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Presentation For National ASTPHND Meeting
June, 2005
Health Resources And Services AdministrationMaternal And Child Health Bureau
Peter C. van Dyck, M.D., M.P.H.
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JUNE 2005 2
MCH BUREAU
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JUNE 2005 3
The MCH Block Grant (Title V) States’ Program 501(a)(1)(a-d)
“Title V authorizes appropriations to states to improve the health of all mothers and children”
“To provide and assure mothers and children... Access to quality maternal and child health services”
“To reduce infant mortality…preventable diseases and handicapping conditions among children…increase number of...Immunized children…”
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JUNE 2005 4
The MCH Block Grant (Title V) States’ Program 501(a)(1)(a-d)
“To increase low income children receiving health assessments and…diagnosis and treatment services”
“Promote health…by providing prenatal, delivery, and postpartum care…”
“Promote health of children by providing preventive and primary care services…”
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JUNE 2005 5
The MCH Block Grant (Title V) States’ Program 501(a)(1)(a-d)
“To provide rehabilitation services for blind and disabled individuals under 16 receiving benefits under Title XVI, to the extent…it is not provided under Title XIX”
“To provide and promote family-centered, community-based, coordinated care…for children with special health care needs…and facilitate… community based systems of services for such children and their families”
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JUNE 2005 6
MCH BUREAU
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JUNE 2005 7
MCHB Strategic Plan Goals
Provide National Leadership for Maternal and Child Health by creating a shared vision and goals for MCH, informing the public about MCH needs and issues, modeling new approaches to strengthen MCH, forging strong collaborative partnerships, and fostering a respectful environment that supports creativity, action, and accountability for MCH issues.
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JUNE 2005 8
MCHB Strategic Plan Goals
Eliminate health disparities in health status outcomes, through the removal of economic, social and cultural barriers to receiving comprehensive timely and appropriate health care
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JUNE 2005 9
MCHB Strategic Plan Goals
To assure the highest quality of care through the development of practice guidance, data monitoring, and evaluation tools; the utilization of evidence-based research; and the availability of a well-trained, culturally diverse workforce
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JUNE 2005 10
MCHB Strategic Plan Goals
To facilitate access to care through the development and improvement of the MCH health infrastructure and systems of care to enhance the provision of the necessary coordinated, quality health care
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JUNE 2005 11
MCH BUREAU
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JUNE 2005 12
The MCH Block Grant
(Title V) history
1912--Creation of the Children’s Bureau “to investigate and report on the status of
children and on their common as well as special needs”
1913—Prenatal Care published 1914—Infant Care published 1921--Sheppard-Towner Act
First federal grant-in-aid program to States for health, “to promote the welfare and hygiene of maternity and infancy”
1930—American Academy of Pediatrics
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JUNE 2005 13
The MCH Block Grant (Title V) history
1935--Title V of the Social Security Act Grants-in-aid to States for MCH
programs, services for crippled children, and child welfare services
1943—Autism is officially described by Dr. Leo Kanner
1950—disposable diapers are invented by Marion Donovan
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JUNE 2005 14
The MCH Block Grant (Title V) history
1957—Mental retardation programs Congress earmarked $1M for demonstration
clinical programs for children with mental retardation
1962—St. Judes founded by Danny Thomas 1963-5—MIC and C & Y programs
Three new grants: NICU, family planning, dental care
1968—electronic fetal monitoring first used 1969--Administration transferred to the
Public Health Service
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JUNE 2005 15
The MCH Block Grant (Title V) history
1981 (OBRA ‘81)--Converted Title V to a block grant by combining seven categorical programs; MCH/CSHCN SSI Lead screening Genetic diseases SIDS counseling programs OBRA ‘81 Hemophilia treatment centers Adolescent program grant
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JUNE 2005 16
