1. MCH 2016-2020: Working Together to Improve MCH in Colorado This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 1 Karen Trierweiler, MS, CNM MCH Director & Deputy Director Prevention Services Division 2/29/16

2. Our Goals Today  Why Do We Do What We Do?  Review MCH outcomes from 2011-2015  Highlight changes in federal MCHB expectations (“MCH 3.0”)  Highlight Colorado’s 2016-2020 MCH Priorities  Introduce the concept of Implementation Science and Performance Management – “MCH Impact” This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 2

3. WhyDoWe DoThisWork?  We envision a future where all women, children, youth and families are healthy and thriving.  The health and well-being of women, children, youth and families is the key to our future as a state and a nation.  MCH is the protector and guarantor of health and well-being for children and youth with special health care needs This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 3

4. Our Ultimate Goal To optimize the health and well-being of the MCH population throughout the life course – to improve people’s lives This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 4

5. How Do We Do This Work? Narrower Increasing individual effort needed Increasing population impact Broader This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 5 Telling patients to eat healthy and be physically active Rx for cardiovascular disease Immunizations, cessation treatment, colonoscopy Addressing poverty, lack of education, poor housing, lack of transportation access, inequality Fluoridation, trans fat bans, smoke free laws SOURCE: A Framework for Public Health Action: The Health Impact Pyramid Thomas R. Frieden. Am J Public Health. 2010 April; 100(4): 590–595. doi: 10.2105/AJPH.2009.185652 PMCID: PMC2836340A Framework for Public Health Action: The Health Impact Pyramid Counseling & Education Clinical interventions Long lasting protective interventions Changing the context to make individual’s default decisions healthy Socioeconomic factors Health Impact Pyramid

6. How Do We Do This Work? Biology 20% This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 6 Health Care 10% Environment 19% Lifestyle 51% Smoking Obesity Nutrition Alcohol Use Factors Influencing Health Status

7. How Do We Do ThisWork? This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 7 We focus…  our work on primary prevention and early intervention.  on identifying and implementing evidence-based or evidence-informed strategies for impact.  on implementing complementary state & local strategies and monitoring their success to improve MCH.

8. 2010 - 2015 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 8

9. How Did We Do in 2011–2015? This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 9 Statewide quantitative improvements noted for: Pregnancy-Related Depression Developmental Screening Early Childhood Obesity Prevention Teen Fertility

10. Qualitative Observations - State Successful progress associated with:  Implementation of well conceived state level strategies  Deliberate adherence to state level action plan/timeline with real-time course corrections  Cohesive, functional advisory groups and partnerships  Garnering of add’l resources/$$ based on forward progress  State staff skill in population health and implementation science This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 10

11. Qualitative Observations - Local This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 11 Successful progress associated with:  Implementation of well-conceived/logical local level strategies  Deliberate adherence to a local level action plan/timeline with real-time course corrections  Quality of State TA  Local staff skill in population health, convening and facilitating partnerships, policy change and systems development  Agency/community political will to work on the priority

12. Process Outcomes – State & Local This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 12 Pregnancy-Related Depression  CO home visitation programs screen all women.  Medicaid reimburses for one screening per woman/year. Developmental screening and referral  Different types of screening intentionally connected.

13. Process Outcomes – (Cont.) This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 13 Early Childhood Obesity Prevention Breastfeeding initiation, exclusivity and duration rose 5% between 2011 and 2012. More CACFP child care providers served low fat milk & whole grains, limiting juice and processed meats.

14. Process Outcomes – (Cont.) This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 14 Medical Home All four LPHAs doing non-ABCD-related medical home are working with RCCOs.

15. Process Outcomes – (Cont.) This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 15 Teen Motor Vehicle Safety  Parent course on teen driving and the GDL law led to positive behavior change.  Parents increased knowledge:  about passenger restrictions from 56% to 93%.  about curfew restrictions from 44% to 93%.  Parents more willing to enforce GDL at home Youth systems  Legislation passed (HB 239) broadening support (unfunded) for youth systems work.

16. MCH 3.0: “Moving the Needle” This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 16 Federal Expectations  5-year Needs Assessment  7-10 State priorities for 2015-2020  Choice of 8/15 Federal NPMs within 6 Domains  Results!

17. MCHB Performance Measure Domains This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 17  Women’s/Maternal Health  Perinatal/Infant Health  Child Health  Adolescent Health  CYSHCN  Cross-cutting or Life Course

18. Colorado MCH Priorities 2016-2020 Colorado MCH Priorities 2016 – 2020 Women’s Mental Health, including PRD Substance use among women (tobacco, MJ, prescription drugs) Youth Suicide/ Bullying Prevention Early Childhood Obesity Prevention Reducing Infant Mortality among African Americans This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 18 Developmental Screening and Referral Medical Home for CYSHCN

19. How Will We Do This Work? By recognizing…  the unique and fundamental responsibility of public health to act at the population health level.  that our work complements health care By focusing…  our work in priority areas, using evidence-based/informed primary prevention and early intervention strategies for impact with logic models and action plans.  on implementation science and performance mgmt (MCH Impact) This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 19

20. Moving Forward Together: Uniting Aspirations and Operations This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 20

21. Uniting Aspirations and Operations

22. Together WeCan Improve MCH! This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 22

23. Thank you! This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 23