presentation for national astphnd meeting june, 2005 health resources and services administration...

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.

JUNE 2005 2

MCH BUREAU

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…”

JUNE 2005 4


“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…”

JUNE 2005 5


“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”

JUNE 2005 6

MCH BUREAU

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.

JUNE 2005 8


Eliminate health disparities in health status outcomes, through the removal of economic, social and cultural barriers to receiving comprehensive timely and appropriate health care

JUNE 2005 9


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

JUNE 2005 10


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

JUNE 2005 11

MCH BUREAU

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

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

JUNE 2005 14


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

JUNE 2005 15


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

JUNE 2005 16


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

JUNE 2005 17


1991—Healthy start enacted 1996—Abstinence education

program begun 2000—Performance measures,

CSHCN survey, www.mchdata.net, newborn screening, abstinence, poison control, bioterrorism

JUNE 2005 18


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

JUNE 2005 19

MCHB

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)

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


2006(PB)

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


2006(PB)

JUNE 2005 23

MCH BUREAU

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.

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

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

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

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.

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

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

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

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)

JUNE 2005 33


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

JUNE 2005 34


Pediatric Nutrition Surveillance System 40 of 59 States participate 36 (61%) sample size is large enough


JUNE 2005 35


WIC Nutrition Survey 53 of 59 States participate 48 (81%) sample size is large enough


JUNE 2005 36

MCH BUREAU

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

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

JUNE 2005 39


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.

JUNE 2005 40


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.

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

JUNE 2005 42

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.)

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)

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)

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.

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

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

JUNE 2005 49

Innovative Approaches to Promoting


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

JUNE 2005 50

Innovative Approaches Promoting


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

JUNE 2005 51

Innovative Approaches Promoting


*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

JUNE 2005 52

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

JUNE 2005 53

“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

JUNE 2005 54

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

JUNE 2005 55

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

JUNE 2005 56

Coordination and Collaboration

Commitment for coordination with all other major children’s programs-- WIC, Medicaid, SCHIP, Head Start, early intervention programs

JUNE 2005 57

MCH BUREAU

JUNE 2005 58

What Is Bright Futures?

Bright Futures is A vision

A philosophy

A set of expert guidelines A practical developmental

approach to providing health supervision

JUNE 2005 59

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

JUNE 2005 60

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

JUNE 2005 61

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

JUNE 2005 62

Bright Futures Materials

JUNE 2005 63

MCH BUREAU

JUNE 2005 64

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

JUNE 2005 65


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)

JUNE 2005 66


Demographics Physical and mental health status Health insurance Health care utilization and access Medical home Family functioning Parents’ health Neighborhood characteristics

JUNE 2005 67

Child Outcomes

ChildCharacteristics

Family LevelInfluences

Neighborhoodand

CommunityInfluences

NSCH Survey Domains

JUNE 2005 68

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

JUNE 2005 69

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

JUNE 2005 70

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

JUNE 2005 71


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

JUNE 2005 72

JUNE 2005 73

JUNE 2005 74

JUNE 2005 75

JUNE 2005 76

MCH BUREAU

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

3 Disorders (1)

U.S. Newborn Screening

Mandated Disorders – January 2005 (Note: Other disorders may be offered

but are not mandated)

DC

3 Disorders (1)

4 Disorders (6)




DC

3 Disorders (1)

5 Disorders (2)

4 Disorders (6)




DC

3 Disorders (1)

6 Disorders (4)

5 Disorders (2)

4 Disorders (6)




DC

3 Disorders (1)

7 Disorders (4)

6 Disorders (4)

5 Disorders (2)

4 Disorders (6)




DC

3 Disorders (1)

7 Disorders (4)

6 Disorders (4)

5 Disorders (2)

4 Disorders (6)

8 Disorders (2)U.S. Newborn Screening



DC

3 Disorders (1)

More than 8 Disorders (32)

7 Disorders (4)

6 Disorders (4)

5 Disorders (2)

4 Disorders (6)




DC

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)


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

JUNE 2005 86

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

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.

JUNE 2005 88

WEB Sites

Mchdata.net Stopbullyingnow.hrsa.gov Cshcndata.org Brightfutures.aap.org Nschdata.org Mchb.hrsa.gov

JUNE 2005 89

JUNE 2005 90

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

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

Contact

presentation for national astphnd meeting june, 2005 health resources and services administration...

Documents

mch health infrastructure

health resources

mch issues

special health care

child health servicesto

child health bureaupeter

health status outcomes

systems of care