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Presentation For MCHCOM.COM April, 2003

Presentation For MCHCOM.COM April, 2003. Health Resources And Services Administration Maternal And Child Health Bureau Peter C. van Dyck, M.D., M.P.H.

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Presentation For MCHCOM.COM April, 2003

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  1. Presentation For MCHCOM.COMApril, 2003 Health Resources And Services Administration Maternal And Child Health Bureau Peter C. van Dyck, M.D., M.P.H. • 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.

  2. CSHCN SURVEY

  3. Partnership between HRSA’s Maternal and Child Health Bureau (MCHB) and National Center for Health Statistics (NCHS) • Using SLAITS, complete 750 CSHCN interviews per state • Data available Winter 2002-2003

  4. Establish uniform state, regional, and national prevalence estimates for CSHCN under 18 with existing special health care needs using the MCHB definition. • Provide state, regional, and national data for CSHCN characteristics and systems impact as baseline estimates for federal and state performance measures, Title V needs assessment activities; and HP 2010.

  5. Screened 196,888 households with children • Screened 373,055 children for special health care needs • Completed 38,866 CSHCN interviews

  6. Outline of National Survey of Children With Special Health Care Needs • Introduction • Prevalence of Special Health Care Needs • Health and Functional Status of CSHCN • Health Insurance Coverage • Health Care Needs and Access to Care • Care Coordination • Family-Centered Care • Impact on Families • State by State Data • Appendix

  7. Children with special health care needs (CSHCN) are defined by the Department of Health and Human Services as “…those who have or are at increased risk for chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally.”1

  8. To identify CHSCN, the survey asked whether the child used more medical care, mental health, or educational services than usual for most children of the same age; whether the child used specialized therapies, mental health counseling, or prescription medication; or whether the child was limited or prevented in any way in his or her ability to do things most children of the same age can do, due to a medical, behavioral, or other health condition that is expected to last at least one year.

  9. Prevalence of Special Health Care Needs

  10. Children with Special Health Care Needs 12.8% Children without Special Health Care Needs 87.2% Prevalence of Special Health Care Needs: Persons

  11. 15.7 14.5 7.8 Prevalence of Special Health Care Needs: By Age 20 Percent 10 0-5 years 6-11 years 12-17 years

  12. 16.8 15.2 14.2 13.0 9.8 8.6 4.3 Prevalence of Special Health Care Needs: By Race and Ethnicity 20 Percent 10 Native Hawaiian/ Pacific Islander Hispanic Non- Hispanic White Non- Hispanic Black Native American/ Alaska Native Asian Mixed Race

  13. Household with Children with Special Health Care Needs 20.0% Household with Children without Special Health Care Needs 80.0% Prevalence of Special Health Care Needs: Households

  14. Health and Functional Status Of CSHCN

  15. The population of children with special health care needs is diverse, including children with a wide range of conditions with varying levels of impact. This section describes the types of special needs these children have and the impact of their conditions on both children and their families.

  16. 74.3 45.5 28.7 21.4 17.4 Proportion of CSHCN with Different Needs 80 60 Percent 40 20 Emotional/ Behavioral/ Developmental Services Prescription Medicines Elevated Service Use Limitation in Activities Specialized Therapies

  17. Health Insurance Coverage

  18. Health insurance, whether financed through the private or the public sector, is an essential ingredient for access to care for children with special health care needs. Without health insurance, children are more likely to forgo necessary preventive health care, and acute health care when children are sick can leave their families with overwhelming medical bills. This section reviews the survey’s findings on insurance coverage among children with special health care needs, the adequacy of their coverage, and the other programs and services they use to meet their medical and educational needs.

  19. Ever Uninsured in Past 12 months 11.8% Insured Full Year 88.3% Health Insurance Coverage for CSHCN Over the Past Year

  20. 19.7 13.9 13.9 9.8 Percent of CSHCN Ever Uninsured in the Past Year, By Race and Ethnicity 20 Percent 10 0 Non-Hispanic White Non-Hispanic Black Non-Hispanic Other Hispanic

  21. Ever Uninsured in Past 12 months 11.8% All Criteria For Adequate Insurance Are Usually Or Always Met 66.4% Percent of CSHCN with Inadequate Insurance

  22. 43.0 38.2 31.7 28.2 100%-199% FPL 400%+ FPL 0-99% FPL* 200%-399% FPL Percent of CSHCN with Inadequate Insurance** By Income Level 50 Percent 30 10 *Federal Poverty Level **One or more criteria are not always or usually met: adequate benefits, access to needed providers, and reasonable charges.

  23. Health Care Needs and Access to Care

  24. Children with special health care needs require a broad range of services, from primary and specialty medical care to prescription medications, medical equipment and therapies. In addition to the needs of the child, families of CSHCN may need additional services, such as respite care, family counseling, or genetic counseling. This section describes both the prevalence of need for a variety of medical and support services and the proportion of children who have unmet needs for each service. Other aspects of access to care, such as access to referrals and the presence of a usual source of care, are also presented here.