The MCH Block Grant (Title V) history
1982—Prenatal test for sickle cell disease 1984—Emergency medical services for
children enacted 1989 (OBRA ‘89)--Introduced major
changes Application with needs assessment and
priorities Measurable objectives Budget accountability Documentation of match Maintenance of effort
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JUNE 2005 17
The MCH Block Grant (Title V) history
1991—Healthy start enacted 1996—Abstinence education
program begun 2000—Performance measures,
CSHCN survey, www.mchdata.net, newborn screening, abstinence, poison control, bioterrorism
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JUNE 2005 18
The MCH Block Grant (Title V) history
2004—Performance measures, CSHCN survey, child health survey, anti-bullying campaign, early childhood, newborn screening, women’s health, discretionary grants reporting system, data and evaluation, training strategic plan
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JUNE 2005 19
MCHB
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JUNE 2005 20
MCH Budget for 2004, 2005, and 2006(millions)
MCHBG…$729.8...$723.9...$723.9 State….…$594.4.....$591.1…..$601.9 SPRANS..$104.9…...$102.7…..$106.2 CISS….….$15.0…....$14.6…….$15.8 Earmark..$15.5…....$15.5… ..$0.0
FY2004
2005
1-numbers may not add due to rounding
2006(PB)
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JUNE 2005 21
MCH Budget for 2004, 2005, and 2006(millions)
Healthy Start…$97.8...$102.5…..$97.7 Hearing………..$ 9.9...$ 9.8 …$ 0.0 EMSC…………..$19.9....$ 19.8….$ 0.0 TBI………………$ 9.4…..$ 9.3…..$ 0.0 Sickle Cell… ..$ 0.0…..$ 0.2…..$ 0.0
FY2004
2005
1-numbers may not add due to rounding
2006(PB)
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JUNE 2005 22
MCH Budget for 2004,2005, and 2006(millions)
SPRANS Earmarks Oral Health…..$4.97…..$4.96 …..…$0.0 Sickle Cell….…$3.98.....$3.97……...$0.0 Epilepsy……....$2.98…..$2.98…..….$0.0 Genetics….……$1.99…..$1.98……...$0.0 Mental Health.$1.59…..$1.59…..….$0.0
FY2004
2005
1-numbers may not add due to rounding
2006(PB)
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JUNE 2005 23
MCH BUREAU
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JUNE 2005 24
Title V MCH Block Grant
“Year of the Needs Assessment” Planning document for State Title V programs for
the next 5 years. Face-to-face review process, which includes
Federal program staff and State MCH leadership.
2007 Application Guidance Current Office of Management and Budget
clearance will expire in May 2006. Workgroup formed to provide input on areas of
suggested revision/update.
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JUNE 2005 25
DIRECT
HEALTH CARE
SERVICES
(GAP FILLING)
Examples:
Basic Health Services and Health Services for CSHCN
ENABLING SERVICES
Examples:
Transportation, Translation, Outreach, Respite Care,Health Education, Family Support Services, Purchase ofHealth Insurance, Case Management, Coordination with
Medicaid, WIC and Education
POPULATION--BASED SERVICES
Examples:
Newborn Screening, Lead Screening, Immunization, Sudden Infant DeathCounseling, Oral Health, Injury Prevention, Nutrition and Outreach/Public Education
INFRASTRUCTURE BUILDING SERVICES
Examples:
Needs Assessment, Evaluation, Planning, Policy Development, Coordination, Quality Assurance, Standards Development, Monitoring, Training, Applied Research,
Systems of Care and Information Systems
CORE PUBLIC HEALTH SERVICES DELIVERED BY MCH AGENCIES
MCH
EPSDT
CHC SCHIP
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JUNE 2005 26
Numbers Served In MCH Block Grant Program, 1997 And 2003
INDIVIDUALS SERVED 1997
SERVED 2003
% OF ALL SERVED 2003
PREGNANT WOMEN
1,963,797 2,460,873 62%
INFANTS
2,907,840 3,868,155 97%
CHILDREN 16,456,435 17,718,132 22%
CSHCN 875,648 1,114,073 12%
OTHER 1,810,999 3,031,291 N/A
TOTAL 24,014,719 28,192,524 N/A
SOURCE: TITLE V INFORMATION SYSTEM
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JUNE 2005 27
MCH Bureau Performance Measurement System
DIRECT
HEALTH
ENABLING
SERVICES
POPULATION
BASED
INFRASTRUCTURE
SERVICES
MCHB
PROGRAM AND RESOURCE
ALLOCATION
MCHB
PERFORMANCE
MEASURES
MCHB
OUTCOME
MEASURES
STATEBLOCKGRANT
SPRANS
HEALTHYSTART
EMERGENCYSERVICES
FOR CHILDREN
PRIORITIES
AND GOALS MCHB
MCHB
NEEDS ASSESSMENT
HEALTH STATUS
INDICATORS
I. DECREASE
DISPARITIES
II. INCREASE
QUALITY
III. IMPROVE
INFRASTRUCTURE
STATE/NATIONAL
INDICATORS
HEALTHYPEOPLE
2010
LEGISLATIVEPRIORITIES
PARTNERSHIPSINPUT
PERINATALMORTALITY
INFANTMORTALITY
NEONATALMORTALITY
POSTNEONATALMORTALITY
CHILDMORTALITY
INFANTDEATH
DISPARITY
TRAUMATICBRAININJURY
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JUNE 2005 28
18 National Performance Measures Title V MCH Block
Grant Program
10) The rate of deaths to children aged 1-14 caused by motor vehicle crashes per 100,000 children.
