Presentation For National ASTPHND Meeting June, 2005 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.

JUNE MCH BUREAU

JUNE The MCH Block Grant (Title V) States’ Program 501(a)(1)(a-d) “Title V authorizes appropriations to states to improve the health of all mothers and children” “To provide and assure mothers and children... Access to quality maternal and child health services” “To reduce infant mortality…preventable diseases and handicapping conditions among children…increase number of...Immunized children…”

JUNE The MCH Block Grant (Title V) States’ Program 501(a)(1)(a-d) “To increase low income children receiving health assessments and…diagnosis and treatment services” “Promote health…by providing prenatal, delivery, and postpartum care…” “Promote health of children by providing preventive and primary care services…”

JUNE The MCH Block Grant (Title V) States’ Program 501(a)(1)(a-d) “To provide rehabilitation services for blind and disabled individuals under 16 receiving benefits under Title XVI, to the extent…it is not provided under Title XIX” “To provide and promote family-centered, community-based, coordinated care…for children with special health care needs…and facilitate… community based systems of services for such children and their families”

JUNE MCH BUREAU

JUNE MCHB Strategic Plan Goals Provide National Leadership for Maternal and Child Health by creating a shared vision and goals for MCH, informing the public about MCH needs and issues, modeling new approaches to strengthen MCH, forging strong collaborative partnerships, and fostering a respectful environment that supports creativity, action, and accountability for MCH issues.

JUNE MCHB Strategic Plan Goals Eliminate health disparities in health status outcomes, through the removal of economic, social and cultural barriers to receiving comprehensive timely and appropriate health care

JUNE MCHB Strategic Plan Goals To assure the highest quality of care through the development of practice guidance, data monitoring, and evaluation tools; the utilization of evidence-based research; and the availability of a well-trained, culturally diverse workforce

JUNE MCHB Strategic Plan Goals To facilitate access to care through the development and improvement of the MCH health infrastructure and systems of care to enhance the provision of the necessary coordinated, quality health care

JUNE MCH BUREAU

JUNE The MCH Block Grant (Title V) history Creation of the Children’s Bureau “to investigate and report on the status of children and on their common as well as special needs” 1913—Prenatal Care published 1914—Infant Care published Sheppard-Towner Act First federal grant-in-aid program to States for health, “to promote the welfare and hygiene of maternity and infancy” 1930—American Academy of Pediatrics

JUNE The MCH Block Grant (Title V) history Title V of the Social Security Act Grants-in-aid to States for MCH programs, services for crippled children, and child welfare services 1943—Autism is officially described by Dr. Leo Kanner 1950—disposable diapers are invented by Marion Donovan

JUNE The MCH Block Grant (Title V) history 1957—Mental retardation programs Congress earmarked $1M for demonstration clinical programs for children with mental retardation 1962—St. Judes founded by Danny Thomas —MIC and C & Y programs Three new grants: NICU, family planning, dental care 1968—electronic fetal monitoring first used Administration transferred to the Public Health Service

JUNE The MCH Block Grant (Title V) history 1981 (OBRA ‘81)--Converted Title V to a block grant by combining seven categorical programs; MCH/CSHCN SSI Lead screening Genetic diseases SIDS counseling programs OBRA ‘81 Hemophilia treatment centers Adolescent program grant

JUNE The MCH Block Grant (Title V) history 1982—Prenatal test for sickle cell disease 1984—Emergency medical services for children enacted 1989 (OBRA ‘89)--Introduced major changes Application with needs assessment and priorities Measurable objectives Budget accountability Documentation of match Maintenance of effort

JUNE The MCH Block Grant (Title V) history 1991—Healthy start enacted 1996—Abstinence education program begun 2000—Performance measures, CSHCN survey, newborn screening, abstinence, poison control, bioterrorismwww.mchdata.net

JUNE The MCH Block Grant (Title V) history 2004—Performance measures, CSHCN survey, child health survey, anti- bullying campaign, early childhood, newborn screening, women’s health, discretionary grants reporting system, data and evaluation, training strategic plan

JUNE MCHB

JUNE MCH Budget for 2004, 2005, and 2006(millions) MCHBG…$ $ $723.9 State….…$ $591.1…..$601.9 SPRANS..$104.9…...$102.7…..$106.2 CISS….….$15.0…....$14.6…….$15.8 Earmark..$15.5…....$15.5…..$0.0 FY numbers may not add due to rounding 2006(PB)

JUNE MCH Budget for 2004, 2005, and 2006(millions) Healthy Start…$ $102.5…..$97.7 Hearing………..$ $ 9.8 …$ 0.0 EMSC…………..$ $ 19.8….$ 0.0 TBI………………$ 9.4…..$ 9.3…..$ 0.0 Sickle Cell…..$ 0.0…..$ 0.2…..$ 0.0 FY numbers may not add due to rounding 2006(PB)

