Charlan D. Kroelinger, PhD Team Lead Maternal and Child Health Epidemiology Program June 2011 Integrating Science, Policy, and Practice: The Maternal and Child Health Epidemiology Program (MCHEP) in States National Center for Chronic Disease Prevention and Health Promotion Division of Reproductive Health

Introduction: Data to Support the Evidence  2009 Assessment of Capacity: MCH Epidemiology in States  2004: 43% of states reported at least substantial MCH epi capacity  2006: 47% reported at least substantial capacity  2009: 55% reported at least substantial capacity  2004: 25% of states reported minimal to no capacity in MCH epidemiology  2006: 23% reported minimal to no capacity  2009: 12% reported minimal to no capacity  MCH Epi capacity in top 3 (Infectious = 92%; Bioterrorism/Emergency Response = 73%)

Introduction: Data to Support the Evidence  MCH Epidemiologists collaborate across disciplines:  Chronic disease (63%)  Oral health (59%)  Injury (53%)  MCH Epidemiologists work to impact science, program, and policy  Linking data systems (57%)  Translating data findings to program and policy (69%)  Priority setting (73%)  Performance measurement (67%)  Program planning (67%)  Needs assessments (82%)  Program evaluation (53%)

Maternal and Child Health Epidemiology Program (MCHEP)  MCHEP initiated in 1986 by the Centers for Disease Control and Prevention, and the Health Resources and Services Administration / Maternal and Child Health Bureau  Request for Applications to provide  Direct assistance to states  Time-limited assignments  Envisioned as a mechanism to promote collaboration between federal agencies and states  35+ senior MCH epidemiologists to more than 33 states and 6 other public health organizations

Maternal and Child Health Epidemiology Program (MCHEP) Promote and improve the health and well- being of women, children and families by building MCH epidemiology and data capacity at the state, local, and tribal levels to effectively use information for public health action. Mission: Promote and improve the health and well- being of women, children and families by building MCH epidemiology and data capacity at the state, local, and tribal levels to effectively use information for public health action.

Previous Evaluation of MCHEP  1999, University of Illinois at Chicago  Case-study evaluation of program; N=9 states (5 MCHEP; 4 non-MCHEP)  MCHEP contributed to: Epi capacity building as a state priority Adequately trained personnel to support MCH epi activities Integrated information systems Analytic leadership for MCH epi activities  2010 MCH epidemiology capacity follow-up study  Interview with all 50 states and Washington DC  MCH epi capacity contributed to: Doctoral level key staff Agenda-setting by consensus process Organizational position of MCH epidemiology effort

Methodology: MCHEP Structure  Minimum qualifying criteria for applicants  PhD or MD with a MPH in epidemiology or related field  Intermediate knowledge or experience in epidemiology, statistics, and programming  Experience working in MCH or on MCH issues  Intermediate experience in communicating effectively to leaders, staff, communities, colleagues, and audiences  Experience working on a multi-disciplinary team  Potential to become a MCH epidemiology leader  Bi-annual submission process: Review / Screening Interview Matching

Methodology: MCHEP Structure  Proposal requirements for a host state / agency  Purpose of the assignment  Funding mechanism for the assignment  Justification for the assignment  Assignment structure  First year projects to be completed by the assignee  Proposals are accepted throughout the year, matching occurs two times per year

Maternal Child Health Epidemiology Program: Team Structure Atlanta Members (11) – Provide overall support and leadership in the national context with the field and in connection with partners Field Assignees (12) – Lead a state agenda to develop MCH Epidemiology capacity – 20% time on CDC activities

MCHEP Sponsored Regions, States, and Public Health Agencies, October 2010

What we do:  Develop MCH Epidemiology Leaders  Advance MCH Epidemiology Data and Analytic Capacity  Evaluate, Train, and Educate in the Field of MCH  Create Peer Exchange Opportunities  Promote MCH Partnerships Maternal and Child Health Epidemiology Program (MCHEP) Goals