11) Percentage of mothers who breastfeed their infants at hospital discharge.
12) Percentage of newborns who have been screened for hearing impairment before hospital discharge.
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JUNE 2005 29
The 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
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JUNE 2005 30
State Priority Needs Keyword Search
Nutrition/Physical Activity 33 States with 46 Priority Needs Identified
(Includes needs related to breastfeeding; overweight; iron-deficiency anemia; nutritional status of women, infants and children; folic acid use; healthy behaviors; and physical fitness)
Obesity
15 States with 17 Priority Needs Identified
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JUNE 2005 31
State Performance Measures Keyword
Search
Nutrition/Physical Activity 36 States with 54 Performance Measures
Obesity 21 States with 25 Performance Measures (6 Measures target WIC Program
Participants) WIC
11 States with 13 Performance Measures
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JUNE 2005 32
The 9 Health Systems Capacity Indicators
09C) The ability of States to monitor overweight or obesity among children and youth (as reported in the 2003 Annual Block Grant Report)
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JUNE 2005 33
The 9 Health Systems Capacity Indicators
YRBS 47 of 59 States participate 35 (60%) sample size is large enough
for statewide estimates 12 (20%) sample size too small 12 (20%) do not participate
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JUNE 2005 34
The 9 Health Systems Capacity Indicators
Pediatric Nutrition Surveillance System 40 of 59 States participate 36 (61%) sample size is large enough
for statewide estimates 4 (7%) sample size too small 19 (32%) do not participate
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JUNE 2005 35
The 9 Health Systems Capacity Indicators
WIC Nutrition Survey 53 of 59 States participate 48 (81%) sample size is large enough
for statewide estimates 5 (9%) sample size too small 6 (10%) do not participate
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JUNE 2005 36
MCH BUREAU
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JUNE 2005 37
MCHB Cross-Division Nutrition Committee
MCHB nutrition strategic plan focuses on four major areas:
1. Breastfeeding promotion and support2. Overweight/obesity prevention and
healthy lifestyle promotion3. Public health nutrition leadership and
training4. Coordination and collaboration with
federal, state and local partners
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JUNE 2005 38
Breastfeeding Support
Systems support Liaison to the U.S. Breastfeeding committee
Strategic plan for breastfeeding in the U.S. National breastfeeding coalition workshop
(2006)
Expert work group meetings (MCHB and CDC) Oral health and breastfeeding Safe and appropriate use of human milk
substitutes for the breastfed infant in the U.S
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JUNE 2005 39
Breastfeeding Support
Hospital Support Baby Friendly Hospital Project
– Identification of barriers to implementing the TEN Steps to Successful Breastfeeding.
Work site support Development of a Best Start Social Marketing
program to provide breastfeeding support to employers and women returning to work/school.
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JUNE 2005 40
Breastfeeding Support
Provider Support Academy of Breastfeeding Medicine
Development of protocols and support for annual meeting.
AAP Breastfeeding Promotion in Physicians’ Office Practices (BPPOP – Phase III)
3-year program to initiate and sustain system-wide changes in breastfeeding management at the national, state and community levels.
Builds on 1997-2000 and 2001-2004 programs.
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JUNE 2005 41
Breastfeeding Support BPPOP III
Focuses 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.
Developing breastfeeding curriculum for medical residency training programs.
http://www.aap.org/advocacy/bf/bppopIII.htm
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JUNE 2005 42
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JUNE 2005 43
Overweight And Obesity
Proposed in the MCHB Nutrition Strategic Plan is the funding of interdisciplinary training for health providers working as a team to 1) treat pediatric overweight/obesity and 2) develop prevention programs.
Maternal obesity is also an area of interest. (Potential for an IOM Study to examine factors that contribute to recommended prenatal weight gain.)