JUNE MCH Budget for 2004, 2005, and 2006(millions) SPRANS Earmarks Oral Health…..$4.97…..$4.96 …..…$0.0 Sickle Cell….…$ $3.97……...$0.0 Epilepsy……....$2.98…..$2.98…..….$0.0 Genetics….……$1.99…..$1.98……...$0.0 Mental Health.$1.59…..$1.59…..….$0.0 FY numbers may not add due to rounding 2006(PB)

JUNE MCH BUREAU

JUNE Title V MCH Block Grant “Year of the Needs Assessment” Planning document for State Title V programs for the next 5 years. Face-to-face review process, which includes Federal program staff and State MCH leadership Application Guidance Current Office of Management and Budget clearance will expire in May Workgroup formed to provide input on areas of suggested revision/update.

JUNE 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

JUNE Numbers Served In MCH Block Grant Program, 1997 And 2003 SOURCE: TITLE V INFORMATION SYSTEM

JUNE MCH Bureau Performance Measurement System DIRECT HEALTH ENABLING SERVICES POPULATION BASED INFRASTRUCTURE SERVICES MCHB PROGRAM AND RESOURCE ALLOCATION MCHB PERFORMANCE MEASURES MCHB OUTCOME MEASURES STATE BLOCK GRANT SPRANS HEALTHY START EMERGENCY SERVICES FOR CHILDREN PRIORITIES AND GOALS MCHB MCHB NEEDS ASSESSMENT HEALTH STATUS INDICATORS I. DECREASE DISPARITIES II. INCREASE QUALITY III. IMPROVE INFRASTRUCTURE STATE/ NATIONAL INDICATORS HEALTHY PEOPLE 2010 LEGISLATIVE PRIORITIES PARTNERSHIPS INPUT PERINATAL MORTALITY INFANT MORTALITY NEONATAL MORTALITY POSTNEONATAL MORTALITY CHILD MORTALITY INFANT DEATH DISPARITY TRAUMATIC BRAIN INJURY

JUNE National Performance Measures Title V MCH Block Grant Program 10) The rate of deaths to children aged 1-14 caused by motor vehicle crashes per 100,000 children. 11) Percentage of mothers who breastfeed their infants at hospital discharge. 12) Percentage of newborns who have been screened for hearing impairment before hospital discharge.

JUNE The 37 Discretionary Performance Measures 08) Percent of graduates of MCHB long- term training programs that demonstrate field leadership after graduation 33) The degree to which a State system for nutrition services has been established for MCH populations

JUNE State Priority Needs Keyword Search Nutrition/Physical Activity 33 States with 46 Priority Needs Identified (Includes needs related to breastfeeding; overweight; iron-deficiency anemia; nutritional status of women, infants and children; folic acid use; healthy behaviors; and physical fitness) Obesity 15 States with 17 Priority Needs Identified

JUNE State Performance Measures Keyword Search  Nutrition/Physical Activity  36 States with 54 Performance Measures  Obesity  21 States with 25 Performance Measures  (6 Measures target WIC Program Participants)  WIC  11 States with 13 Performance Measures

JUNE The 9 Health Systems Capacity Indicators 09C) The ability of States to monitor overweight or obesity among children and youth (as reported in the 2003 Annual Block Grant Report)

JUNE The 9 Health Systems Capacity Indicators YRBS 47 of 59 States participate 35 (60%) sample size is large enough for statewide estimates 12 (20%) sample size too small 12 (20%) do not participate

JUNE The 9 Health Systems Capacity Indicators Pediatric Nutrition Surveillance System 40 of 59 States participate 36 (61%) sample size is large enough for statewide estimates 4 (7%) sample size too small 19 (32%) do not participate

JUNE The 9 Health Systems Capacity Indicators WIC Nutrition Survey 53 of 59 States participate 48 (81%) sample size is large enough for statewide estimates 5 (9%) sample size too small 6 (10%) do not participate

JUNE MCH BUREAU

JUNE MCHB Cross-Division Nutrition Committee MCHB nutrition strategic plan focuses on four major areas: 1. Breastfeeding promotion and support 2. Overweight/obesity prevention and healthy lifestyle promotion 3. Public health nutrition leadership and training 4. Coordination and collaboration with federal, state and local partners

JUNE Breastfeeding Support Systems support Liaison to the U.S. Breastfeeding committee Strategic plan for breastfeeding in the U.S. National breastfeeding coalition workshop (2006) Expert work group meetings (MCHB and CDC) Oral health and breastfeeding Safe and appropriate use of human milk substitutes for the breastfed infant in the U.S

JUNE Breastfeeding Support Hospital Support Baby Friendly Hospital Project – Identification of barriers to implementing the TEN Steps to Successful Breastfeeding. Work site support Development of a Best Start Social Marketing program to provide breastfeeding support to employers and women returning to work/school.

