MCH 2015 State Needs Assessment

1. Linda Kenney, MPH November 6, 2009 MCH 2015 State Needs Assessment

2. GENERAL INTRODUCTION REQUIREMENTS Maternal & Child health services block grant program

3. Authorized under Title V of Social Security Act, 1935 To improve the health of ALL mothers and children in the State Consistent with Health Objectives for the Nation -- Healthy People 2010 Maternal & Child health services block grant program

4. $4.7 million per year down from $5 million in FFY 1994 To have the same buying power in 2009 we would need $7.2 M (2.46% inflation) State match requirement $3.5 M Local agencies match another $7.7 M KS Maternal & Child health services block grant program

5. Three population groups: • Pregnant women and infants • Children and adolescents • Children with special health care needs Maternal & Child health services block grant program

6. Assure or provide programs for maternity, infant, and child care, as well as a full range of medical services for children. $ to states -- physicians, dentists, public health nurses, medical social workers, and nutritionists. Maternal & Child health services block grant program

7. Public Health Nurse graduates, 1912

8. OBRA 89 - Coordinate with Medicaid Conduct a survey of MCH needs every 5 years. Set priorities based on needs. Maternal & Child health services block grant program

9. Home visiting, Circa 1903

10. Introduction to Needs Assessment Involving Stakeholders Sources of Needs Assessment Data Needs as Values: Need Discrepancies Setting Priorities Selecting Solutions TIMELINE PLENARY Outline

11. Public health is what we do collectively as a society to create those conditions in which we can be healthy Maternal and child health (MCH) is a fundamental component of public health MCH promotes the nation’s interest in improving the health and well-being of all children and their families Introduction

12. Focus is on the POPULATION • Emphasis is on PREVENTION • Orientation is toward the COMMUNITY • Efforts are directed at SYSTEMS • Overarching role is one of LEADERSHIP Introduction

13. MCH programs engage in the core functions of public health: • Assessment • Policy development • Assurance Introduction

14. “It is the responsibility of every public health agency to regularly and systematically collect, assemble, analyze and make available information on the health of the community, including statistics on health status, community health needs and epidemiologic and other studies of health problems” IOM 1988 The Future of PublicHealth Institute of Medicine:

15. 1. Assess and monitor MCH to identify problems 2. Diagnose and investigate health problems and hazards 3. Inform and educate the public and families 4. Mobilize community partnerships between policymakers, health care providers, families, the general public to identify and solve MCH problems 5. Provide leadership for priority-setting, planning and policy development to support community efforts MCH Essential Services

16. 6. Promote and enforce legal requirements 7. Link women, children and youth to health and other community and family services and assure access to comprehensive, quality systems of care 8. Assure the capacity and competency of the public health and personal health work force 9. Evaluate the effectiveness, accessibility and quality of personal health and population-based services 10. Support research and demonstrations MCH Essential Services

17. Required of KDHE as the State Title V agency • Comprehensive N.A. every 5 years • ID State MCH priorities • Use priorities to set program and policy activities • Use state performance measures to monitor the success of these efforts • Population-based and community-focused Introduction

18. Nurse and mother, 1909

19. Assessment is not new to MCH • 1912 charter establishing the Children’s Bureau states as its mission: “. . .to investigate and report upon matters pertaining to the welfare of children and child life among all classes of people . . .” • “investigate and report” = assessment! Introduction

21. “. . . to assure the health of all mothers and children . . .” requires ongoing monitoring and assessment of trends in population characteristics, health status indicators, risk factors, health system attributes, and the availability and accessibility of quality services for mothers and children. MCH Mission

22. School nurse, 1909

23. Use of the most appropriate programs and policies to promote the health of women, children, adolescents, and children with special health care needs, and their families – budget constraints A fundamental element of any program planning activity So, needs assessment is about change Targeting our Energy & Resources

24. Ongoing planningcycle that enables us to 1. assess problems, needs, assets and strengths 2. develop and implement solutions 3. allocate resources 4. evaluate activities 5. monitor performance 6. begin anew, back to #1 Introduction

25. Basically, data-driven But, involves politics of policy-making, program development and resource allocation So, important to engage and involve the community of interest, the stakeholders Introduction

26. Ideally N.A. bridges: • Science and politics • Data and community values • Needs and strategies for their solution All within a comprehensive planning process Introduction

