Getting Ready for the Title V 5-year Needs Assessment: Using the FHOP Data Sources

1. Getting Ready for the Title V 5-year Needs Assessment: Using the FHOP Data Sources Gerry Oliva, M.D. UCSF Family Health Outcomes Project July 14th, 2008, San Diego, CA

2. Today’s Objectives • Successfully navigate the FHOP website to find what you need • Identify the sources of data for the 27 MCAH indicators • Interpret the rate tables in the FHOP Databooks • Interpret the trend tables in the FHOP Databooks • Use the blank  data templates and other planning tools • Using the Title V Indicator Rate table UCSF Family Health Outcomes Project

3. Today’s Agenda • Overview of the Title V planning process- the cliff note version • FHOP’s role in county Title V needs assessment • Navigating the FHOP Websites - finding what you need • Finding and interpreting data for the state MCAH required indicators – using the data spreadsheets and the indicator table • Understanding basic public health statistics and using FHOP’s rate tables • Review analytical and statistical concepts used in trend analysis – how to interpret trend graphs UCSF Family Health Outcomes Project

4. Historical Context • Institute of Medicine Future of Public Health Report 1988 - emphasis on the core functions of public health; focus on population based programs and essential public health services (counting numbers served is no longer sufficient) • Assessment • Planning and Policy Development • Assurance UCSF Family Health Outcomes Project

5. Historical Context • 1989 - OBRA ‘89 requires federal Title V agency MCHB to monitor a set of HP 2000 indicators • 1992 - AB99 Committee in California recommends monitoring a larger number of HP2000 indicators • 1993 - California MCH Branch initiates an effort through FHOP to assist funded local MCH programs to monitor these indicators UCSF Family Health Outcomes Project

6. Historical Context (cont) • 1993 - Government Performance and Results Act (GPRA) mandates federal agencies to develop performance measures • 1997 - Federal MCHB develops a set of measures and Title V guidance requires states to monitor these • 1998 - California MCHB requires local programs to monitor these indicators and incorporate them into their five year needs assessment and plans UCSF Family Health Outcomes Project

7. Historical Context: Essential Core Public Health Functions • Core Functions Steering Committee (1994) • Included representatives from national organizations and federal agencies • Charge: To provide a description and definition of public health • Developed the “Public Health in America” statement UCSF Family Health Outcomes Project

8. Monitor health status Diagnose and investigate Inform, educate, and empower Mobilize community partnerships Develop policies and plans Enforce laws and regulations Link people to needed services / assure care Assure a competent workforce Evaluate health services Research UCSF Family Health Outcomes Project

9. Historical context for MCAH Program Capacity Assessment • CDC’s National Public Health Performance Standards Program (NPHPSP) develops tools to assess state PH programs in the 10 areas • 1995 AMCHP and Federal MCHB develop a set of 10 essential MCAH functions and the MCAH Pyramid that is used as a framework for the Federal Title V Assessment process. • Johns Hopkins School of Public Health in collaboration with AMCHP and Federal MCHB develops the CAST-5 assessment tool that corresponds to the NPHPSP UCSF Family Health Outcomes Project

10. 10 Essential PH Services to Promote MCAH in America • Assess and monitor MCAH status to identify and address problems. • Diagnose and investigate health problems and health hazards affecting women, children and youth. • Inform and educate the public and families about MCAH issues UCSF Family Health Outcomes Project

11. 10 Essential PH Services to Promote MCAH in America • Mobilize community partnerships to identify and solve MCAH problems • Provide leadership for priority setting, planning, and policy development to support community efforts to assure the health of the MCAH population • Promote and enforce legal requirements that protect the MCAH population and ensure public accountability for their well-being UCSF Family Health Outcomes Project

12. 10 Essential PH Services to Promote MCAH in America • Link women, children and youth to health and other community/family services, and assure access to comprehensive quality systems of care. • Assure the capacity and competency of he public health and personal health workforce to effectively and efficiently address MCAH needs UCSF Family Health Outcomes Project

13. 10 Essential PH Services to Promote MCAH in America • Evaluate here effectiveness, accessibility and quality of Personal health and population-based MCAN services • Support research and demonstrations to gain new insights an innovative solutions to MCAH problems. UCSF Family Health Outcomes Project

