1. Author(s) Date Insert Local MCAH/Health Department Logo

2. 1. Provide a brief overview of the Title V Maternal and Child Health Program 2. Discuss the Title V 5-year Needs Assessment Requirement 3. Review community composition and local context related to health and well-being 4. Present local data highlights, including bright spots, areas for improvement and data of interest 5. Provide a summary list of areas for improvement

3.  Enacted in 1935 as a part of the Social Security Act, the Title V Maternal and Child Health (MCH) Program is a Federal-State partnership.  The Federal Title V Maternal and Child Health Program has provided a foundation for ensuring the health of the Nation’s mothers, women, children, and youth, including children and youth with special health care needs, and their families.  Title V converted to a Block Grant Program in 1981.

4. 1. Assure access to quality care, especially for those with low-incomes or limited access to care 2. Reduce infant mortality 3. Provide and ensure access to comprehensive prenatal and postnatal care, especially for low- income and at-risk pregnant women 4. Increase the number of children receiving health assessments and follow-up diagnostic and treatment services 4

5. 5. Provide and ensure access to preventive and child care services as well as rehabilitative services for certain children 6. Implement family-centered, community-based systems of coordinated care for children with special healthcare needs 7. Provide toll-free hotlines and assistance in applying for services to pregnant women with infants and children who are eligible for Title XIX (Medicaid – known as Medi-Cal in CA). 5 Source: http://mchb.hrsa.gov/programs/titlevgrants/http://mchb.hrsa.gov/programs/titlevgrants/

6. State Title V programs: required to conduct a statewide, comprehensive Needs Assessment every five years California: decentralized the statewide needs assessment process and each local health jurisdiction conducts a needs assessment of their population of women and children Key Goals - 1. Build local health jurisdiction needs assessment capacity 2. Obtain extensive stakeholder input at the local level 3. Identify “needs” and issues that would be missed by only analyzing state-level information 4. Focus local MCAH efforts by having each jurisdiction identify priority areas they will focus on during the next 5 years 6

7. 7 CountyState Total Population 37,570,307 Total Population African American 2,195,986 Total Population American Indian/Alaska Native 163,262 Total Population Asian/Pacific Islander 4,994,232 Total Population Hispanic 14,277,952 Total Population White 14,995,619 Total Live Births 501,994 Source: California Department of Finance Population Estimates, 2011

8. Socio-Ecological Models

9. Lifecourse Model

10. 10 Health Happens where we LIVE LEARN WORK and PLAY

11. 11 CountyState Poverty rate for people age 18 to 64 (0-200% FPL) Source: Small Area Health Insurance Estimates (SAHIE), 2009-2011 33.8 Poverty rate for children age 0 to 64 (0-200% FPL) Source: Small Area Health Insurance Estimates (SAHIE), 2009-2011 45.4 Children in foster care per 1,000 children age 0 to 17 Source: California Child Welfare Indicators Project, UCB, 2009-2011 6.7 % of Single mothers living in poverty (0-100% FPL) Source: American Community Survey 1-Year Estimates, 2012 39.4 Unemployment rate Source: State of California Employment Development Department., 2009-2011 12.3 % of Children receiving free or reduced price meals at school Source: As cited on kidsdata.org, California Dept. of Education, Free/Reduced Price Meals Program & CalWORKS Data Files, 2012 57.5 High school dropout rate in grades 9-12 Source: California Dept. of Education, California Basic Educational Data System (CBEDS), 2009-2011 14.7 Number of days with ozone above regulatory standards Source: Centers for Disease Control and Prevention, National Environmental Public Health Tracking Network (Jul. 2013), 2011 16

12.  Bright spots - where we are doing significantly better than the State, have met Healthy People (HP) 2020 goals, or have improved over time  Areas for improvement – where we are doing significantly worse than the State, have gotten worse over time, or are not meeting HP 2020 goals  Additional data of interest – indicators that are of particular concern or interest even though comparisons with the State or previous points in time might not be possible 12

13. Bright spots –  Our % of Uninsured children 1 ages 0 to 18 is lower than the state rate {or the 2000-2002 rate} (insert local rate vs. State rate or rate from before)  Our % of Uninsured women 1 ages 18 to 64 is lower than the state rate {or the 2000-2002 rate} (insert local rate vs. State rate or rate from before) Areas for improvement –  Significantly fewer women are accessing prenatal care in their first trimester 2 than in 2000-2002 (insert current local rate vs. previous local rate)  African American women have lower rates of first trimester 2 prenatal care than White women (insert AA rate vs. White rate) 13 Source: 1 Small Area Health Insurance Estimates (SAHIE), 2009- 2011, 2 California Center for Health Statistics, Vital Statistics, Births Statistical Master File, 2009-2011

14. 14 Bright Spot: Children and Women without Health Insurance Source: Small Area Health Insurance Estimates (SAHIE), 2009-2011

