state health resources for women & children
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State Health Resources for Women & Children. Denise Higgins, Chief Family & Community Health Bureau MT Department of Public Health & Human Services [email protected] April 26, 2013. Conference Objective. - PowerPoint PPT PresentationTRANSCRIPT
State Health Resources for Women & Children
Denise Higgins, ChiefFamily & Community Health Bureau
MT Department of Public Health & Human [email protected]
April 26, 2013
Conference Objective
Identify at least 5 currently available resources for Women
and Children in the State of Montana
Essential Public Health ServicesMonitor health status to identify and solve community
health problems. Diagnose and investigate health problems and health
hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships and action to identify and
solve health problems. Develop policies and plans that support individual and
community health efforts. Enforce laws and regulations that protect health and
ensure safety. Link people to needed personal health services and assure
the provision of health care when otherwise unavailable. Assure competent public and personal health care
workforce. Evaluate effectiveness, accessibility, and quality of personal
and population-based health services. Research for new insights and innovative solutions to
health problems.
Maternal & Child Health
MCH is the professional and academic field that
focuses on the determinants, mechanisms and
systems that promote and maintain the health,
safety, well-being, and appropriate development of
children and their families in communities and
societies, in order to enhance the future health and
welfare of society and subsequent generations.
What does MCH include?Determinants of
healthDisparitiesPregnancy healthPre-conception healthReproductive healthChild healthChildren with special
health care needsSchool health
Adolescent healthOral healthNutritionHealth policiesInternational healthHealth care and
insuranceAdvocacy
Pyramid of Services Infrastructure Building Services form the
foundation of the program. These services create the capacity on which all other MCH services rely, such as maintaining data systems, ensuring a well-trained workforce, and establishing integrated, coordinated systems of care.
Population-Based Services reach the entire MCH population, providing disease prevention and health promotion services such as universal screening programs and public information campaigns.
Enabling Services help vulnerable populations—children and families who are poor, have special health care needs, or are at risk of poor health outcomes—access needed services and optimize health benefits.
Direct Health Care Services provide gap-filling primary and preventive health care services that would not otherwise be available through other funding sources or providers.
*difference is statistically significant
Risk Factors
Mother’s smoking status by age, Montana residentsMontana Office of Vital Statistics, 2008-2010.
(Note: scale is not to 100)<19 20-29 30-39 40+0
10
20
30
40
per
cen
t
Risk Factors
Five-Year Infant Mortality Rates and Fetal Mortality Ratios, Montana Residents, 1962-2011
Prenatal care initiation, low birth weight, and preterm birth in Montana, by age of mother,
Montana Office of Vital Statistics, 2009
Initiation of prenatal care in
the 3rd trimester or no
care
Low birth weight infant
Preterm infant Smoking during pregnancy
0
5
10
15
20
25
30
9.67.4 8.5
25.9
5.17.1
9.1
14.9
15-19
20+
per
cen
t
Source: Montana Office of Vital StatisticsSource: Montana Office of Vital Statistics
14.9
Access and Outcomes
Teen (15-19) birth rates by race, 2 year averages, Montana
Montana Office of Vital Statistics, 2002-2011
Teen Pregnancy
American Indian White0
20
40
60
80
100
MTUS
Per
10
00
pop
ula
tion
29.5
38.7
23.5
Teen (15-19) birth rates by race, MT and USMontana Office of Vital Statistics, 2010
85.7
Teen Pregnancy
By 2017, increase the number of women aged 15-44 years who receive reproductive health care services at Title X clinics from 26,480 to 28,000. (HP 2020 Target: 78.8%)
By 2017, increase the percentage of women who reported entering prenatal care in the first trimester from 72% to 80%. (HP 2020 Target: 78% )
By 2017, increase the percentage of women who report abstaining from smoking during pregnancy from 83% to 90%. (HP 2020 Target: 98%)
By 2017, decrease the rate of live births per 1000 that are preterm from .88 per 1000 live births to .5 per 1000 live births. (HP 2020 Target: 1 per 1000 live births)
Promote the Health of Mother, Infants and Children:
Decreasing teen pregnancy and teen births can be achieved in two ways Contraceptive use among sexually active teensDelay/decrease initiation of sexual activity
Draw the Line/Respect the Line(6th, 7th and 8th grade youth)Focuses on postponing sexual activityAddresses social pressures, communication
and negotiation skills
Evidence-based Interventions
Delaying initiation of sexual activity and pregnancy prevention• Reducing the Risk (High school youth)
