mchb perspective on local mch: citymatch 2008 us department of health and human services health...

MCHB Perspective on Local MCH: MCHB Perspective on Local MCH: CityMatCH 2008CityMatCH 2008

US Department of Health and Human ServicesUS Department of Health and Human ServicesHealth Resources And Services AdministrationHealth Resources And Services Administration

Maternal And Child Health BureauMaternal And Child Health Bureau

Michael D. Kogan, PhDMichael D. Kogan, PhDDirector, Office of Data and Program Development Director, Office of Data and Program Development

forforPeter C. van Dyck, MD, MPHPeter C. van Dyck, MD, MPH

Associate Administrator for Maternal and Child HealthAssociate Administrator for Maternal and Child HealthHealth Resources and Services AdministrationHealth Resources and Services Administration

Sept. 2008Sept. 2008 22

The Importance of

Local Government

Sept. 2008Sept. 2008 33

• Web hits for:

–Local Government: 74,200,000

–State Government: 14,400,000

–Federal Government: 60,800,000

Sept. 2008Sept. 2008 44

The Importance of Local Data

Sept. 2008Sept. 2008 55

Widening Disparities in Infant, Neonatal, and Postneonatal Mortality Among Major US

Metropolitan Cities, 1985-2002

GK Singh, PhD; MD Kogan, PhD; RA Hummer, PhD;

PC van Dyck, MD, MPH; M Badura; K Hench

Sept. 2008Sept. 2008 66

• Considerable disparities in infant mortality exist across major US cities, with the rate in 1999-2002 varying from a low of 4.2 per 1000 live births in San Francisco to a high of 15.5 for Birmingham, AL.

• When broken down by race, the infant mortality rate in 1999-2002 varied from a low of 2.9 for white infants in San Francisco to 18.8 for black infants in Pittsburgh.

Sept. 2008Sept. 2008 77

• The infant mortality rate for most cities declined by ≥30%, but not for a number of cities.

• However, overall disparities in infant, neonatal, and postneonatal mortality widened between 1985 and 2002, especially postneonatal mortality.

Sept. 2008Sept. 2008 88

Metropolitan Cities with 15 highest and 15 Lowest Infant Mortality Rates, 1985-1988

6.48.5

7.86.8

9.4

9.9

8.07.9

10.18.78.8

8.0

10.18.8

10.111.1

10.59.7

8.810.0

7.59.6

11.39.1

11.68.4

11.5

14.325.9

17.315.7

19.2

19.6

14.820.4

17.915.0

18.1

14.1

22.818.7

21.720.8

18.724.3

18.218.7

22.517.9

15.919.0

23.421.1

19.8

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28

San Francisco, CAEl Paso, TX

San Jose, CAAustin, TX

Portland, ORSanta Ana, CA

Seattle, WAAnaheim, CA

San Diego, CALos Angeles, CALong Beach, CA

Houston, TXNew York, NY

Mesa, AZDallas, TX

Chicago, ILJacksonville, FLPhiladelphia, PA

Norfolk, VABaltimore, MD

Pittsburgh, PAMilwaukee, WI

Newark, NJWashington, DC

Cleveland, OHCincinnati, OH

St Louis, MODetroit, MI

Memphis, TNBirmingham, AL

Black

White

Sept. 2008Sept. 2008 99

Metropolitan Cities with 15 highest and 15 Lowest Infant Mortality Rates, 1999-2002

2.95.9

4.33.7

4.86.6

6.23.6

4.54.64.9

3.65.4

4.6

5.56.8

6.16.2

5.76.4

6.84.8

4.09.7

8.86.2

11.28.1

9.1

11.08.0

3.712.1

7.9

9.111.4

16.110.3

10.010.4

10.112.4

10.2

16.416.2

14.815.3

13.818.8

16.810.1

16.116.0

18.018.3

16.518.3

18.1

4.6

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28

San Francisco, CAEl Paso, TX

San Jose, CAAustin, TX

Portland, ORSanta Ana, CA

Seattle, WAAnaheim, CA

San Diego, CALos Angeles, CALong Beach, CA

Houston, TXNew York, NY

Mesa, AZDallas, TX

Chicago, ILJacksonville, FLPhiladelphia, PA

Norfolk, VABaltimore, MDPittsburgh, PAMilwaukee, WI

Newark, NJWashington, DC

Cleveland, OHCincinnati, OH

St Louis, MODetroit, MI

Memphis, TNBirmingham, AL

Black

White

Sept. 2008Sept. 2008 1010

The Importance of Neighborhood Data

Sept. 2008Sept. 2008 1111

• 5 year project examined racial disparities in preterm birth across neighborhoods in Maryland, Michigan, and North Carolina, and Philadelphia.

• Examined neighborhood-level factors such as employment, housing, and residential stability.

• Developed a neighborhood deprivation index.

Sept. 2008Sept. 2008 1212

• Across all sites, non-Hispanic white women were 57% more likely to deliver preterm in neighborhoods with the most deprivation (compared to non-Hispanic white women in the least deprived areas).