  25. One Unmet Health Need 11.6% No Unmet Health Needs 82.3% More Than One Unmet Health Need 6.1% Percent of CSHCN with Unmet Health Service Needs

  26. More than One Unmet Health Need 27.0 8.5 One Unmet Health Need 6.8 16.7 19.2 3.5 15.2 8.8 Private Only Uninsured Public Only Both Number of Unmet Health Service Needs By Insurance Type 50 30 Percent 10

  27. Impact on Families

  28. Having a child with special health care needs can affect a family’s finances, employment status, and mental health. The demands on families may require that parents cut down their work hours or give up a job, at the same time that they face burdensome out-of-pocket health care costs. This section describes the impact that children with special health care needs have on their families, including their out-of-pocket expenditures, the time spent caring for their children, and the impact of children’s needs on parents’ employment.

  29. 2-5 hours 22.3% 1 hour or less 57.5% 6-10 hours 6.7% 11+ hours 13.5% Time Spent Providing, Arranging, or Coordinating Care for CSHCN, Per Week

  30. Percent of CSHCN Whose Families Spend 11 or More Hours Per Week Providing, Arranging, or Coordinating Their Care by Income Level 30 25 20 26.7 15 20.7 Percent 10 10.3 5 6.0 0 0-99% FPL* 100%-199% FPL 200%-399% FPL 400%+ FPL * Federal Poverty Level

  31. Experience Financial Problems 20.8% Percent of CSHCN whose Families Experience Financial Problems Due to Child’s Condition Do Not Experience Financial Problems 79.2%

  32. 42.3 30.6 24.3 16.7 Percent of CSHCN Whose Families Experience Financial Problems, By Insurance Type 50 40 30 Percent 20 10 0 Private Only Public Only Both Uninsured

  33. Stopped Working 13.1% No Reported Impact 70.2% Cut Back On Work 16.8% Impact of Child’s Condition on Parent’s Employment

  34. 17.5 19.6 Cut Back On Work 16.9 25.1 14.5 19.0 Stopped Working 9.8 6.9 Impact of Child’s Condition on Parent’s Employment by Income Level 50 40 30 Percent 20 10 0 0-99% FPL* 100%-199% FPL 200%-399% FPL 400%+ FPL * Federal Poverty Level

  35. State-by-State Data The second section of this chart book shows selected indicators for each of the 50 States and the District of Columbia. These indicators are displayed for each state, except in cases where the sample size would compromise the respondents’ confidentiality.

  36. State-by-State Data pages

  37. Breastfeeding Promotion in Physicians’ Office Practices Betty L. Crase, BA, IBCLC Project Director Administered by: American Academy of Pediatrics in partnership with the Department of Health and Human Services Maternal and Child Health Bureau

  38. Goal 1 Increase the number of pediatricians, obstetricians, family physicians, and other health care providers who effectively promote and manage breastfeeding in racially and ethnically diverse populations toward achievement of Healthy People 2010 goals and objectives.

  39. Objective 1A Enroll 300 pediatricians, obstetricians, family physicians, and other health care providers with racially and ethnically diverse backgrounds and those working with underserved populations in the program (Year 4).

  40. Total Enrollment • 694 individual applications • 350 applicants enrolled (50%) • 7 Voluntary Withdrawals • 432 applicants AAP members (62%) • 259 AAP members enrolled (74%)

  41. Objective 1B Determine and compare breastfeeding attitudes, knowledge, and management skills of the 300 program participants through the baseline (Year 5) and follow-up (Year 6) administration of the Physician Self-assessment Questionnaire, adapted to capture cultural competence and behavior changes.

  42. Objective 1C Distribute up to 15 technical and educational culturally appropriate publications and products to help program participants more effectively promote, support, and manage breastfeeding in their medical practices (Years 5 and 6).

  43. Objective 1D Provide technical assistance to all physicians and other health care providers in breastfeeding promotion, support, education, and effective management, including assisting them to utilize publications and products provided through the program (Years 4, 5, 6).

  44. Technical Assistance • 623 requests for technical assistance since October 1, 2001 • Major categories • Breastfeeding materials • Breastfeeding recommendations • Medication questions • Policy statements • BPPOP - Phase II program questions

  45. Objective 1E Through the use of the Parent Survey Tool, track changes in breastfeeding initiation and duration rates in participating medical practices before and after the educational and technical assistance interventions (Years 5, 6).

  46. Goal 2 Develop strategies to bring health professional organizations and public health representatives together around breastfeeding promotion and support to increase the incidence and duration of breastfeeding and decrease racial and ethnic disparities as determined in the Healthy People 2010 goals and objectives.

  47. Objective 2A Engage representatives from up to 10 health professional organizations and public health service providers in a collaborative network to meet the needs of racially and ethnically diverse populations via formation and utilization of a multidisciplinary project advisory committee (Years 4, 5, and 6).

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