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Building the Best Environments for Families and Children CityMatCH Meeting August, 2007

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

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Building the Best Environments for Families and Children CityMatCH Meeting August, 2007

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  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. Building the Best Environmentsfor Families and ChildrenCityMatCH MeetingAugust, 2007 US Department of Health and Human Services Health Resources And Services Administration Maternal And Child Health Bureau Peter C. van Dyck, M.D., M.P.H.

  2. MCH BUREAU LEADERSHIP

  3. CORE PUBLIC HEALTH SERVICES DELIVERED BY MCH AGENCIES DIRECT HEALTH CARE SERVICES (GAP FILLING) Examples: Basic Health Services and Health Services for CSHCN MCH CHC EPSDT SCHIP ENABLING SERVICES Examples: Transportation, Translation, Outreach, Respite Care, Health Education, Family Support Services, Purchase of Health Insurance, Case Management, Coordination with Medicaid, WIC and Education POPULATION--BASED SERVICES Examples: Newborn Screening, Lead Screening, Immunization, Sudden Infant Death Counseling, 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

  4. Numbers Served In MCH Block Grant Program, 1997 And 2005 SOURCE: TITLE V INFORMATION SYSTEM

  5. MCHB BUDGET 2008

  6. MCH Formula and Allocation • Whenever the total appropriation exceeds $600 million; • 12.75% of the amount is used to fund the Community Integrated Service System (CISS) set-aside program • Remainder is allocated as 85% to States and 15% retained by the Secretary for SPRANS projects

  7. MCH Budget for 2007 and 2008(PB), (H), and (S)(millions) FY2007 2008(PB) 2008(H) 2008(S) • MCHBG…$693.0….$693.0….$750.0….$673.0 • State..….$566.5…..$578.9…....$568.9…...$566.5 • SPRANS...$99.9..…$102.2……..$100.4…..…$79.9 • CISS………$10.6….…$11.9....…..$10.1…..…$10.6 • Earmark...$16.0………------….….$70.6……..$16.0 1-numbers may not add due to rounding

  8. MCH Budget for 2007 and 2008(PB), (H), and (S)(millions) FY2007 2008(PB) 2008(H) 2008(S) • Healthy Start...$101.5….$100.5….$120.0….$101.5 • Hearing…….….....$9.8…....-----.……$11.0……$12.0 • EMSC……….…….$19.8.…...-----…….$22.3……$20.0 • TBI………….………$8.9….....-----….….$8.9……$10.0 • Sickle Cell….…....$2.2….…$2.2………$2.2….….$3.2 • Family to Family.$3.0…....$4.0………$4.0……..$4.0 • Autism………….….-----……..-----……..$0.0…...$37.0 1-numbers may not add due to rounding

  9. MCH Budget for 2007 and 2008(PB), (H), and (S)(millions) 2007 2008(PB) 2008(H) 2008(S) SPRANS Earmarks • Oral Health…...$4.80……$0.0…….$12.0…….$4.8 • Sickle Cell…..…$3.84……$0.0……...$4.0…….$3.84 • Epilepsy…….....$2.88..….$0.0………$5.8..….$2.88 • Genetics….….…$1.92……$0.0…..….$3.8..….$1.92 • Mental Health..$1.54……$0.0……….$0.0…...$0.0 • Fetal Alcohol.…$0.99……$0.0……….$0.0…...$0.99 • 1rst Mother……..-----…….-----………..-----..…$1.54 • Prepare Birth…..-----…….-----..…...$15.0….…----- • Autism……………-----……..-----…..…$30.0…….----- 1-numbers may not add due to rounding

  10. MCH BUREAU PERINATAL DEPRESSION

  11. The Blues”-Common but Transient Very common:60% to 80% of new mothers Little functional impact: Short duration Symptoms: Irritability, anxiety, tearfulness Onset: 3 to 12 days after delivery.

  12. Clinical Depression--- Common and Functionally Impairing Common—5 to 15% of new mothers One study reported even higher rates in teen mothers. Onset within 4 weeks after delivery though other definitions used. Some research includes major & minor depression; others only Major Depression Disorders (MDD)

  13. Criteria for Major Depression: Postpartum Onset Symptoms: 5 or more during same 2 week period • Depressed mood • Diminished pleasure in activities • Weight loss or gain • Insomnia or hypersomnia • Psychomotor agitation or retardation • Fatigue • Feelings of worthlessness; guilt • Poor concentration; indecisiveness • Recurrent thoughts of death Onset: Within 4 wks---Up to 6-12 months after birth

  14. Criteria for Postpartum Psychosis Rare: 1-2 per 1000 Symptoms: • Extreme confusion • Hopelessness • Cannot sleep • Refuse to eat • Distrust other people • Seeing things or hearing voices that are not there • Thoughts of hurting self or baby Onset: Within 4 wks---Up to 6-12 months after birth

  15. Detection of Depression Only one-half of depressions in primary care patients are detected and even fewer postpartum depressions are detected