15. 15 Data of interest: Children and women who visited a doctor in the last year Source: CHIS (California Health Interview Survey), 2011-2012

16. Areas for improvement -  Births within 24 months of a previous pregnancy 1 per 100 females age 15 to 44 delivering a live birth (County = 24.2 vs. CA = 21.0)  Substance use diagnoses 2 per 1,000 hospitalizations of pregnant females age 15 to 44 (County = 69.8 vs. CA = 13.8) 16 Sources: 1 California Center for Health Statistics, Vital Statistics, Births Statistical Master File, 2009-2011; 2 Office of Statewide Health Planning and Development (OSHPD). Hospital discharge data, 2009-2011

17. 17 Area for improvement: Smoking during 1 st or 3 rd Trimester of Pregnancy + Regional Data Source: MIHA (Maternal Infant Health Assessment Survey), 2011

18. Data of interest -  Rate of Domestic Violence 1 per 100,000 population in higher than state rate (County = 674 vs. State = 439)  Rate of mood disorder hospitalizations 2 per 100,000 female population age 15 to 44 in 2009-2011 is higher than state rate (County= 1,763 vs. State = 1,030), and higher than it was in 2000-2002 (County = 1,602) 18 Sources: 1 California State Department of Justice, Office of the Attorney General, Domestic Violence-Related Calls for Assistance, 2009-2011; 2 Office of Statewide Health Planning and Development (OSHPD). Hospital discharge data, 2009-2011

19. Bright spots -  Rate of live births weighing less than 2,500 grams at birth is lower than the state (County = 6.0% vs. CA = 6.8%)  HP 2020 Objectives achieved for:  Low birth weight (6.0%)  Very low birth weight (1.0%)  Premature births - less than 37 weeks (8.2%) 19 Source: California Center for Health Statistics, Vital Statistics, Births Statistical Master File, 2009-2011

20. Bright spot -  Exclusive in-hospital breastfeeding – better than the state (County = 85.6% vs. CA = 62.6%) Source: California Department of Public Health, Center for Family Health, Genetic Disease Screening Program, Newborn Screening Data, 2012 20

21. 21 Data of interest: Overweight and obesity among students and women Source (Students): Babey, S. H., et al. (2011). A patchwork of progress: Changes in overweight and obesity among California 5th-, 7th-, and 9th-graders, 2005-2010. Source (Women): CHIS (California Health Interview Survey), 2011-2012

22. Bright Spot - Teen births  Births per 1,000 females age 15 to 17 in 2009-2011 are lower than the State (County = 13.5 vs. CA = 16.8), HP2020 Objective achieved  Births declined from 19.9 per 1,000 females age 15 to 17 in 2000-2002 to 13.5 in 2009- 2011 22 Source: California Center for Health Statistics, Vital Statistics, Births Statistical Master File, 2009-2011

23. Areas for improvement -  Births within 24 months of a previous birth per 100 females under 20 years old delivering a live birth  Increased from 51.2% in 2000-2002 to 67.0% in 2009-2011  Significant increasing trend for White females under 20 to giving birth within 24 months of a previously giving birth 23 Source: California Center for Health Statistics, Vital Statistics, Births Statistical Master File, 2009-2011

24. Areas for improvement -  Substance abuse hospitalizations per 100,000 population age 15 to 24 higher than State rate (County = 1055 vs. CA = 638.9) Data of interest -  Mental health hospitalizations per 100,000 population age 15 to 24 higher than state rate (County = 1,734 vs. CA = 1,282) 24 Source: Office of Statewide Health Planning and Development (OSHPD). Hospital discharge data, 2009-2011

25. 25 Area for Improvement: Death Rates Source: Death Statistical Master files, 2009-2011

26. Accessing prenatal care in their first trimester Births within 24 months of a previous birth per 100 females age 15 to 44 delivering a live birth Births within 24 months of a previous birth per 100 females under 20 years old delivering a live birth Substance use diagnoses per 1,000 hospitalizations of pregnant females age 15 to 44 Smoking during 1 st or 3 rd Trimester of Pregnancy Overweight and obesity among public school students Overweight and obesity among females ages 15-44 Substance abuse hospitalizations per 100,000 population age 15 to 24 Deaths per 100,000 population age 15 to 19 Deaths per 100,000 population age 20 to 24

27. Accessing prenatal care in their first trimester Births within 24 months of a previous birth per 100 females age 15 to 44 delivering a live birth Births within 24 months of a previous birth per 100 females under 20 years old delivering a live birth Substance use diagnoses per 1,000 hospitalizations of pregnant females age 15 to 44 Smoking during 1 st or 3 rd Trimester of Pregnancy Overweight and obesity among public school students Overweight and obesity among females ages 15-44 Substance abuse hospitalizations per 100,000 population age 15 to 24 Deaths per 100,000 population age 15 to 19 Deaths per 100,000 population age 20 to 24