• Across all sites, non-Hispanic African-American women were 15% more likely to deliver preterm in neighborhoods with the most deprivation (compared to non-Hispanic African-American women in the least deprived areas).

Sept. 2008Sept. 2008 1313

Can Interventions Help?

Sept. 2008Sept. 2008 1414

Healthy Start Program and Feto-Infant Morbidity Outcomes: Evaluation of Program Effectiveness

HM Salihu, AK Mbah, D Jeffers, AP Alio, L Berry

Sept. 2008Sept. 2008 1515

• Measured impact of Hillsborough, Florida Healthy Start program on low birth weight and preterm birth.

• Pregnant women in Healthy Start offered initial screening and assessment, health education, care coordination and utilization.

• Healthy Start women who received assessment and/or care coordination compared to Healthy Start women who had none of the above or just initial contact.

Sept. 2008Sept. 2008 1616

• The Hillsborough Healthy Start program reduced the level of low birth weight and preterm delivery by 30% among service recipients as compared to non-recipients.

• The higher the recipients’ initial risk score, the greater the benefit of program services.

Sept. 2008Sept. 2008 1717

MCH BureauMCH Bureau

Sept. 2008Sept. 2008 1818

The Community-Based Doula ProgramThe Community-Based Doula Program

• MCHB was allotted $1.4 million to launch the Community-Based Doula Initiative.

• Purpose: to provide first time motherhood demonstration programs to urban and rural communities to support community-based Doulas.

• Projects identify and train indigenous community workers to mentor pregnant women during the months of pregnancy, birth and at least twelve weeks post-partum, (optimally one year post-partum).

Sept. 2008Sept. 2008 1919


• Up to 6 awards made to urban and rural community-based organizations to support community-based Doula activities.

• Rural portions will 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 given to applications which emphasized breastfeeding initiation and retention.

Sept. 2008Sept. 2008 2020

Percentage Ever Breastfed by State, NSCH, 2003

45.0-64.0

64.0-67.3

67.3-73.0

73.0-80.0

80.0-88.0

AK

HI

Sept. 2008Sept. 2008 2121

Percentage Breastfeeding for At least 6 Months, NSCH, 2003

17.3-28.9

28.9-32.9

32.9-38.0

38.0-46.0

46.0-56.0

AK

HI

Sept. 2008Sept. 2008 2222


• An additional award 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.

Sept. 2008Sept. 2008 2323

Breastfeeding Worksite SupportBreastfeeding Worksite Support

• Includes:– Resource kit: The Business

Case for Breastfeeding – Full kits and individual

components available from MCHB at: www askhrsa.com or 1-888-ASK HRSA

– Training and TA

Sept. 2008Sept. 2008 2424

First-Time Motherhood/First-Time Motherhood/New Parent InitiativeNew 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.

Sept. 2008Sept. 2008 2525


• The target populations are those disproportionately affected by adverse pregnancy outcomes in their community including racial/ethnic minorities.

• Organizations should also outreach to providers who service these populations.

Sept. 2008Sept. 2008 2626


• 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.

• Public awareness campaigns could be

Statewide or countywide.

Sept. 2008Sept. 2008 2727


• MCHB was allocated approximately $4.8 million for this activity.

• 13 awards were given.

Sept. 2008Sept. 2008 2828

Combating Autism Act 2006Combating Autism Act 2006

• Background & Purpose– 1 in 150 children diagnosed with Autism Spectrum

Disorder– Need to know more & need more services – Purpose of Combating Autism Act 2006 to improve

upon previous activities by:• Expanding research, increasing awareness and

integrating health, education and disability programs.

Sept. 2008Sept. 2008 2929

HRSA’s Combating Autism Act HRSA’s Combating Autism Act Initiative (CAAI)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.)

Sept. 2008Sept. 2008 3030

State Autism Demonstration GrantsState 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.

• Grantees will implement existing state plans to improve services.

Sept. 2008Sept. 2008 3131

Data Initiatives

Sept. 2008Sept. 2008 3232

National Survey of Children with Special National Survey of Children with Special Health Care Needs, 2005-2006Health Care Needs, 2005-2006

– Measures and Tracks Prevalence of CSHCN

– Nationally

– By State

– Describes Demographic Characteristics

– Other Measures Include

– Functional Limitations

– Health Care Access

– Needs and Satisfaction with Care

– Burden and Impact on Family

Sept. 2008Sept. 2008 3333

Prevalence of CSHCN: Prevalence of CSHCN: State VariationState Variation

17.7 17.5

11.9 11.4 11 10.4 9.9

17.718.5 18.3

02468

101214161820

KY WV AR ME DE AK ID UT NV CA

CS

HC

N

Pre

vale

nce

5 Highest and 5 Lowest Prevalence States

Sept. 2008Sept. 2008 3434

CSHCN in a Medical HomeCSHCN in a Medical Home

47.1

34.0

41.3

51.0

56.2

0

10

20

30

40

50

60

All CSHCN 0-99% FPL 100-199%FPL

200-399%FPL

400% + FPL

Percentage of CSHCN Receiving Care Through a Medical Home, by Family Income

Sept. 2008Sept. 2008 3535

Impact on Parent’s EmploymentImpact on Parent’s Employment

Percent of CSHCN

CSHCN Whose Parents Cut Back on Work or Stopped Working to Care for the Child

9.1

23.8

46.8

23.8

0 10 20 30 40 50

All CSHCN

Activities affected usually, often, or a

great deal

Daily activities moderately affected

some of the time

Daily activities never affected

Sept. 2008Sept. 2008 3636

Reduce/Stop Work Because of Child’s Reduce/Stop Work Because of Child’s Care and =>10 Hours Providing CareCare and =>10 Hours Providing Care