14. Federal MCHB PYRAMID UCSF Family Health Outcomes Project

15. 2000 and Beyond • In 1999 Federal MCHB added a requirement for states to monitor a set of needs indicators • State MCH programs are awaiting the specific Title V guidance on requirements for the 5 year plan due in 2010 • California MCAH will require that local MCH programs submit a needs assessment by July of 2009 to use in its document due in July of 2010 UCSF Family Health Outcomes Project

16. Fiscal and Policy Changes Affecting MCAH • National budget deficits are resulting in cuts for basic social and health services for poor families • The state Title V Block Grant funds have been reduced several times in the past 5 years with no increases in sight • Some of the use of local funds as matching funds for public health nursing functions are being challenged UCSF Family Health Outcomes Project

17. New Expectations from Federal Funders • The CDC has a number of major initiatives on promoting evidence based prevention strategies • This requires that state and local governments either use an evidence based model or have an evaluation that provides new evidence on the program’s cost and effectiveness UCSF Family Health Outcomes Project

18. New Emphases at California DPH • Focus on planning at the local level • Focus on local solutions • Increased interest in longitudinal data • Explosion of programs using GIS to examine local health issues UCSF Family Health Outcomes Project

19. County Housing Laws Policies Workplace Family City Child Community Healthcare Provider Daycare Jobs School State Legal System Availability of health services National Politics Emerging Concepts : Ecological Model UCSF Family Health Outcomes Project

20. Emerging Concepts: Life Course Model Mother overweight/diabetic Poverty/fast food/food habits in young woman Infant born LGA/Abnormal GT Adolescent with increased # fat cells/ abnormal GT Working Mom-Infant Fed Formula School with no PE, unsafe parks latch key child watches TV / gets more overweight Family Culture - high fat, high sugar diet- child overweight UCSF Family Health Outcomes Project

21. Societal/ Policy Level Level Lack of Affordable/Accessible Family Planning Clinics SES Factors Environmental Factors Economic factors Healthcare Policies Education Policy Safety Family/Community Level Nuclear Family Factors Community Networks friends Connection to religious or other community groups Local School/ Workplace Factors Quality issues Health Care Provider Issues Individual Level/ Individual Level Psychosychological Factors Cognitive Factors Genetic/Biological Characteristics Genetic/Biological Characteristics Health Behaviors Specific Biological Risk Factors Immediate Causal Factor(s) Targeted Indicator Identified Problem Consequences Economic, Physical, etc Generic Framework for Health Problem Analysis UCSF Family Health Outcomes Project

22. 2004 Local MCAH Needs Assessment Convene Public Health/ Community Coalition Assess 27 indicators & Prioritize Health Status/Problems Evaluate/ Measure Performance Plan & Implement Programs Assess Community Resources & Strengths Assess MCH Program Capacity Develop Objectives Analyze Problem & Select Interventions UCSF Family Health Outcomes Project

23. 2009 Local MCAH Needs Assessment Convene Public Health/ Community Coalition Assess 27 Indicators/ Review Priorities Evaluate/ Measure Performance Assess Community Resources & Strengths Plan & Implement Programs Assess MCAH Program Capacity Develop Objectives Analyze Problem where no progress made on priority area UCSF Family Health Outcomes Project

24. Challenges for Local Health Jurisdictions • Monitor results of program cuts • Advocate for local resources to sustain threatened programs • Advocate at state level for general fund monies to sustain programs • Determine where to allocate reduced resources UCSF Family Health Outcomes Project

25. Preparing for the 5-year Plan • MCAH Epi has developed guidelines on what will be required of LHJs • MCAH Epi with input from FHOP and county subcommittee has finalize tool for Program Capacity Assessment • FHOP is revising the guide “Developing an Effective Planning Process: A Guide for Local Health Programs” • FHOP and MCAH Epi are identifying or developing most of the data that local programs will need • Trainings will be provided on the essential components of the assessment UCSF Family Health Outcomes Project

26. What help can FHOP provide during the process? • The website has been updated with 2006 data for databooks and the other indicators in the indicator table • Telephone conference calls will be held to help with specific issues • Additional trainings will be held in the 2008-2009 contract year • Telephone technical assistance will be provided UCSF Family Health Outcomes Project

27. I bet you can’t wait to get started !!!! UCSF Family Health Outcomes Project