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

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AUGUST DIRECT HEALTH CARE SERVICES (GAP FILLING) Examples: Basic Health Services and Health Services for CSHCN 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 CORE PUBLIC HEALTH SERVICES DELIVERED BY MCH AGENCIES MCHEPSDTCHCSCHIP

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

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AUGUST 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

AUGUST MCH Budget for 2007 and 2008(PB), (H), and (S)(millions) 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………$10.6….…$ …..$10.1…..…$10.6 Earmark...$16.0………------….….$70.6……..$16.0 FY (PB) 1-numbers may not add due to rounding 2008(H)2008(S)

AUGUST MCH Budget for 2007 and 2008(PB), (H), and (S)(millions) 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 FY (PB) 1-numbers may not add due to rounding 2008(H)2008(S)

AUGUST MCH Budget for 2007 and 2008(PB), (H), and (S)(millions) 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…… numbers may not add due to rounding 2008(PB)2008(H)2008(S)

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AUGUST 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.

AUGUST 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)

AUGUST 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

AUGUST 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

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

AUGUST 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]

AUGUST DEPRESSION DURING AND AFTER PREGNANCY: A Resource for Women, Their Families and Friends

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

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AUGUST 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

AUGUST National Survey of Children’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

AUGUST National Survey of Children’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

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AUGUST 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 /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

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AUGUST The Children’s Health Survey AK HI

AUGUST The Children’s Health Survey AK HI AK HI

AUGUST The National Survey of Children’s Health

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AUGUST Infant Death Rates by Race and Ethnicity, Source: NVSS, NCHS, CDC.

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

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

AUGUST Percentage N (13) (18) (9) (11) 9.0 or more – – 6.9 Percent Low Birthweight by State, D.C. Source: NVSS, NCHS, CDC. US LBW= 8.15%

AUGUST Source: IOM

AUGUST 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

AUGUST 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.

AUGUST Economic Cost of Low Birth Weight <28 weeks weeks weeks weeks 1.5 Mean Length of Stay for Hospitalization GestationalLength of Stay Age Days IOM, Preterm Births, 2007 IHC data

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

AUGUST 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

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

AUGUST Economic Cost of Low Birth Weight <28 weeks 2, weeks 6, weeks 31, weeks293, Mental Retardation 3 Year CasesPrevalence Survivorsper 1000 IOM, Preterm Births, 2007 MADDSP data

AUGUST 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)

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AUGUST 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

AUGUST MCH Timeline- Historical Markers

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AUGUST How Can I Use this Site? Orientation for new faculty Orientation for new trainees Preparation for Speaking to Community Groups Personal Rejuvenation and Inspiration

AUGUST WEB Sites Mchdata.net Stopbullyingnow.hrsa.gov Cshcndata.org Brightfutures.aap.org Nschdata.org Mchb.hrsa.gov Genes-r-us.uthscsa.edu

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AUGUST Peter C. van Dyck, M.D., M.P.H. HRSA/MCHB Contact