peter c. van dyck, md, mph associate administrator for maternal and child health
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Health Resources and Services Administration
Maternal and Child Health Bureau
Annual MeetingAssociation of State and Territorial Public Health
Nutrition Directors
June 10, 2008Peter C. van Dyck, MD, MPH
Associate Administrator for Maternal and Child HealthHealth Resources and Services Administration
June 2008 2
MCH Bureau
June 2008 3
MCH Budget for 2007 and 2008 (millions)
MCHBG…$693.0….$693.0….$750.0….$673.0….$666.2 State..….$566.5...$578.9…..$568.9...$566.5…$556.6 SPRANS...$99.9…$102.2…..$100.4..…$79.9.….$78.6 CISS………$10.6…$11.9......$10.1….…$10.6…...
$10.4 Earmark...$16.0…------….….$70.6…...$16.0…...$20.6
FY2007
2008(PB)
1-numbers may not add due to rounding
2008(H)2008(S)2008(APPR)
June 2008 4
MCH Budget for 2007 and 2008 (millions)
Healthy Start...$101.5...$100.5...$120.0...$101.5…$99.7 Hearing…….….....$9.8…...-----.……$11.0.…$12.0….$11.8 EMSC……….…….$19.8.....-----…….$22.3..…$20.0.…$19.5 TBI………….………$8.9…...-----….….$8.9……$10.0…..$8.8 Sickle Cell….…....$2.2…...$2.2………$2.2.….$3.2…….$2.7 Family to Family.$3.0…...$4.0………$4.0…..$4.0…….$4.0 Autism………….….-----…...-----……..$0.0…...$37.0….$36.4
FY2007
2008(PB)
1-numbers may not add due to rounding
2008(H) 2008(S)2008(A)
June 2008 5
MCH Budget for 2007 and 2008 (millions)
SPRANS Earmarks Oral Health…...$4.80…$0.0….$12.0…….$4.8……$4.72 Sickle Cell…..…$3.84…$0.0…...$4.0…….$3.84.…$3.77 Epilepsy…….....$2.88...$0.0……$5.8..….$2.88….$2.83 Genetics….….…$1.92…$0.0..….$3.8..….$1.92….$1.89 Mental Health..$1.54…$0.0…….$0.0…...$0.0……$0.0 Fetal Alcohol.…$0.99…$0.0…….$0.0…...$0.99….$0.97 1rst Mother……..-----….-----……..-----..…$1.54….$1.51 Prepare Birth…..-----….-----…...$15.0….…-----…..$4.9 Autism……………-----…..-----……$30.0…….-----…..$0.0
2007
1-numbers may not add due to rounding
2008(PB)2008(H)2008(S)2008(A)
June 2008 6
MCH Bureau
June 2008 7
MCHB Data MCH Block Grant – Title V Information System
(TVIS) https://performance.hrsa.gov/mchb/mchreports
Discretionary Grants – Discretionary Grants Information System (DGIS) https://perfdata.hrsa.gov/MCHB/DGISReports/
default.aspx Chartbooks and Reports on Women’s and
Children’s Health http://www.mchb.hrsa.gov/data/chartbooks.htm
Evaluation and Epidemiological Surveys, Reports, Resources and Training http://mchb.hrsa.gov/programs/dataepi/
June 2008 8
DGIS Released in April 2008
Companion information system to TVIS. Tracks performance measurement and program
data for MCHB’s discretionary grants (e.g., Financial data, grantees’ reporting on a total of 36 National Performance Measures, Project Abstracts, and other program data.)
Data collection began in October 2004. Nearly two years of complete data has been collected and is available for viewing at the DGIS website: https://perfdata.hrsa.gov/MCHB/DGISReports/default.aspx
June 2008 9
DGIS Web Reports
June 2008 10
DGIS - 37 Discretionary Performance Measures
08) Percent of graduates of MCHB long-term training programs that demonstrate field leadership after graduation.
33) The degree to which a State system for nutrition services has been established for MCH populations.