JUNE Breastfeeding Support Provider Support Academy of Breastfeeding Medicine Development of protocols and support for annual meeting. AAP Breastfeeding Promotion in Physicians’ Office Practices (BPPOP – Phase III) 3-year program to initiate and sustain system-wide changes in breastfeeding management at the national, state and community levels. Builds on and programs.

JUNE Breastfeeding Support BPPOP III Focuses on educating and supporting future and practicing physicians and health care professionals in culturally effective breastfeeding promotion and support – directed at achievement of Healthy People 2010 goals. Developing breastfeeding curriculum for medical residency training programs.

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JUNE Overweight And Obesity Proposed in the MCHB Nutrition Strategic Plan is the funding of interdisciplinary training for health providers working as a team to 1) treat pediatric overweight/obesity and 2) develop prevention programs. Maternal obesity is also an area of interest. (Potential for an IOM Study to examine factors that contribute to recommended prenatal weight gain.)

JUNE Child And Adolescent: Overweight And Obesity Needs assessment conducted to determine current practices of pediatricians, nurses and dietitians in the assessment and treatment of childhood overweight and obesity (MCHB, CDC, NCEMCH, and ILSI) - Findings published as a Supplement to the Journal Pediatrics (July 2002)

JUNE Child And Adolescent: Overweight And Obesity Expert panel convened in February 2005 to develop recommendations for the assessment, prevention and management of child and adolescent overweight/obesity (MCHB, CDC and AMA)

JUNE National Business Group on Health MCHB nutrition staff serve on the Obesity Institute, an initiative that encourages members to: Network with other corporate leaders to raise awareness about the health and cost consequences of obesity. Identify and test solutions to obesity that have a positive return on investment. Advance health plans’ and vendors’ efforts to implement solutions.

JUNE National Business Group on Health With MCHB support, developed An Employer Toolkit for Addressing Overweight Among Employees and Their Children. Toolkit includes: Issue Brief PowerPoint Presentation Family Fact Sheets Tip Sheets

JUNE Innovative Approaches To Promoting a Healthy Weight in Women Purpose: to develop creative, innovative approaches that are effective in reducing the prevalence of overweight/obesity in women;  Efforts must target women in communities with limited access to preventive health services, particularly women of color, who are disproportionately affected by this risk factor

JUNE Innovative Approaches to Promoting a Healthy Weight in Women  Approaches must be substantive in nature and incorporate nutrition, physical activity and health/wellness components  Must also link women, when appropriate, with Title V/other relevant services to provide comprehensive care

JUNE Innovative Approaches Promoting a Healthy Weight in Women 7 Grantees; approximately $150,000/yr. for 3 yrs., funding began September 2004 and *May 2005  Texas State University, San Marcos, TX  NorthEast Ohio Neighborhood Health Services, Cleveland, OH  Holyoke Health Center, Holyoke, MA

JUNE Innovative Approaches Promoting a Healthy Weight in Women *Funded May 2005  Mariposa Community Health Center, Nogales, AZ  Orange County Health Department, Orlando, FL  Bad River Band of Lake Superior Chippewa Indians, Odanah, WI  Christiana Care Health Services, Inc., Wilmington, DE

JUNE Development of a national nutrition blueprint for action (MCHB, NIH, CDC) Blueprint for action. Nutrition and physical activity: cornerstones of a healthy lifestyle Stakeholder consensus document that brings focus and urgency to critical goals and strategies that will frame nutrition and physical activity for the next years. MCH Nutrition Leadership

JUNE “Umbrella” document that can be adapted to reflect local and state needs Document to use at all levels to educate decision makers on priority actions. Document that fosters joint efforts for greater impact with well-utilized resources. Blueprint for Action Nutrition and Physical Activity: Cornerstones of a Healthy Lifestyle

JUNE Initial Meeting (April 2004) Participants included nutrition and physical activity experts representing public and non-profit organizations. Second Meeting (April 2005) Document expected to be released in 2006 Blueprint for Action Nutrition and Physical Activity: Cornerstones of a Healthy Lifestyle

JUNE The Maternal and Child Health Training Program Supports Nutrition Discipline Training in: Public Health (3) Pediatrics (4) FY 2005 Profile: Fund 7 MCH Centers of Excellence in Nutrition Grant Awards Range from $120,000 to $210,000 Per Year

JUNE Coordination and Collaboration Commitment for coordination with all other major children’s programs-- WIC, Medicaid, SCHIP, Head Start, early intervention programs