Decrease sexual initiationDecrease sexual risk taking Increase contraception use for sexually active teens
Teen Outreach Program(High school youth)After-school service program that focuses on positive
self-image, life management skills and goal setting
Evidence-based Interventions
MCH in MontanaFunding to 54 local County Health
DepartmentsImmunizations
Women’s and Men’s HealthWICHome VisitingChildren with Special Health Care NeedsNewborn Hearing and Metabolic ScreeningClinical GeneticsRecruitment, Retention, Loan Repayment
Montana WIC• WIC contracts with 27 Regional
Programs to offer the WIC program benefits to women, infants, and children throughout MT
• Nutrition education, breastfeeding support, food packages
• Serve an average of 20,000 participants each month
Who we serve• Pregnant, breastfeeding and postpartum women
• Infants & children up to 5 years old
• <185% poverty level
• Adjunctively eligible: Medicaid, TANF, SNAP, free/reduced school lunch
• Live in Montana
• At nutritional risk
• Refer all pregnant women
Nutritional Services
At certificationScreen income, check residence and ID, physical presenceCollect anthropometric & biochemical data (ht, wt, hgb)Collect dietary, socioeconomic and medical data = Assess/Risk CodeProvide client centered education based on riskCreate care plan including referrals, follow up schedule and ed. topics
Follow upRefer to care plan, f/u on education, referrals, goals, current education
Mid-year assessmentAnthropometrics, brief assessment & education
Montana WIC Program
1400 Broadway, Cogswell Bldg. C305PO Box 202951
Helena, MT 59620-2951Telephone: 800-433-4298 or
(406) 444-5533 www.wic.mt.gov
Women’s & Men’s HealthWomen’s & Men’s Health• 14 Title X clinics around the state• Resources on:• Family Planning• Teen pregnancy prevention• Health education & outreach• Information on breast & cervical health• Men’s health• STI/HIV prevention
Who is a Title X patient?Who is a Title X patient?• Anyone can receive services from a Title X Family Planning
Clinic. However, for those services to be subsidized by Title X funds, the patient must be:
– Females or males who want to avoid unintended pregnancies or achieve intended pregnancies.
– Post-menopausal women are not eligible for Title X services
since they are unable to become pregnant and would not need contraceptive counseling. There is no such limit for men as they do not have a definite end to their reproductive years.
– Adolescents may be served confidentially* as long as they receive counseling on the following:
• Importance of family involvement • Abstinence• Sexual coercion• Confidentiality• STI/HIV prevention
*MCA 41-1-402: Validity of consent of minor for health services
Patient ServicesPatient Services• Reproductive Health exams for
men and women• Testing
– STI– HIV– Pregnancy
• Contraception• Cancer Screening
– Breast– Cervical– Colo-rectal
• Referral that includes– Pregnancy– Weight management– Primary care– Abnormal breast and pap
follow-up– Mental health
• Education and counseling that
includes
• Birth control methods
• Adolescent counseling
(parental involvement,
sexual coercion,
abstinence, confidentiality
and STI/HIV and
pregnancy prevention)
• Tobacco cessation
• Nutrition and physical
activity
• Immunization
• Reproductive Life Plans
Women’s and Men’s Health Section Montana Department of Public Health and Human Services
1400 E Broadway A116 Helena MT 59620
Phone: 406-444-0983Fax: 406-444-2606
www.dphhs.mt.gov/publichealth/wmh/womensreproductive.shtml
Maternal and Early Childhood Home Visiting
Evidence-based models • Nurse-Family Partnership
– Missoula & RiverStone Health
• Parents As Teachers– Lake, Flathead, Lincoln and Mineral
Referral networks with local health departments
Nurse-Family Partnership
• Focus: Healthy pregnancy, knowledgeable and responsible parenthood, and personal growth and development
• Clients: First time, low income pregnant women, to the child’s second birthday
• Enrollment timing: By the end of the 28th week of pregnancy
• Visits: weekly (1st 4 weeks and 1st 6 weeks postpartum), otherwise every other week, then monthly when child is 21-24 months
• Nurse home visitor
Parents as Teachers• Focus: parenting education, family support,
school readiness, building protective factors within the family
• Clients: identified by community, recommend enrolling prenatally or in infancy; served until the child turns 3 or 5
• Visits: Every week to every other week• Personal visits and group connections• Parent educator
Domains• Child health• Maternal health• Child development and school readiness• Family economic self-sufficiency• Linkages and referrals• Parenting practices• Child maltreatment• Juvenile delinquency, family violence, and crime
Maternal and Infant Home VisitingMontana Department of Public Health and Human Services
1400 E Broadway B102Helena MT 59620
Phone: 406-444-6940Fax: 406-444-2606
www.dphhs.mt.gov/publichealth/homevisiting/miechv.shtml
Children’s Special Health Services
• Partner with regional sites to assure access to pediatric specialty care.