  16. Health Risk of Maternal Depression • Maternal depression is a serious disorder. Depression compromises a women’s health, reduces her quality of life and functional status, and can impair her ability to maintain important social relationships. • Women who suffer from depression while pregnant are 3.4 times as likely deliver preterm and 4 times as likely to have low birth weight babies. They are also more likely to suffer obstetrical complications such as pre-eclampsia, excessive bleeding, placenta rupture and premature rupturing of the waters. [NBGH, 2005]

  17. DEPRESSION DURING AND AFTER PREGNANCY: A Resource for Women, Their Families and Friends www.mchb.hrsa.gov/pregnancyandbeyond/depression

  18. MCH BUREAU BREASTFEEDING

  19. The Kit will be divided into 5 sections; Cost savings information Support breastfeeding employees Templates for tools for companies Employees guide Outreach marketing guide Business Case for Breastfeeding

  20. MCH BUREAU CHILDREN'S SURVEY

  21. The National Survey of Children’s Health • The 2003 NSCH was conducted by the Maternal and Child Health Bureau and the National Center for Health Statistics using the State and Local Area Integrated Telephone System mechanism (SLAITS) • Its purpose was to produce national and state-based estimates on the health and well-being of children, their families, and their communities

  22. 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

  23. National Survey ofChildren’s Health • Prevalence of obesity across States • Pevalence 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

  24. What is the Data Resource Center? A website that delivers: • Hands-on, user-friendly access to national, state and regional data from the 2001 NS-CSHCN and the 2003 National Survey of Children’s Health (NS-CH) • 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

  25. The Children’s Health Survey AK HI

  26. The Children’s Health Survey AK AK HI HI

  27. The National Survey of Children’s Health

  28. MCH BUREAU LOW BIRTH WEIGHT

  29. Infant Death Rates by Race and Ethnicity, 1995 - 2004 Source: NVSS, NCHS, CDC.

  30. Infant Mortality Rate by State, 2002-2004 2010 Target = 4.5 D.C. N Per 1,000 live births (4) (8) (11) (16) (12) 9.0 or more 8.0 - 8.9 7.0 – 7.9 6.0 – 6.9 Less than 6.0 Obj. 16-1c Source: NVSS, NCHS, CDC.

  31. Total and Preterm Infant Mortality Rates by Race and Ethnicity of Mother, 2004 Source: NVSS, NCHS, CDC.

  32. Percent Low Birthweight by State, 2004-2005 US LBW= 8.15% D.C. N Percentage (13) (18) (9) (11) 9.0 or more 8.0 - 8.9 7.0 – 7.9 6.0 – 6.9 Source: NVSS, NCHS, CDC.

  33. Source: IOM

  34. Economic Cost of Low Birth Weight • Medical Care=$16.9 Billion • >85% is for infancy care • Education=$1.7 Billion • Early Intervention=$611 Million • Special Education for 4 Conditions=$1.1 Billion • Cerebral Palsy-CP • Mental Retardation-MR • Vision Impairment-VI • Hearing Loss- HL

  35. Economic Cost of Low Birth Weight • Extremely preterm babies (<28 weeks) represent 6% of all preterm births yet accounted for more than 33% of the total medical costs of all preterm births through 7 years of age.

  36. Economic Cost of Low Birth Weight Mean Length of Stay for Hospitalization Gestational Length of Stay Age Days <28 weeks 67.4 28-31 weeks 44.4 32-36 weeks 6.7 37-40 weeks 1.5 IOM, Preterm Births, 2007 IHC data

  37. Economic Cost of Low Birth Weight Total Annual Medical Costs, U.S., 2005 Birth Year Year 2 Year 3-4 <28 weeks $190,467 $12,172 $4,944 28-31 weeks $94,785 $7,715 $2,534 32-36 weeks $13,621 $1,736 $814 37-40 weeks $3,325 $1,328 $661 IOM, Preterm Births, 2007

  38. Economic Cost of Low Birth Weight • 40% of the medical costs for preterm births are paid for by Medicaid (33% of all births). Medicaid costs for the cohort born in 2005 for the first 7 years of life are estimated to be $6.4 Billion. IOM, Preterm Births, 2007 Russell, 2005

  39. Economic Cost of Low Birth Weight Medical Costs by Developmental Disability Developmental Medical Costs Disability Mental Retardation $123,205 Cerebral Palsy $83,169 Vision Impairment $32,058 Hearing Loss $23,209 IOM, Preterm Births, 2007 Honeycutt, et.al.

  40. Economic Cost of Low Birth Weight Mental Retardation 3 Year Cases Prevalence Survivors per 1000 <28 weeks 2,785 176 63.2 28-31 weeks 6,281 171 27.2 32-36 weeks 31,568 407 12.9 37-40 weeks 293,949 1988 6.8 IOM, Preterm Births, 2007 MADDSP data

  41. Conclusion • Interventions to reduce preterm births have potential to save significant economic resources • Savings accrue primarily in first year of life, thus returns are rapid • Savings will depend on exact nature of shift in birth weight distribution (some shifts increase costs)

  42. MCH BUREAU MCHB TIMELINE

  43. www.mchb.hrsa.gov/timeline

  44. Why Develop an MCH Timeline? • Wisdom of the past helps us make better decisions today • MCH History provides us with: • A common frame of reference • A shared identity • A source of inspiration

  45. MCH Timeline- Historical Markers

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