MCHB Perspective on Local MCH: CityMatCH 2008

1. This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation • In Slide Show, click on the right mouse button • Select “Meeting Minder” • Select the “Action Items” tab • Type in action items as they come up • Click OK to dismiss this box • This will automatically create an Action Item slide at the end of your presentation with your points entered. MCHB Perspective on Local MCH: CityMatCH 2008 US Department of Health and Human Services Health Resources And Services Administration Maternal And Child Health Bureau Michael D. Kogan, PhD Director, Office of Data and Program Development for Peter C. van Dyck, MD, MPH Associate Administrator for Maternal and Child Health Health Resources and Services Administration

2. The Importance of Local Government

3. Web hits for: • Local Government: 74,200,000 • State Government: 14,400,000 • Federal Government: 60,800,000

4. The Importance of Local Data

5. 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

6. 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.

7. 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.

10. The Importance of Neighborhood Data

11. 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.

12. 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).

13. Can Interventions Help?

14. Healthy Start Program and Feto-Infant Morbidity Outcomes: Evaluation of Program Effectiveness HM Salihu, AK Mbah, D Jeffers, AP Alio, L Berry

15. 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.

16. 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.

17. MCH Bureau NEW GRANT PROGRAMS

18. The 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).

19. The Community-Based Doula Program • 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.

20. AK HI

21. AK HI

22. The Community-Based Doula Program • 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.

23. Breastfeeding 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

24. 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. 

25. First-Time Motherhood/New Parent Initiative • 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.  

26. 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.  • Public awareness campaigns could be Statewide or countywide. 

27. First-Time Motherhood/New Parent Initiative • MCHB was allocated approximately $4.8 million for this activity. • 13 awards were given.

28. Combating 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.

29. 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.)

30. 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. • Grantees will implement existing state plans to improve services.

31. Data Initiatives

32. National Survey of Children with Special Health 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

33. Prevalence of CSHCN: State Variation 5 Highest and 5 Lowest Prevalence States CSHCN Prevalence

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

35. Impact on Parent’s Employment CSHCN Whose Parents Cut Back on Work or Stopped Working to Care for the Child All CSHCN Activities affected usually, often, or a great deal Daily activities moderately affected some of the time Daily activities never affected Percent of CSHCN

36. Reduce/Stop Work Because of Child’s Care and =>10 Hours Providing Care Source: 2005-6 National Survey of CSHCN

37. Health Insurance Coverage Percentage of CSHCN, by Type of Health Insurance 2001 2001* 2006

38. National Survey of Children’s Health, 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

39. 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 NSCH Topic Areas

40. Release of 2007 NSCH Data • February or March 2009 • Public use microdata files • Extensive documentation • Online data query system • http://www.childhealthdata.org

42. 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

43. Other Programs

44. Released October 2007 • 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” Bright Futures and MCHB solicit your ideas for tools/strategies to facilitate public health implementation cdegraw@hrsa.gov brightfutures@aap.org

45. 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.

46. The Early Childhood 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.

47. The Early Childhood Comprehensive Systems Program (ECCS) • State ECCS grants support “use ofleadership and convening powersto foster the development of early childhood systems” • Building ECCS requires intentional efforts to: • Bridge the gaps left between programs to provide health, mental health, early learning, family support, etc. • Support integrated, cross-systems development through partnerships • Develop governance and structural mechanisms that are needed to sustain comprehensive systems

48. The Early Childhood Comprehensive 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.

49. The Early Childhood Comprehensive Systems Program (ECCS) 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

50. Local Maternal and Child Health