Community Medical Center, Missoula St. Vincent’s, Billings Great Falls Clinic, Great Falls
Ensuring a broad range of Pediatric Specialty Clinics
• Cystic Fibrosis Team Clinic• Cerebral Palsy/Spasticity• Cleft/Craniofacial Team Clinic• Endocrine Clinic• Epilepsy Clinic• Genetic Evaluation &
Outreach Services – Shodair Hospital
• Hemophilia Clinic• High Risk Infant Follow-up
Clinic• Juvenile Rheumatoid Arthritis
• Metabolic Clinic (PKU)• Muscular Dystrophy• Nephrology Clinic• Neurology Clinic• Neural Tube Defects/Spina
Bifida Clinic • Neurology Outreach Clinic• Orthopedic Clinic• Pulmonary Clinic• Rehabilitation Clinic• Rheumatology Clinic• Urology
Travel Distance for CF Patients who Attend CF Team Clinics
ELIGIBILITY
1. Age- birth through 18 years of age.2. Is diagnosed with special health care
needs. OR
3. At risk for chronic physical, developmental, behavioral, or emotional conditions.
AND 4. Requires health and related services of a type or amount beyond that required by children of the same age.
Financial Assistance• CSHS
o $2,000 capo Financial and clinical criteriaoCan be renewed annually
• Genetic Testing oClinical criteriao For genetic laboratory testingoAll ages qualify
Children’s Special Health Services
Montana Department of Public Health and Human Services PO Box 202951
Helena MT 59620-2951(406) 444-3622 (local)
(800) 762-9891 (toll free in state)Fax: (406) 444-2750Email: [email protected]
www.cshs.mt.gov
Early Hearing Detection and Intervention (EHDI) National
Goals
• Goal 1: All newborns will be screened for hearing loss before one month of age, preferably before hospital discharge.
• Goal 2: All infants who screen positive will have a diagnostic audiologic evaluation before 3 months of age.
• Goal 3: All infants identified with a hearing loss will receive appropriate early intervention services before 6 months of age.
NBHSI Program Partners
• Montana School for the Deaf and the Blind• Parents• NBHS Stakeholders Group• 28 Birth Hospitals• Midwives• Pediatric Audiologists• Hearing Conservation Program Audiologists (Montana
Office of Public Instruction)• Montana Part C Program• Montana Physicians• County Health Departments/Home Visiting Programs
Hearing Conservation Program Audiologists, 2013, Montana
Carl Clark Jeff Griffin
Sharon Nash
Shey Mayland
Sharlene Schmidt
Sue Roller Sue Bressler
Tina Hoagland
Tina Berg
Susan Kalarchik
Counties Providing Hearing Screenings, 2013, Montana
NBHS Pilot Sites
Home Visiting Sites Providing Hearing Screening
Home Visiting Sites Who Plan To Implement Hearing Screening
Pediatric Audiologists, 2013, Montana
Greg Freeman**, M.S. CC-A
Leah Jacobsen,Au.D.
Ruth Fugleberg, M.C.S.D.
Hillary Carter**, Au.D.
Ashley Anderson**, Au.D.
Kristy Foss, M.C.S.D.Janice Johnson, Au.D.Kelsey Mann**, Au.D.
Tracy Hayden, Au.D.Crystal Dvorak**, Au.D.
** New Pediatric Audiologists since 2011
Primary Care OfficePrimary Care Office main focus is to use
available data, i.e. Medicaid/Medicare visits to determine areas of the state that are in need of primary care doctors, dentists, nurses, and other health care professionals. These areas may be eligible to apply for Federal Funding by working with the Primary Care Association.
Information source for loan repayment options for primary care and mid-level health care professionals to work in health shortage areas.
Questions?