: Selected NPMs connect logically to needs assessment priorities, and ESMs are well-defined with appropriate evidence linkages
• Performance trends: The state's performance data shows progress, stability, or is accompanied by credible explanations for declines
• Budget-strategy alignment: Resource allocation connects logically to stated priorities and strategies

MCHB may provide feedback and request revisions to the state's TVIS submission. Each state has an assigned MCHB Project Officer who serves as the primary federal point of contact for the review process and ongoing technical assistance. Building a strong working relationship with your MCHB Project Officer is one of the most important things a state MCH director can do.

Annual Application Timeline

The Title V grant year aligns with the federal fiscal year (October 1 through September 30). The typical annual application/report cycle follows this pattern:

States should build their internal data collection and reporting processes around this cycle. Waiting until the TVIS submission deadline to begin compiling data is a recipe for incomplete and low-quality submissions. For guidance on building effective data systems, see the Reporting & Performance Measures section.

Tips for a Strong TVIS Submission

• Start with the needs assessment: Every element of your application should trace back to a finding in your needs assessment. If it does not, either the needs assessment is incomplete or the activity is not a Title V priority.
• Be specific in narratives: Avoid generic language. Instead of "the state will improve breastfeeding rates," describe the specific evidence-based strategies, target populations, implementation sites, and expected reach.
• Document data sources: For every performance measure, clearly identify the data source, the time period covered, and any limitations or caveats. MCHB reviewers value transparency about data quality.
• Address health equity explicitly: Disaggregate data by race/ethnicity and geography wherever possible, and describe how your strategies address identified disparities. This is increasingly important in MCHB reviews.
• Engage your MCHB Project Officer early: Do not wait until the submission deadline to reach out. Your Project Officer can provide guidance on MCHB expectations and help you strengthen your submission before it enters formal review.