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JUNE 2005 44
Child And Adolescent: Overweight And Obesity
Needs assessment conducted to determine current practices of pediatricians, nurses and dietitians in the assessment and treatment of childhood overweight and obesity (MCHB, CDC, NCEMCH, and ILSI)
- Findings published as a Supplement to the Journal Pediatrics (July 2002)
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JUNE 2005 45
Child And Adolescent: Overweight And Obesity
Expert panel convened in February 2005 to develop recommendations for the assessment, prevention and management of child and adolescent overweight/obesity (MCHB, CDC and AMA)
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JUNE 2005 46
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.
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JUNE 2005 47
National Business Group on Health
With MCHB support, developed An Employer Toolkit for Addressing Overweight Among Employees and Their Children.
Toolkit includes: Issue Brief PowerPoint Presentation Family Fact Sheets Tip Sheets
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JUNE 2005 48
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
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JUNE 2005 49
Innovative Approaches to Promoting
a Healthy Weight in Women
Approaches must be substantive in nature and incorporate nutrition, physical activity and health/wellness components
Must also link women, when appropriate, with Title V/other relevant services to provide comprehensive care
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Innovative Approaches Promoting
a Healthy Weight in Women
7 Grantees; approximately $150,000/yr. for 3 yrs., funding began September 2004 and *May 2005 Texas State University, San Marcos, TX NorthEast Ohio Neighborhood Health
Services, Cleveland, OH Holyoke Health Center, Holyoke, MA
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Innovative Approaches Promoting
a Healthy Weight in Women
*Funded May 2005 Mariposa Community Health Center,
Nogales, AZ Orange County Health Department,
Orlando, FL Bad River Band of Lake Superior
Chippewa Indians, Odanah, WI Christiana Care Health Services, Inc.,
Wilmington, DE
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Development of a national nutrition blueprint for action (MCHB, NIH, CDC)
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 next 10-20 years.
MCH Nutrition Leadership
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“Umbrella” document that can be adapted to reflect local and state needs
Document to use at all levels to educate decision makers on priority actions.
Document that fosters joint efforts for greater impact with well-utilized resources.
Blueprint for Action Nutrition and Physical Activity:
Cornerstones of a Healthy Lifestyle
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Initial Meeting (April 2004) Participants included nutrition and physical
activity experts representing public and non-profit organizations.
Second Meeting (April 2005) Document expected to be released in 2006
Blueprint for Action Nutrition and Physical Activity:
Cornerstones of a Healthy Lifestyle
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The Maternal and Child Health Training Program
Supports Nutrition Discipline Training in: Public Health (3) Pediatrics (4)
FY 2005 Profile: Fund 7 MCH Centers of Excellence in
Nutrition Grant Awards Range from $120,000 to
$210,000 Per Year
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Coordination and Collaboration
Commitment for coordination with all other major children’s programs-- WIC, Medicaid, SCHIP, Head Start, early intervention programs
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MCH BUREAU
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What Is Bright Futures?
Bright Futures is A vision
A philosophy
A set of expert guidelines A practical developmental
approach to providing health supervision
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Increase family knowledge, skills, and participation in health-promoting and disease prevention activities
Enhance health professionals’ knowledge, skills, and practice of developmentally appropriate health care in the context of family and community
Bright Futures Goals
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Bright Futures Organizations
American Academy of Pediatrics American Academy of Pediatric Dentistry American Dietetic Association American Medical Association National Association of Pediatric Nurse
Associates and Practitioners American Academy of Physician Assistants American School Health Association American Public Health Association
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Bright Futures Implementation
Building Bright Futures--1995
Incorporated into EPSDT guidelines, SCHIP, Head Start, and WIC programs
Used to revise standards of practice
Used to promote program development
Used as a training tool for health professionals and health departments
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Bright Futures Materials
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MCH BUREAU
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National Survey ofChildren’s Health
Designed to produce reliable State and National data for HP 2010, Title V needs assessment, and for Title V program planning and assessment
To provide a new data resource for researchers, advocacy groups, and others
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National Survey ofChildren’s Health
SLAITS mechanism 2,000 children in each State-
102,000 nationally Data collection from Jan 2003-
Apr 2004 Technical advisory panel Field test with 1000 interviews Two age groups(0-5 and 6-17)
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National Survey ofChildren’s Health
Demographics Physical and mental health status Health insurance Health care utilization and access Medical home Family functioning Parents’ health Neighborhood characteristics
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Child Outcomes
ChildCharacteristics
Family LevelInfluences
Neighborhoodand
CommunityInfluences
NSCH Survey Domains
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Unique Features of the NSCH
Comprehensive detailed snapshotChild – family – neighborhood
Contains a variety of positive indicators to track youth development: family strengths family relationships and behavior family processes household routines
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Survey yields over 60 key indicators of child health & well-being in the following areas:
Child’s health status: physical, emotional, dental
Child’s health care – including medical home
Child’s school & activities
Child’s family – including maternal health status
Child & Family’s neighborhood
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Nat. Survey of Children’s Health
HOMEPAGE
www.nschdata.org
Data Resource Center for Child & Adolescent Health
www.childhealthdata.org
Nat. Survey of Children w/ Special Health
Care NeedsHOMEPAGE
www.cshcndata.org
AVAILABLE NOW!