June 2008 11
TVIS - MCH Block Grant 18 National Performance
Measures
11) The percent of mothers who breastfeed their infants at 6 months of age. (Revised in 2006 from “The percent of mothers who breastfeed their infants at hospital discharge.”)
14) Percentage of children, ages 2 to 5 years, receiving WIC services with a Body Mass Index (BMI) at or above the 85th percentile. (New performance measure beginning in 2006.)
June 2008 12
TVIS - Obesity/OverweightState Performance
Measures
Total number of obesity State performance measures reported and number of States reporting on such a measure increased significantly between 2002 and 2005.
2002 200520 measures reported 45 measures reported by 19 States by 37 States
FY 2006 – 42 measures reported by 35 States(NPM #14 added in 2006 application)
June 2008 13
TVISState Performance
Measures
Nutrition and Physical Activity In 2006:
47 States with 73 Performance Measures (Obesity Measures Included)
25 States with 31 Measures Not Related to Obesity
In 2000 41 States with 60 Performance Measures
(Obesity Measures Included)
June 2008 14
Changes in MCH Priorities Between 2000 and 2005
Among new priority areas identified in 2005, there was a substantial increase in the number of States that identified the need to reduce overweight and obesity.
2000 2005 Obesity and Overweight 10 States 33 States
Nutrition/Physical Exercise 9 States 15 States
(Under contract funding from MCHB, report prepared by Cecil G. Sheps Center for Health Services Research, UNC at Chapel Hill, Meeting State MCH Needs: A Summary of State Priorities and Performance Measures, January 2008.)
June 2008 15
2005 State MCH Priority Needs
State has Nutrition/Physical Activity priority need
State has Obesity/Overweight priority need.
State has Obesity /Overweight and Nutrition/Physical Activity priority need
State and Jurisdictional MCH Agencies with Obesity & Overweight and Nutrition & Exercise as Priority Needs in Their 2005 Needs Assessment
June 2008 16
Healthy People 2010 Progress Review
Nutrition and Overweight
1 Presentation by Dr. Edward Sondik, NCHSWebsite: http://www.cdc.gov/nchs/about/otheract/hpdata2010/focusareas/fa19-nutrition2.htm
Summary Presented at April 3, 2008 Meeting1: Weight status objectives for children,
adolescents and adults moved away from their targets.
Fruit, vegetable and grain objectives, total usual sodium intake showed little or no progress.
Total usual calcium intake moved toward the target.
The weight status and diets of Americans remain an important public health and economic concern.
June 2008 17
MCHBNutrition Strategic Plan
June 2008 18
Child and Adolescent Overweight and Obesity
Expert Panel Convened in February 2005 to Develop Recommendations for the Prevention, Assessment, and Treatment of Child and Adolescent Overweight/Obesity (AMA in collaboration with HRSA and CDC)
Committees’ recommendations were released in Pediatrics Journal supplement in 2007.
June 2008 19
Healthy Tomorrows Partnership for Children
Program
Promotes child health by encouraging communities to: Enhance prevention programs; and Make health care for every child more
accessible.
A total of 54 projects are currently funded in 44 States, Guam and Puerto Rico.
10 innovative, community-based grants have a focus on child health issues, such as obesity prevention, healthy lifestyle and physical activity.
June 2008 20
Reexamination of IOM Pregnancy Weight
Guidelines Funding provided by HRSA (along with
other Federal agencies and the March of Dimes) to support an Ad Hoc Committee to review and update the 1990 IOM pregnancy weight gain recommendations.
Committee will also recommend ways to encourage the adoption of the revised guidelines through consumer education, implementation strategies for practitioners, and public health strategies.
June 2008 21
Reexamination of IOM Pregnancy Weight
Guidelines Report will be issued at the end of the 22-
month project (Summer 2009). January 2008 - Sponsor Meeting March 10-11,2008 – Irvine, CA
Meeting 1: “Biological, Behavioral, and Social Determinants of Gestational Weight Gain and Pregnancy Outcome.”
