1. Mono County Maternal Child & Adolescent Health Title V Needs Assessment Public Health Planning Team Meeting
Presented by: Sandra Pearce, RN, PHN, MS, CNS
MCAH Director
January 23, 2014

2. Outline Purpose of Meeting and Needs Assessment Participation
Title V Maternal, Child, and Adolescent Health (MCAH) Block Grant
10 Essential Public Health and MCAH Services
The Title V Needs Assessment and Timeline
California’s MCAH Priorities
Local Data
Priority Setting for Mono County

3. Why Are We Here? MCAH cannot do this without you!
Collaborative effort to prioritize and determine the most effective use of the County’s MCAH funds over the next 5 years.
What is the County’s capacity to achieve local goals, and ability to leverage funds, avoid duplication of services, and use resources wisely.
Public Health Planning Team
Review the indicator data and prioritize local health problems
Develop problem statements
Identify partners and interventions to address selected priorities
Community Partners and Stakeholders
Consult on factors that contribute to local priorities
Develop mutually beneficial goals and interventions between agencies
Network and build working relationships to maximize resources

4. Title V MCAH Block Grant
Mission:
To improve the health of all of America’s mothers and children.
Vision:
An America where all children and families are healthy and thriving.
Partnership:
Collaboration on the federal, state, and local level.
Flexibility:
Allows states and local jurisdictions to address the unique needs of their MCAH populations.

5. The 10 Essential Public Health Services
10 MCAH Essential Services

6. Title V Needs Assessment
At the beginning of every five year grant cycle, a comprehensive statewide needs assessment must be conducted of the MCAH population.
The state decentralizes this process by having each local jurisdiction conduct their own needs assessment.
The goals of the local needs assessment process include:
Obtaining stakeholder /community partner input
Building local jurisdiction needs assessment capacity
Identifying public health issues that would be missed by only using state level information
Developing an action plan to address identified issues

7. Timeline Public Health Planning Team Meetings
January 23, 2014:
Review needs assessment process and identify and prioritize problems.
February 27, 2014:
Analyze problems and develop problem statements.
March 27, 2014:
Identify strategies, partners and activities to address selected priority problems.
Community Partner and Stakeholder Participation
April – May 2014
Local Needs Assessment Due to State MCAH: June 16, 2014
5 Year Action Plan Due to State MCAH: May 15, 2015
State Needs Assessment due to Federal MCAH: July 2015

8. California’s MCAH Priorities
Goal 1: Improve Outreach and Access to Quality Health and Human Services
Access to health care
Access to dental care
Access to mental health care
Goal 2: Improve Maternal Health
Late initiation of prenatal care and/or inadequate prenatal care
Perinatal mood and anxiety disorders
Partner/family violence
Goal 3: Improve Infant Health
SIDS/SUID
Prematurity/Low birth weight
Perinatal substance use

9. California’s MCAH Priorities
Goal 4: Improve Nutrition and Physical Activity
Exclusive breastfeeding initiation and duration
Overweight/obesity – children, adolescents, or women
Goal 5: Improve Child Health
Childhood Injury
Child abuse
Oral health
Goal 6: Improve Adolescent Health
Adolescent sexual health
Adolescent pregnancy
Adolescent injuries
Adolescent violence
Adolescent mental health

10. The Data
There are many data limitations in a small county with few residents.
The difference of one case can make local rates seem very high or very low.
Confidence intervals, which tell us if differences in rates are significant, are wide. Therefore, Mono County’s rates are often statistically equivalent to the State’s rates, even if they seem much better or worse.
Data can be insufficient for data analysis when there are too few cases.
Data is often grouped by years or by multiple counties so there is enough data to analyze. Grouping counties can lead to an incorrect picture of local health indicators.
Mono County strives to have significantly better rates than the State, and to surpass the Healthy People 2020 objectives.
Healthy People provides science-based, 10-year national objectives for improving the health of all Americans.

11. Data Legend Local rates have surpassed the HP2020 objectives
Local rates are statistically equivalent to HP2020 objectives
Local rates are significantly better than the State
Local rates are statistically equivalent to the State
Local rates are higher or lower than the State, but significance cannot be determined.
Local rates are significantly worse than the State or HP2020 objectives
Data Legend