27. N.A. ongoing process; process is revisited & formalized every 5 years INTERVENING YEARS – implement strategies and focused assessment Introduction

28. National baby week, 1918

29. NOT BECAUSE • “We have to” • We need to justify our current efforts • Forget it, if we do not intend to act on the results • BECAUSE • recognize the dynamic nature of MCH • good stewards of the public’s trust • must set priorities within limited resources Introduction

30. Parameters vary • Statewide or in specific community? • Entire population or certain population group? • All of MCH or just certain aspects? • Any health issue or focused topic? • Independent or in collaboration with other groups? Introduction

31. AAP founded, 1930s

32. Keep as broad and comprehensive as possible • Do focused assessment in the intervening years, while the ongoing broad-based monitoring continues • Examples of focused assessment - adolescents, farm injuries, needs of recent immigrants, frontier counties, specific urban neighborhoods, etc MCH 5-Year Needs Assessment

33. To begin . . . Where do we start? with the data? or with the community? MCH Needs Assessment

34. This is NOT a trivial question! How much do we want to shape (or control) the process? By presenting data first, we potentially limit the universe of possibilities, but we also clarify the parameters of our capacity By seeking input from the community first, we potentially open ourselves up to unrealistic expectations but we gain a wealth of insight that limited data cannot possibly give us MCH Needs Assessment

35. Regardless of where we begin, it is absolutely essential to the entire needs assessment process that we involve and engage our stakeholders early on and throughout the process • Ultimately what we do in public health is about the public, and if the public doesn’t buy that a problem exists or doesn’t buy your solution to the problem, we’ve got an uphill battle on our hands Involving Stakeholders

36. Who are “stakeholders”? • Represent a group with an interest in the process & outcomes • Has a “stake” in the process & outcomes, with a vested interest (beware of the conflicts of interest that will arise . . .) • N.A. is about change, so lots of folks will have something to say about the process & outcomes . . . Involving Stakeholders

37. For MCH these typically include: • Other state agencies/programs • Local health departments • Providers and facilities serving MCH populations • Professional organizations • Funders and/or elected officials • Clients of service programs, persons served • The media • The public at large • Community-based and advocacy organizations Involving Stakeholders

39. How do they help? • Identify the full scope of needs • Interpret available data or collect new • Sort out priorities • Identify and select solutions • Build awareness of your program • Build consensus • Advocate for needed changes • Support your overall efforts Involving Stakeholders

40. Ways to involve stakeholders: • Can be a source of data • Serve on formal advisory committees • Informally review proposals in N.A. process • Assemble into coalitions to support the N.A. recommendations Involving Stakeholders

41. Advisory Committees (EXPERT PANELS) • Possibly a significant amount of work, assembling various stakeholders into groups: 1. engages people in the process 2. elicits rapport and good will 3. addresses opposition 4. legitimizes the NA process Involving Stakeholders

42. Various ways to do this: • Convene chairs of multiple advisory committees • Assemble multiple ad hoc advisory committees to focus on specific issues • Assemble one large advisory committee with subcommittees to see you through the whole process Involving Stakeholders

43. Possible types of committees • Data committee • State agency partners committee • Local health agency partners committee • Community partners committee • Population subgroup committees • Pregnant Women & Infants • Children & Adolescents • Children & Youth with Special Health Care Needs Involving Stakeholders

45. Population Subgroup Committee: • Review data and ID needs • Set priorities and recommend strategies • Set an advocacy agenda • Develop evaluation plan with performance measures Involving Stakeholders

46. Any comments at this point? Ways expert panels are helpful? Ways expert panels are not helpful? Ideas to improve process? Involving Stakeholders

47. Essentially 4 sources • Population-based data (vital records, census) • Surveillance systems and survey data • Program or service data • Public forums or focus groups Sources of Data

48. Population-based Data • Census • Vital Records • Births • Deaths • Fetal Deaths • Abortions (not all states have individual records) • Marriages, divorces, adoptions Sources of Data

50. Surveillance Systems and Survey Data • Every state has access to SLAITS data • Every state has BRFSS data • Most states have YRBS data • Some states have PRAMS data • Every state has communicable disease incidence data • Many states have registry data • Some states conduct their own surveys routinely or as needed to answer a particular question Sources of Data