June 5-6,2008 – Washington, DC Meeting 2: “Implications of Weight Gain for Pregnancy Outcomes: Issues and Evidence.”
June 2008 22
Innovative Approaches To Promoting
a Healthy Weight in Women
Purpose: To develop creative, innovative approaches that are effective in reducing the prevalence of overweight/obesity in women.
Efforts must target women in communities with limited access to preventive health services, particularly women of color, who are disproportionately affected by this risk factor.
12 Grantees have been funded for approximately $150,000/year for 3 years. (3 Grants awarded in 2004; 4 Grants awarded in 2005; and 5 Grants awarded in 2006.)
June 2008 23
National Business Group on Health
MCHB nutrition staff serve on the Obesity Institute, an initiative that encourages members to: Network with other corporate leaders to
raise awareness about the health and cost consequences of obesity.
Identify and test solutions to obesity that have a positive return on investment.
Advance health plans’ and vendors’ efforts to implement solutions.
June 2008 24
National Business Group on Health
The Obesity Institute has established a new committee - Leadership Committee on Innovation in Health Behavior Change.
Mission is to: 1) Understand perceptions and overcome
resistance to behavioral change messages and products; and
2) Identify the best new ideas with application to corporate health improvement and risk reduction programs.
June 2008 25
MCHBNutrition Strategic
Plan
June 2008 26
Breastfeeding Support
Systems Support Liaison to the U.S. Breastfeeding Committee
Provider Support Academy of Breastfeeding Medicine AAP Breastfeeding Promotion in Physicians’
Office Practices (BPPOP) Focus is on educating and supporting future and
practicing physicians and health care professionals in culturally effective breastfeeding promotion and support – directed at achievement of Healthy People 2010 goals.
June 2008 27
Breastfeeding Provider Support - BPPOP
Current Activities: Finalizing breastfeeding curriculum and
tools for medical residency training programs, which have been tested and are currently undergoing evaluation.
Creating a micro-site off the www.aap.org/breastfeeding website to house curriculum materials.
Performing cost-benefit analysis on curriculum implementation.
June 2008 28
The Business Case for Breastfeeding
New HRSA resource kit developed to improve lactation support in the workplace.
June 2008 29
Business Case for Breastfeeding
Goals are to:
1) Increase awareness among employers of
the economic benefits of breastfeeding; 2) Outline manageable and flexible models
for implementing or enhancing a worksite breastfeeding support program, and
3) Increase the number of U.S. employers that utilize a worksite breastfeeding support program.
June 2008 30
Impact of Employmenton Breastfeeding
Full-time employment shortens breastfeeding duration(Fein & Roe 1998)
Most women wean before end of first month back at work(Cardenas 2005)
Common challenges: Maintaining milk production Job settings not always
conducive to milk expression Lack of empathy/support
June 2008 31
U.S. Breastfeeding Rates
75
50
25
40
17
73.8
41.5
20.9
30.5
14.2
0
10
20
30
40
50
60
70
80
Initiation 6 months 12 months Exclus - 3mos
Exclus - 6mos
Healthy People 2010 Goal 2004 Rate
Source: Centers for Disease Control and Prevention
June 2008 32
Women in the Workforce
60 percent of women work outside the home.
Mothers are the fastest growing segment of the U.S. workforce: 55 percent with children under age 3 are
employed. 62 percent with children under age 6 are
employed. 78 percent are employed full-time. Growth rate has increased by 80 percent
over the last 20 yearsU.S. Department of Labor, Commission on Leave (2007). FMLA Survey.
June 2008 33
Women in the Work Force
70.6
6359.9
70.1
6259.3
76.171
66.266.6
60.256.8
5248.1
60.5
0
10
20
30
40
50
60
70
80
With Children Children Under Age 6 Children Under Age 3
Women Caucasian African Am Asian Hispanic
17
June 2008 34
Disparities in Breastfeeding
Women of lower Socioeconomic Status (SES) have lower rates of breastfeeding among all racial/ethnic groups.