May 2005
COMING June 2005
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National Survey ofChildren’s Health
Prevalence of obesity across States Prevalence of Breastfeeding Prevalence of asthma by State Children’s access to medical home Children with a personal doctor Children with child care Parents’ health practices related to child
health status Parents’ reading to children Children in stressful family situations How safe are neighborhoods and schools
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MCH BUREAU
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MCHB’s Vision for Newborn Screening
Systems approach with defined public health roles at state and national level
Presence of Quality assurance
Public–private partnerships for assurance of systems approach and comprehensive, efficient care and management
Equity for families
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3 Disorders (1)
U.S. Newborn Screening
Mandated Disorders – January 2005 (Note: Other disorders may be offered
but are not mandated)
DC
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3 Disorders (1)
4 Disorders (6)
U.S. Newborn Screening
Mandated Disorders – January 2005 (Note: Other disorders may be offered
but are not mandated)
DC
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3 Disorders (1)
5 Disorders (2)
4 Disorders (6)
U.S. Newborn Screening
Mandated Disorders – January 2005 (Note: Other disorders may be offered
but are not mandated)
DC
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3 Disorders (1)
6 Disorders (4)
5 Disorders (2)
4 Disorders (6)
U.S. Newborn Screening
Mandated Disorders – January 2005 (Note: Other disorders may be offered
but are not mandated)
DC
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3 Disorders (1)
7 Disorders (4)
6 Disorders (4)
5 Disorders (2)
4 Disorders (6)
U.S. Newborn Screening
Mandated Disorders – January 2005 (Note: Other disorders may be offered
but are not mandated)
DC
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3 Disorders (1)
7 Disorders (4)
6 Disorders (4)
5 Disorders (2)
4 Disorders (6)
8 Disorders (2)U.S. Newborn Screening
Mandated Disorders – January 2005 (Note: Other disorders may be offered
but are not mandated)
DC
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3 Disorders (1)
More than 8 Disorders (32)
7 Disorders (4)
6 Disorders (4)
5 Disorders (2)
4 Disorders (6)
8 Disorders (2)U.S. Newborn Screening
Mandated Disorders – January 2005 (Note: Other disorders may be offered
but are not mandated)
DC
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3 Disorders (1)
More than 8 Disorders (32) [More than 30 Disorders (17)]
7 Disorders (4)
6 Disorders (4)
5 Disorders (2)
4 Disorders (6)
8 Disorders (2)U.S. Newborn Screening
Mandated Disorders – January 2005 (Note: Other disorders may be offered but are
not mandated)
>30
>30 26
>30
>30
9>30
>30
>30
>30
>30
26
40
14
29
9
9
>30
29
19
9
10
21
>30
13 10
>30
>3027
DC
>30
>30>30
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ACMG Report: Objectives
1. Develop a uniform panel of conditions2. Develop a decision-making tool for use
in NBS program expansion or contraction
3. Enable program evaluation to ensure realization of expected outcomes
4. Consider value of a national process for quality assurance and oversight of NBS
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Resource Center
National Newborn Screening and Genetics Resource Center
http://[email protected]
Serves as a focal point for national newborn screening and genetics activities, and provides related resources to benefit consumers, health professionals, the public health community, and government officials.
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WEB Sites
Mchdata.net Stopbullyingnow.hrsa.gov Cshcndata.org Brightfutures.aap.org Nschdata.org Mchb.hrsa.gov
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Peter C. van Dyck, M.D., M.P.H.
HRSA/MCHBhttp://mchb.hrsa.gov/
Contact