were later authorized to the bureau to provide states with direct funding for personal health services under the Sheppard-Towner Act of 1922. This landmark legislation was the first to establish the practice of giving states the funds to implement their own public health programs (NRC, 1988). In 1935, the role of MCHB was expanded with the enactment of Title V of the Social Security Act, which mandated that the bureau administer both maternal and child health service programs covering a broad spectrum of public health topics. The programs under Title V were converted and consolidated (under the same title) into the federal MCH Block Grant Program in 1981, a transformation that gave states more latitude in the expenditure of funds. The purpose of the block grant ($681 million in FY 1997) is to enable states to develop service systems in maternal and child health that reduce infant mortality, provide preventive and primary care services and immunizations, reduce adolescent pregnancy, and prevent injury and violence, among other goals (HRSA, 1997).

Under the MCH block grant, states are given funds on a formula basis (related to population and poverty indices) and are required to match 3 dollars for every 4 dollars they receive in federal appropriations. As a result of legislation in 1989, states are required to earmark funds for broad categories such as preventive and primary care services for children. Injury is subsumed under each major category, but not directly specified by the legislation. MCHB is committed to injury prevention and treatment through its Injury and Violence Prevention Program, which strives to reduce injury and violence among children and their families through a relatively modest portfolio of discretionary grants and contracts authorized under Title V and other authorities.

Discretionary grants and contracts constitute about 15 percent of the Title V block grant appropriation, but they cover a host of other maternal and child health topics besides injury. Title V grants and contracts fall under two authorities: the Special Projects of Regional and National Significance (SPRANS) and the Community Integrated Service Systems (CISS) (HRSA, 1997). In addition to these discretionary resources, the bureau and a related office within HRSA administers two other categorical grant programs that more directly address state and local injury prevention and control: the Emergency Medical Services for Children (EMS-C) and the Traumatic Brain Injury (TBI) programs.

Resources and Structure

MCHB spent a total of about $17.6 million in FY 1997 for injury prevention through four separate programs (described in the next section). In FY 1997, programs under Title V distributed about $2.3 million in injury-related grants and contracts. Another $12.5 million and $2.8 million were awarded under the EMS-C and the TBI programs, respectively. Funds were awarded for service delivery, research, demonstrations, training, and public education under four different grant and contract programs. All four programs, which make awards



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