African American women consistently have lower rates of BF (CDC MMWR, 2007)
African-American women are more likely to return to full time work sooner. (Cricco-Lizza, 2002; Bronner, 1996)
June 2008 35
Business perspective Designed for multiple groups Based on research and
strategy Includes:
Resource Kit: The Business Case for Breastfeeding
Full kits and individual components available from MCHB at: www.ask.hrsa.gov or 1-888-ASK HRSA
Training and TA
June 2008 36
Component 1: For Business Managers
The Business Case for Breastfeeding
Target: Employers Key content:
Bottom line benefits to supporting breastfeeding
Quick overview of what comprises a lactation support program
Available individually
June 2008 37
Component 2: Easy Steps to Supporting
Breastfeeding Employees
Target: Human Resource Managers
Key content: Lactation support program
options Implementation strategies Gaining buy-in Promotion
Available individually
June 2008 38
Component 3: Tool Kit
Target: Human Resource Managers
Key Content: CD-ROM with reproducible templates Worksite policy Assessment and feedback
forms Promotional items Resource Guide Employer Snapshots
June 2008 39
Component 4: Employees’ Guide to Breastfeeding and
Working
Target: Pregnant and Breastfeeding Employees
Key content: Combining breastfeeding
and employment Ways to talk with
supervisor and colleagues about breastfeeding needs
Available individually
June 2008 40
Component 5: Outreach Marketing Guide
Target: Lactation educators and outreach workers
Key content: Conducting effective
outreach w/businesses Supporting working mothers “Outreach Marketing
Resources” CD-ROM PowerPoint presentation Templates for outreach
letters Legislative language Lesson plans
June 2008 41
Training Workshops State Breastfeeding Coalitions (SBCs)
January 2008 – 10 SBCs trainedCalifornia Connecticut Georgia HawaiiIndiana Louisiana Oregon R.I.
Texas Utah 2009-2010 – additional SBCs to be
trained
Healthy Start Communities 2008 – 6 Healthy Start communities
Baltimore Washington, D.C. BirminghamDublin, GA Michigan Inter-Tribal Fresno, CA
2009-2010 – additional HS trainings
June 2008 42
National Business Group on Health (NBGH)
Recently issued a Model Benefit Plan for Maternal and Child Health (supported by MCHB and the Office on Women’s Health.)
Preventive Postpartum Care Recommendation: Breastfeeding counseling and support by
credentialed lactation consultants. MCHB is providing supplemental funding
to NBGH to adapt Resource Kit for work with large Fortune 500 companies.
June 2008 43
MCH Bureau
June 2008 44
The Community-Based Doula Program
Purpose: to provide first time motherhood demonstration programs to urban and rural communities to support community-based Doulas.
This approach identifies and trains indigenous community workers to mentor pregnant women during the months of pregnancy, birth and at least twelve (12) weeks post-partum, (optimally one year post-partum).
June 2008 45
The Community-Based Doula Program
Up to (6) awards will be made to urban and rural community-based organizations to support community-based Doula activities to improve infant health, strengthen families and provide support to ensure family success.
Funding for the rural portion of the demonstration should focus on the best ways of delivering supportive services, including delivery outside the hospital setting both before and after the birth of the child.
Priority will be given to applications which emphasize breastfeeding initiation and retention.
June 2008 46
The Community-Based Doula Program
Up to (1) award will be made to an organization with expertise in replicating community-based Doula programs, to offer outreach, training, technical assistance and evaluation services to the Doula grantees in order to maximize project effectiveness and quality care across all projects.
HRSA’s Maternal and Child Health Bureau was allotted $1.4 million to launch the Community-Based Doula Initiative through the Consolidated Appropriations Act 2008 (P.L. 110-161) .
June 2008 47
First-Time Motherhood/New Parent Initiative
Purpose: Develop, implement, evaluate and disseminate novel social-marketing approaches that:
Concurrently increase awareness of existing preconception/interconception, prenatal care, and parenting services/programs, and
Address the relationship between such services, health/birth outcomes, and a healthy first year of life.
