The Title V Performance Measurement Framework
Title V uses a three-tier performance measurement framework designed to create a logic chain from population health outcomes down to state-level strategy implementation. Understanding this framework is essential for effective reporting and, more importantly, for using data to drive program improvement.
| Tier | Measure Type | Count | Purpose |
|---|---|---|---|
| Tier 1 | National Outcome Measures (NOMs) | 15 | Population-level health outcomes all states report on. Reflect broad MCH health status aligned with Healthy People 2030. |
| Tier 2 | National Performance Measures (NPMs) | 18 | States select a minimum of 8 NPMs to focus improvement efforts on. Represent factors that influence NOMs and are actionable at the state level. |
| Tier 3 | Evidence-based Strategy Measures (ESMs) | State-defined | Track implementation of specific strategies tied to each selected NPM. At least one ESM per selected NPM. |
The logic chain works as follows: ESMs track whether the state is implementing its chosen strategies (Tier 3). Those strategies, if evidence-based and well-implemented, should improve the selected NPMs (Tier 2). Improvements in NPMs should ultimately contribute to better population health outcomes as measured by NOMs (Tier 1). This framework creates accountability at every level while giving states flexibility to choose strategies appropriate to their context.
National Outcome Measures (NOMs)
All 59 states and jurisdictions report on the same 15 NOMs. These are population-level measures drawn primarily from national data systems. States do not select their NOMs — all are required. The 15 NOMs span the Title V population domains:
| NOM | Measure | Primary Data Source |
|---|---|---|
| NOM 1 | Percent of women who reported a preventive dental visit during pregnancy | PRAMS |
| NOM 2 | Rate of severe maternal morbidity per 10,000 delivery hospitalizations | State inpatient data / SID |
| NOM 3 | Maternal mortality rate per 100,000 live births | Vital statistics |
| NOM 4 | Percent of low birth weight deliveries (<2,500 grams) | Vital statistics |
| NOM 5 | Percent of preterm births (<37 weeks gestation) | Vital statistics |
| NOM 6 | Percent of early term births (37-38 weeks gestation) | Vital statistics |
| NOM 7 | Percent of non-medically indicated early elective deliveries | State perinatal data |
| NOM 8 | Perinatal mortality rate per 1,000 live births plus fetal deaths | Vital statistics |
| NOM 9 | Infant mortality rate per 1,000 live births | Vital statistics |
| NOM 10 | Neonatal mortality rate per 1,000 live births | Vital statistics |
| NOM 11 | Post-neonatal mortality rate per 1,000 live births | Vital statistics |
| NOM 12 | Percent of children with and without special health care needs having a medical home | NSCH |
| NOM 13 | Percent of children meeting the criteria for being overweight or obese | WIC / NSCH |
| NOM 14 | Percent of children ages 1-17 who have decayed teeth or cavities | NSCH |
| NOM 15 | Child mortality rate per 100,000 (ages 1-9) and adolescent mortality rate per 100,000 (ages 10-19) | Vital statistics / CDC WONDER |
NOMs are primarily derived from national data systems, which means states do not collect NOM data directly through their own surveys. Instead, NOMs are populated through vital statistics, the National Survey of Children's Health (NSCH), PRAMS, and other federal data sources. The state's role is to interpret NOM trends, connect them to their Title V strategies, and use them as context for understanding whether their work is contributing to population-level improvement.
National Performance Measures (NPMs)
NPMs are the actionable middle tier of the framework. Each state selects at least 8 NPMs spanning at least 5 of the 6 population health domains. NPMs represent factors that are modifiable through state-level MCH programs and that logically contribute to NOM improvement. For the complete NPM list and selection guidance, see the Application & Needs Assessment Guide.
NPM data comes from a mix of national surveys (NSCH, NIS, PRAMS) and state-collected data. States are responsible for ensuring that the data supporting their NPM reporting is accurate, timely, and methodologically sound. Where NPM data comes from national surveys, states must understand the survey methodology, sample sizes, confidence intervals, and data release timelines for their state.
NPM Reporting Requirements
For each selected NPM, states must report through TVIS:
- Current data: The most recent available data point for the measure
- Trend data: At least five years of historical data showing the trajectory of the measure
- Annual objective: A specific numeric target for the coming year, set based on trend analysis and program capacity
- Narrative interpretation: Analysis of the data trend, explanation of factors driving performance, and connection to state strategies
- Disaggregated data: Where available, breakdowns by race/ethnicity, geography, and other equity-relevant dimensions
Evidence-based Strategy Measures (ESMs)
ESMs are the most operationally actionable tier of the framework. Unlike NOMs and NPMs, which are standardized nationally, ESMs are defined by each state to track the implementation of its own strategies. A state must define at least one ESM for each selected NPM, though many states develop multiple ESMs per NPM.
