2. 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.

3. AUGUST 2007 2 MCH BUREAU

4. AUGUST 2007 3 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

5. AUGUST 2007 4 Numbers Served In MCH Block Grant Program, 1997 And 2005 SOURCE: TITLE V INFORMATION SYSTEM

6. AUGUST 2007 5 MCHB

7. AUGUST 2007 6 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

8. AUGUST 2007 7 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….…$11.9....…..$10.1…..…$10.6 Earmark...$16.0………------….….$70.6……..$16.0 FY20072008(PB) 1-numbers may not add due to rounding 2008(H)2008(S)

9. AUGUST 2007 8 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 FY20072008(PB) 1-numbers may not add due to rounding 2008(H)2008(S)

10. AUGUST 2007 9 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…….----- 2007 1-numbers may not add due to rounding 2008(PB)2008(H)2008(S)

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12. AUGUST 2007 11 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.

13. AUGUST 2007 12 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)

14. AUGUST 2007 13 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

15. AUGUST 2007 14 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

16. AUGUST 2007 15 Detection of Depression Only one-half of depressions in primary care patients are detected and even fewer postpartum depressions are detected

17. AUGUST 2007 16 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]

18. AUGUST 2007 17 DEPRESSION DURING AND AFTER PREGNANCY: A Resource for Women, Their Families and Friends www.mchb.hrsa.gov/pregnancyandbeyond/depression

19. AUGUST 2007 18 MCH BUREAU

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21. AUGUST 2007 20 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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23. AUGUST 2007 22 MCH BUREAU

24. AUGUST 2007 23 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

25. AUGUST 2007 24 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

26. AUGUST 2007 25 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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28. AUGUST 2007 27 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 email/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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30. AUGUST 2007 29 The Children’s Health Survey AK HI

31. AUGUST 2007 30 The Children’s Health Survey AK HI AK HI

32. AUGUST 2007 31 The National Survey of Children’s Health

33. AUGUST 2007 32 MCH BUREAU

34. AUGUST 2007 33 Infant Death Rates by Race and Ethnicity, 1995 - 2004 Source: NVSS, NCHS, CDC.

35. AUGUST 2007 34 Per 1,000 live births N (4) (8) (11) (16) (12) 9.0 or more 8.0 - 8.9 7.0 – 7.9 6.0 – 6.9 Less than 6.0 Infant Mortality Rate by State, 2002-2004 D.C. Obj. 16-1c Source: NVSS, NCHS, CDC. 2010 Target = 4.5

36. AUGUST 2007 35 Total and Preterm Infant Mortality Rates by Race and Ethnicity of Mother, 2004 Source: NVSS, NCHS, CDC.

37. AUGUST 2007 36 Percentage N (13) (18) (9) (11) 9.0 or more 8.0 - 8.9 7.0 – 7.9 6.0 – 6.9 Percent Low Birthweight by State, 2004-2005 D.C. Source: NVSS, NCHS, CDC. US LBW= 8.15%

38. AUGUST 2007 37 Source: IOM

39. AUGUST 2007 38 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

40. AUGUST 2007 39 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.

41. AUGUST 2007 40 Economic Cost of Low Birth Weight <28 weeks 67.4 28-31 weeks 44.4 32-36 weeks 6.7 37-40 weeks 1.5 Mean Length of Stay for Hospitalization GestationalLength of Stay Age Days IOM, Preterm Births, 2007 IHC data

42. AUGUST 2007 41 Economic Cost of Low Birth Weight <28 weeks $190,467 $12,172 $4,944 28-31 weeks $94,785 $7,715 $2,534 32-36 weeks $13,621 $1,736 $814 37-40 weeks $3,325 $1,328 $661 Total Annual Medical Costs, U.S., 2005 Birth YearYear 2Year 3-4 IOM, Preterm Births, 2007

43. AUGUST 2007 42 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

44. AUGUST 2007 43 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.

45. AUGUST 2007 44 Economic Cost of Low Birth Weight <28 weeks 2,785 176 63.2 28-31 weeks 6,281 171 27.2 32-36 weeks 31,568 407 12.9 37-40 weeks293,949 1988 6.8 Mental Retardation 3 Year CasesPrevalence Survivorsper 1000 IOM, Preterm Births, 2007 MADDSP data

46. AUGUST 2007 45 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)

47. AUGUST 2007 46 MCH BUREAU

48. AUGUST 2007 47 www.mchb.hrsa.gov/timeline

49. AUGUST 2007 48 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

50. AUGUST 2007 49 MCH Timeline- Historical Markers

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52. AUGUST 2007 51 How Can I Use this Site? Orientation for new faculty Orientation for new trainees Preparation for Speaking to Community Groups Personal Rejuvenation and Inspiration

53. AUGUST 2007 52 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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55. AUGUST 2007 54 Peter C. van Dyck, M.D., M.P.H. HRSA/MCHB http://mchb.hrsa.gov/ Contact