June 2008 48
First-Time Motherhood/New Parent Initiative
The target population should include women and men who are from populations disproportionately affected by adverse pregnancy outcomes in their community including racial/ethnic minorities.
Organizations should also outreach to providers who service populations disproportionately affected by adverse pregnancy outcomes in their community including racial/ethnic minorities.
June 2008 49
First-Time Motherhood/New Parent Initiative
Services promoted through the public awareness campaign should augment programs that have already been implemented by States to encourage a healthy first year of life and promote educational and social support services for expectant mothers/new parents.
Applicants may choose to create
Statewide, countywide or targeted public awareness campaigns.
June 2008 50
First-Time Motherhood/New Parent Initiative
HRSA’s Maternal and Child Health Bureau was allotted approximately $4.8 million for this activity through the Consolidated Appropriations Act 2008 (P.L. 110-161) .
Only one application per State will be accepted.
Up to ten (10) awards are anticipated.
June 2008 51
Combating Autism Act 2006
Background & Purpose 1 in 150 children diagnosed with Autism Need to know more & need more services Part of reauthorization of Title 1 of the
Children’s Health Act of 2000 (PL106-310) Purpose of Combating Autism Act 2006 to
improve upon previous activities by: Expanding research, increasing awareness
and integrating health, education and disability programs.
June 2008 52
HRSA’s Combating Autism Act Initiative
(CAAI)Funding Summary:
$37 Million$34 Million (after rescission)
_______________________________$20 Million LEND/Developmental Behavioral
Pediatrics (DBP) Training (SPRANS)$ 6 Million LEND Expansion$ 6 Million Autism Intervention Research (AIR)
Networks - Network on Physical Health (AIR-P) - Network on Behavioral, Mental
Health (AIR-B)$ 2+Million Information/Education/Tool Dissemination
(State Demonstration Grants, DBP, evaluation, etc.)
June 2008 53
State Autism Demonstration Grants
6 State Autism Demonstration Grants. To improve State and local
infrastructure for serving individuals with Autism Spectrum Disorders and other Developmental Disabilities.
To improve public awareness.
June 2008 54
MCH Bureau
June 2008 55
Supporting the implementation of a National Nutrition Blueprint for Action through a contract with ASTPHND. Currently, four sub-grants are being implemented.
Blueprint for Action. Nutrition and Physical Activity: Cornerstones of a Healthy Lifestyle Stakeholder consensus document that brings focus
and urgency to critical goals and strategies that will frame nutrition and physical activity for the future.
MCH Nutrition Leadership
June 2008 56
The Maternal and Child Health Training Program
Supports Nutrition Discipline Training in: Public Health Pediatrics Maternal Nutrition
FY 2008: Competition for the MCH Centers of
Excellence in Nutrition Grants Grants expected to be awarded by July 1 ,
2008.
June 2008 57
The Maternal and Child Health Training Program
MCH Leaders Develop effective MCH leaders.
Knowledge to Practice Generate, translate, and integrate new
knowledge to enhance MCH training, inform policy, and improve health outcomes.
Collaborating with Others Develop broad-based support for MCH
training Nutrition Training Grantees have a
collaborative project around overweight/obesity.
June 2008 58
Released October 2007
Bright Futures and MCHB solicit your ideas for
tools/strategies to facilitate public health implementation
cdegraw@hrsa.gov
brightfutures@aap.org
First complete revision
Includes CSHCN
Accompanied by Toolkit for clinical implementation
Transparency of evidence-base
One set of guidelines for health promotion and prevention— Replaces AAP guidelines & AMA “GAPS”
June 2008 59
Bright Futures Nutrition III
Third edition of Bright Futures in Practice: Nutrition is under development. Update is supported through the Cooperative Agreement with AAP.
Document is expected to be released in late 2008.
June 2008 60
Peter C. van Dyck, M.D., M.P.H.
HRSA/MCHBhttp://mchb.hrsa.gov/
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