ESM Data Collection
Because ESMs are state-defined, the data collection infrastructure for ESMs must be built by the state. This is where many states struggle — they define ambitious ESMs during the application process but lack the data systems to actually measure them. Common ESM data sources include:
- Program administrative data: Service delivery records, training attendance logs, provider participation data from Title V-funded programs
- Sub-recipient reporting: Data collected from local health departments and other sub-recipients through standardized reporting templates
- State surveillance systems: Data from state-operated registries, surveillance programs, or quality improvement collaboratives
- Partner agency data: Data shared by Medicaid, WIC, early intervention, or other partner agencies through data-sharing agreements
Before finalizing an ESM, ensure that the data needed to calculate it is actually available or can be made available within the reporting timeline. An ESM that cannot be measured is worse than useless — it creates a reporting gap that will be flagged during MCHB review.
Key Data Sources for Title V Reporting
Title V reporting draws on a constellation of data sources. Understanding these sources, their strengths, limitations, and release timelines is essential for accurate and timely reporting.
| Data Source | Measures Supported | Key Characteristics |
|---|---|---|
| Vital Statistics | NOMs 3-11, 15; NPM 2 | Birth and death certificates. Complete population data (not sampled). 1-2 year data lag. |
| NSCH | NOMs 12-14; NPMs 6, 8, 10, 11, 12, 14 | National Survey of Children's Health. Annual, parent-reported survey. State-level estimates available. |
| PRAMS | NOM 1; NPMs 1, 4, 5 | Pregnancy Risk Assessment Monitoring System. State-based survey of recent mothers. Not all states participate. |
| NIS | NPMs related to immunization | National Immunization Survey. Phone survey + provider verification. State-level estimates. |
| State-specific data | ESMs, some NPMs | Medicaid claims, state registries, program administrative data. Quality and availability vary widely by state. |
Performance Trend Analysis
TVIS requires states to report multi-year trend data for each NOM and NPM. Trend analysis is not just a reporting requirement — it is the analytical foundation for program improvement. Effective trend analysis includes:
- Multi-year trajectory: At least five years of data to distinguish meaningful trends from year-to-year fluctuations. Pay attention to confidence intervals for survey-based measures — apparent changes may not be statistically significant.
- Comparison to national benchmarks: How does your state compare to the national average and to Healthy People 2030 targets? Are you above, below, or on pace?
- Equity disaggregation: Breaking data down by race/ethnicity, geography (urban/rural), income, and other dimensions to identify disparities that the statewide average masks
- Strategy-outcome linkage: Can you connect changes in NPM trends to the implementation of specific Title V strategies? This is the most challenging and most valuable type of analysis.
The TVIS Application/Report Cycle
Because the Title V application and annual report are combined into a single document, the reporting cycle is integrated with the application cycle. Each year, states simultaneously report on the prior year and apply for the coming year. The typical workflow follows the federal fiscal year (October 1 – September 30):
- Q1 (Oct – Dec): Grant year begins. Compile prior year data. Identify data gaps. Begin drafting narratives.
- Q2 (Jan – Mar): Complete data entry for NOMs, NPMs, and ESMs. Finalize report narratives. Begin application sections.
- Q3 (Apr – Jun): Submit combined application/report through TVIS. Deadline typically falls in this quarter.
- Q4 (Jul – Sep): MCHB review. Address any requested revisions. Receive notice of award. Prepare for new year.
Building Data Capacity for Title V Reporting
Many state MCH programs struggle with data capacity. Investing in data infrastructure is not just a compliance necessity — it is the foundation for program improvement. Key areas to invest in include:
- MCH epidemiology capacity: Dedicated epidemiologists who understand Title V measures, data sources, and analytical methods. Many states fund MCH epidemiology positions through Title V.
- Data-sharing agreements: Formal agreements with Medicaid, vital records, WIC, immunization registries, and other data-holding agencies to ensure timely access to MCH data.
- Sub-recipient data standards: Standardized data collection templates and reporting formats for local agencies receiving Title V funds, ensuring consistency across the state.
- Data visualization and dashboards: Tools that allow program staff and leadership to monitor performance measures in real-time rather than waiting for annual TVIS compilation.
The Discretionary Grants Information System (DGIS)
In addition to TVIS, MCHB uses the Discretionary Grants Information System (DGIS) for reporting on competitive MCHB grants (SPRANS, CISS, and other discretionary programs). If your state receives both Title V block grant funds and MCHB discretionary grants, you will use both TVIS and DGIS. The two systems have different interfaces, reporting requirements, and timelines, so it is important to track obligations in each system separately.