12. Improve Outreach and Access to Quality Health and Human Services
Goal 1 Indicator Data
Improve Outreach and Access to Quality Health and Human Services
Health Indicator
Local Rate
State Rate
HP2020 Rate
State Comp
HP2020 Comp
% uninsured children (age 0-18)
12.0
( )
9.3
( )
% uninsured women (age 18-64)
23.0
( )
22.1
( )
% Medi-Cal insured deliveries
46.9
( )
47.2
( )
n/a
% prenatal care in the first trimester (for live births)
74.6
( )
83.3
( )
77.9
% children who had a doctor visit in the last year (age 0-17)
89.3
( )
89.4
( )
% women who had a doctor visit in the last year (age 18+)
85.6
( )
85.9
( )
% children who had a dental visit in the last year (age 3-11)
83.2
( )
85.8
( )
* Data is preliminary and undergoing a final review

13. Improve Maternal Health
Goal 2 Indicator Data
Improve Maternal Health
Health Indicator
Local Rate
State Rate
HP2020 Rate
State Comp
% females (age 15-44) with birth within 24 months of previous live birth
19.0
( )
21.0
n/a
% low-risk females delivering a live birth by c-section
24.2
( )
27.6
( )
Gestational diabetes per 1,000 females (age 15-44) at delivery
2.5
( )
1.0
( )
Substance use dx per 1,000 hospitalizations of pregnant females (age 15-44)
4.6
( ) 14
( )
Mood disorder hospitalizations per 100,000 females (age 15-44)
454.4
( )
1030.6
( )
Assault hospitalizations per 100,000 females (age 15-44)
10.6
( )
Domestic violence calls per 100,000 people
471.6
( )
439.5
( )
* Data is preliminary and undergoing a final review

14. Goal 2 Indicator Data (continued)
Improve Maternal Health
Health Indicator
Local Rate
State Rate
HP2020 Rate
State Comp
% females (age 15-44) who smoked during the 1st or 3rd trimester of pregnancy
28.3
( )
8.1
( )
n/a
% females (age 18+) who currently smoke
11.3
( )
11.0
% females (age 18+) who in the last year participated in binge drinking
* Data is preliminary and undergoing a final review

15. Goal 3 Indicator Data Improve Infant Health Health Indicator
Local Rate
State Rate
HP2020 Rate
State Comp
HP2020 Comp
Fetal and infant deaths per 1,000 during the perinatal period
n/a
5.9
Infant (less than 1 year) deaths per 1,000 live births
6.0
% live births less than 37 weeks gestation
4.9
( )
8.6
( )
11.4
% live births less than 2,500 grams (low birth weight)
5.8
( )
6.8
( )
7.8
% live births less than 1,500 grams (very low birth weight)
0.7
( )
1.2
( )
1.4
* Data is preliminary and undergoing a final review

16. Improve Nutrition and Physical Activity
Goal 4 Indicator Data
Improve Nutrition and Physical Activity
Health Indicator
Local Rate
State Rate
HP2020 Rate
State Comp
% overweight children (age 2-5) enrolled in CHDP
20.2
42.1
n/a
% overweight and obese children in public schools grades 5,7,9 & 11
32.4 38
% overweight females (age 15-44)
38.9
( )
43.1
( )
% daily folic acid use in the month before pregnancy
26.7
( )
34.4
( )
% exclusive in-hospital breastfeeding
77.4
( )
62.6
( )
* Data is preliminary and undergoing a final review

17. Goal 5 Indicator Data Improve Child Health Health Indicator Local Rate
State Rate
HP2020 Rate
State Comp
HP2020 Comp
Child (age 1-4) deaths per 100,000
22.7
( )
25.7
insufficient data
Child (age 5-14) deaths per 100,000
( )
11.2
( )
n/a
Child (age 0-14) motor vehicle injury hospitalizations per 100,000
18.1
* Data is preliminary and undergoing a final review

18. Improve Adolescent Health
Goal 6 Indicator Data
Improve Adolescent Health
Health Indicator
Local Rate
State Rate
HP2020 Rate
State Comp
HP2020 Comp
Births to teenage females (age 15-17) per 1,000
11.8
( )
16.8
( )
25.7
Births to teenage females (age 15-19) per 1,000
20.6
( )
31.6
( )
n/a
% teenage females (age < 20) with birth within 24 months of previous live birth
100
( )
56.7
( )
Adolescent (age 15-19) deaths per 100,000
( )
41.7
( )
55.7
Adolescent (age 20-24) deaths per 100,000
93.3
( )
70.3
( )
88.5
Adolescent (age 15-14) mental health hospitalizations per 100,000
380.3
( )
1,281.9
(1, ,287.3)
Adolescent (age 15-14) substance use hospitalizations per 100,000
289.8
( )
638.7
( )
Adolescent female (age 15-24) reported cases of Chlamydia per 100,000
1,075.9
2,905.4
* Data is preliminary and undergoing a final review

19. Priorities