Results: Assignee Statistics  Assignments in place for > 5 years  42%  Assignments in place for 1 – 5 years  33%  Assignments in place for < 1 year  25%

Develop MCH Epidemiology Leaders Provide direct assistance to public health agencies –In collaboration with HRSA/MCHB State assignments National, state, regional training Academic training grants Foster the next generation of MCH Epidemiologists –Council of State and Territorial Epidemiologists 7 current MCH CDC/CSTE Fellows –HI, OH, OR, PA, SD, TX, US/Mexico 6 new MCH CDC/CSTE Fellows for 2010 –WI, VA, LA, MA, MO, MI –Epidemic Intelligence Service (EIS) Officers 1 Atlanta-based, 2 Field-based (FL, TX)

Data Capacity – Data assessment and quality improvement – Developing surveillance systems – Data linkage projects – GIS Analytic Capacity – Year long distance-based advanced epidemiology analysis University of Illinois at Chicago (UIC) – Harvard/CDC Evaluation Practicum – CDC/HRSA Epidemiology Training Regional training MCHEPI preconference training MCH Certificate training Advance Data and Analytic Capacity

State Title V MCH Needs Assessment –Facilitated by preconference trainings (AMCHP) MCH Data Tools –Perinatal Periods of Risk (PPOR) CityMatch Urban MCH DaTA Institute –CSTE MCH Epidemiology Capacity Assessment –State Infant Mortality Toolkit Leadership Training –CityMatCH City Leaders –CityMatCH Data Use Institute Evaluate, Educate, and Train

Annual MCH Epi Conference – More than 500 MCH professionals – National MCH Epidemiology Awards – National Best Manuscript Award Regional MCH Epi Conference – More than 200 MCH professionals MCH Epi List Serve – Over 400 members nationally/ internationally MCH Epi Grand Rounds – 7 interactive Web casts per year DataSpeak – Web conferences on MCH related topics Create Peer Exchange Opportunities

Promote Partnerships Among Over 20 MCH Agencies In order to:  Appropriately provide evidence-based data to those providing direct services  Effectively translate research into policy to improve health  Develop relevant research

Integrating Science, Policy and Program – State Examples  Supporting data linkage  MA Pregnancy to Early Life Longitudinal (PELL) database  DE Registry for Improving Birth Outcomes  Investigating trends in infant mortality  WI focus on differing trends in IM regionally  Increasing research capacity  DE Center for Family Health Research and Epidemiology

Integrating Science, Policy and Program – State Examples  Developing a strategic plan  OH Statewide Strategic Planning in MCH  Examining regionalized systems of care  GA focus on volume of births in Level I, II, and III hospitals  Collaborating across disciplines  WY integration of MCH, injury, and diabetes program analyses

CDC Programs for Full-time Field Staff Epidemiologists Career Epidemiology Field Officer (CEFO) Program Strengthen state, local, and territorial epidemiologic capability for public health preparedness and response Office of Science and Public Health Practice / Office of Public Health Preparedness and Response Maternal & Child Health Epidemiology Program (MCHEP) Build capacity and increase infrastructure in maternal and child health epidemiology in states, localities, and tribes Division of Reproductive Health / National Center for Chronic Disease Prevention and Health Promotion State-Based Epidemiology for Public Health Program Support (STEPPS) Program Jump-start the process of building chronic disease epidemiology capacity by providing health departments with resources (funding and/or FTE) to secure the full-time services of a fully trained chronic disease epidemiologist for a period of about four years Division of Adult and Community Health / National Center for Chronic Disease Prevention and Health Promotion

Conclusion  Decreasing resources in states  Decreasing resources at federal agencies  How do we continue to increase capacity?  Partnership, collaboration, and leverage of resources (in-kind) – to include CSTE fellowships; co-sponsorship of activities – joint trainings, pre- conference trainings, access to data

Questions MCHEP Annual MCH Epi Conference AboutConference.htm MCH Epi Grand Rounds DRH Website