JUNE MCH BUREAU

JUNE What Is Bright Futures? Bright Futures is A vision A philosophy A set of expert guidelines A practical developmental approach to providing health supervision

JUNE Increase family knowledge, skills, and participation in health-promoting and disease prevention activities Enhance health professionals’ knowledge, skills, and practice of developmentally appropriate health care in the context of family and community Bright Futures Goals

JUNE Bright Futures Organizations American Academy of Pediatrics American Academy of Pediatric Dentistry American Dietetic Association American Medical Association National Association of Pediatric Nurse Associates and Practitioners American Academy of Physician Assistants American School Health Association American Public Health Association

JUNE Bright Futures Implementation Building Bright Futures Incorporated into EPSDT guidelines, SCHIP, Head Start, and WIC programs Used to revise standards of practice Used to promote program development Used as a training tool for health professionals and health departments

JUNE Bright Futures Materials

JUNE MCH BUREAU

JUNE 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

JUNE National Survey of Children’s Health SLAITS mechanism 2,000 children in each State- 102,000 nationally Data collection from Jan 2003-Apr 2004 Technical advisory panel Field test with 1000 interviews Two age groups(0-5 and 6-17)

JUNE National Survey of Children’s Health Demographics Physical and mental health status Health insurance Health care utilization and access Medical home Family functioning Parents’ health Neighborhood characteristics

JUNE Child Outcomes Child Characteristics Family Level Influences Neighborhood and Community Influences NSCH Survey Domains

JUNE Unique Features of the NSCH Comprehensive detailed snapshot Child – family – neighborhood Contains a variety of positive indicators to track youth development: family strengths family relationships and behavior family processes household routines

JUNE Survey yields over 60 key indicators of child health & well-being in the following areas: Child’s health status: physical, emotional, dental Child’s health care – including medical home Child’s school & activities Child’s family – including maternal health status Child & Family’s neighborhood

JUNE

JUNE National Survey of Children’s Health Prevalence of obesity across States Prevalence of Breastfeeding Prevalence 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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JUNE MCH BUREAU

MCHB’s Vision for Newborn Screening Systems approach with defined public health roles at state and national level Presence of Quality assurance Public–private partnerships for assurance of systems approach and comprehensive, efficient care and management Equity for families

3 Disorders (1) U.S. Newborn Screening Mandated Disorders – January 2005 (Note: Other disorders may be offered but are not mandated) DC

3 Disorders (1) 4 Disorders (6) U.S. Newborn Screening Mandated Disorders – January 2005 (Note: Other disorders may be offered but are not mandated) DC

3 Disorders (1) 5 Disorders (2) 4 Disorders (6) U.S. Newborn Screening Mandated Disorders – January 2005 (Note: Other disorders may be offered but are not mandated) DC

3 Disorders (1) 6 Disorders (4) 5 Disorders (2) 4 Disorders (6) U.S. Newborn Screening Mandated Disorders – January 2005 (Note: Other disorders may be offered but are not mandated) DC

3 Disorders (1) 7 Disorders (4) 6 Disorders (4) 5 Disorders (2) 4 Disorders (6) U.S. Newborn Screening Mandated Disorders – January 2005 (Note: Other disorders may be offered but are not mandated) DC

3 Disorders (1) 7 Disorders (4) 6 Disorders (4) 5 Disorders (2) 4 Disorders (6) 8 Disorders (2) U.S. Newborn Screening Mandated Disorders – January 2005 (Note: Other disorders may be offered but are not mandated) DC

3 Disorders (1) More than 8 Disorders (32) 7 Disorders (4) 6 Disorders (4) 5 Disorders (2) 4 Disorders (6) 8 Disorders (2) U.S. Newborn Screening Mandated Disorders – January 2005 (Note: Other disorders may be offered but are not mandated) DC

3 Disorders (1) More than 8 Disorders (32) [ More than 30 Disorders (17)] 7 Disorders (4) 6 Disorders (4) 5 Disorders (2) 4 Disorders (6) 8 Disorders (2) U.S. Newborn Screening Mandated Disorders – January 2005 (Note: Other disorders may be offered but are not mandated) >30 26 > > > >30 27 DC >30

JUNE ACMG Report: Objectives 1. Develop a uniform panel of conditions 2. Develop a decision-making tool for use in NBS program expansion or contraction 3. Enable program evaluation to ensure realization of expected outcomes 4. Consider value of a national process for quality assurance and oversight of NBS

Resource Center National Newborn Screening and Genetics Resource Center Serves as a focal point for national newborn screening and genetics activities, and provides related resources to benefit consumers, health professionals, the public health community, and government officials.

JUNE WEB Sites Mchdata.net Stopbullyingnow.hrsa.gov Cshcndata.org Brightfutures.aap.org Nschdata.org Mchb.hrsa.gov

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