0

10

20

30

40

50

60

Reduce/Stop Work 10+ Hours

CSHCN with ASD CSHCN with Other EDB Other CSHCN

Source: 2005-6 National Survey of CSHCN

Sept. 2008Sept. 2008 3737

Health Insurance CoverageHealth Insurance Coverage

Percentage of CSHCN, by Type of Health Insurance

Uninsured3.5%

Private andpublic7.3%

Public only28.0%

Private only59.0%

2001*

Uninsured5.2%

Private and public8.1%

Public only21.7%

Private only64.7%

20062001

Sept. 2008Sept. 2008 3838

National Survey of Children’s National Survey of Children’s Health, 2007Health, 2007

• Purpose: To produce national and State-based estimates on the health and well-being of children, their families, and their communities

• Sample: Independent random-digit-dial samples for all 50 States and the District of Columbia (DC) of over 90,000 children

Sept. 2008Sept. 2008 3939

NSCH Topic AreasNSCH Topic Areas• Insurance coverage

consistency and adequacy

• Medical home• Child care arrangements• Reading for pleasure• Television watching• Home alone (6-11)• Working for pay (12-17)• Volunteering (12-17)• Weekly attendance at

religious services

• School enrollment and engagement

• Participation in activities outside of school

• Repeating a grade• Parents’ health status• Parenting aggravation• Smoking in the

household

• Neighborhood amenities, condition, and social support

• Child’s safety in neighborhood and at school

Sept. 2008Sept. 2008 4040

Release of 2007 NSCH DataRelease of 2007 NSCH Data

• February or March 2009– Public use microdata files– Extensive documentation

• Online data query system– http://www.childhealthdata.org

Sept. 2008Sept. 2008 4141

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

Sept. 2008Sept. 2008 4242

What is the Data Resource Center?What is the Data Resource Center?

A website that delivers: – Hands-on, user-friendly access to national, state

and regional data from the 2001 and 2005-2006 NS-CSHCNs and the 2003 National Survey of Children’s Health (NSCH)

– Technical assistance by email/telephone and online materials, such as examples of data use by states and links to related websites

– Education -- thru e-updates, e-facts & in-person, telephone, and online workshops

Sept. 2008Sept. 2008 4343

Other Programs

Sept. 2008Sept. 2008 4444

Released October 2007

Bright Futures and MCHB solicit your ideas for

tools/strategies to facilitate public health implementation

[email protected]

[email protected]

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”

Sept. 2008Sept. 2008 4545

Bright Futures Nutrition IIIBright 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.

Sept. 2008Sept. 2008 4646

The Early Childhood The Early Childhood Comprehensive Systems Program (ECCS)Comprehensive Systems Program (ECCS)

A State-based system of collaborations and partnerships that support families and communities in their development of children that are healthy and ready to learn at school entry.

Sept. 2008Sept. 2008 4747


• State ECCS grants support “use of leadershipleadership and convening convening powerspowers to foster the development of early childhood systems”

• Building ECCS requires intentional efforts to:

– Bridge the gapsBridge the gaps left between programs to provide health, mental health, early learning, family support, etc.

– Support integrated, cross-systems development Support integrated, cross-systems development through partnerships

– Develop governance and structural mechanismsDevelop governance and structural mechanisms that are needed to sustain comprehensive systems

Sept. 2008Sept. 2008 4848

The Early Childhood The Early Childhood Comprehensive Systems ProgramComprehensive Systems Program

To date, there have been two phases of ECCS.

Phase I 2003 – 2004 Development of the State Plan

Phase II 2005 – 2008 Implementation of the State Plan.

Sept. 2008Sept. 2008 4949


There will be a third Phase of ECCS: 2009 – 2012

During this Phase III the implementation of the State Plan will intensify in scope and depth:

Implementation activities to become focused on incorporating goals of partnering agencies

Increased emphasis on community systems building efforts

Call Joe Zogby at (301) 443-4393 or Dena Green at (301) 443-9768 for further information

Sept. 2008Sept. 2008 5050

Local Maternal and Child HealthLocal Maternal and Child Health

Sept. 2008Sept. 2008 5151

Peter C. van Dyck, M.D., M.P.H.

HRSA/MCHBhttp://mchb.hrsa.gov/

ContactContact

mchb perspective on local mch: citymatch 2008 us department of health and human services health...

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