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					Family Health Administration Overview
                January 2009


       Russell W. Moy, MD, MPH, Director
         Joan H. Salim, Deputy Director
Family Health Administration (FHA) Overview


       Programs
      Organization
         Mission
  Successes/Challenges
        Services
        Systems
          Data
      Future Issues
                                         2
                      Family Health Administration (FHA) Programs
With federal, state and special funds, including 20 federally funded grants, Family Health Administration
works with communities to improve the health of all Marylanders, giving special attention to vulnerable
populations in the areas of

                                        Maternal-child health
                              Family planning & reproductive health
                     Genetics and children with special health care needs
                                 Women, Infants & Children (WIC)
                                            Cancer control
                                      Tobacco use prevention
                               Chronic disease & injury prevention
                                              Oral health
                               Public health data, policy & planning
                                    Chronic rehabilitative facilities                             3
                            Family Health Administration (FHA) Organization
                                                                                                                                           FHA FY09 Budget:
                                                                      Director                                                             -$207M ($113M FF –
                                                            Russell Moy, MD, MPH                          Dental Director                   $48M GF – $45M GF)
                                                                                                         Office of Oral Health             FY08 PIN Positions: 189
                                                                                                     Harry Goodman, DMD, MPH               FY08 SPP Positions: 9

                              HEALTH POLICY &                                                          LEGISLATION &
                                 PLANNING                                                              REGULATIONS
                                   Director                                                               Director
                               Jeanette Jenkins                                                         Christi Megna



                                                              Deputy Director
                                                                 Joan Salim                      (Acting) Senior Health Policy Analyst
                                                                                                            Rebecca Love
                  OPERATIONS


                        Director
                       David Long
                                                                                                     FISCAL SERVICES &
                                                                                                      OFFICE SYSTEMS
Western Maryland Center             Deer’s Head Center
 Cindy Pellegrino, CEO              Sandy Smith, CEO                                Financial Management             Office Systems & Support Services
                                                                                           Director                               Director
                                                                                       Joyce Wilkerson                        Sharon Yingling
    Network Services                Human Resources
      Robert Ellis                    Everly Smith




 Center for                 Office for              Office of the                Center for Cancer             Center for Health            Office of Chronic
 Maternal &                Genetics &              Maryland WIC                   Surveillance &             Promotion, Education          Disease Prevention
Child Health                CSHCN                     Program                        Control                 & Tobacco Prevention                Director
  Director                  Director                   Director                      Director                      Director                Audrey Regan, PhD
Bonnie Birkel           Susan Panny, MD           Kathleen Knolhoff                Donna Gugel                    Joan Stine
                                                                                                                                                                     4
                        Family Health Administration (FHA)
                    FY 2009 Budget Appropriation – $207 M

           $48 M
          General
          Funds




                                                 $113 M
 $45 M                                           Federal
Special                                          Funds
Funds

                                                           5
                            Family Health Administration (FHA)
             A public health focus on maternal-child health and
                                    chronic disease prevention

                                       Mission
To protect, promote and improve the health of all Marylanders and their families through
       community-based public health efforts, giving special attention to at-risk and
                                 vulnerable populations.

                                        Vision
A future in which all Marylanders and their families enjoy optimal health and well-being.

                                       Values
                         Diversity – Communication – Respect

                               Strategic Approach
      FHA relies on the power of prevention and community partnerships to improve
                 maternal and child health and prevent chronic diseases.          6
                                                                                     Family Health Administration (FHA)
                                                                        Aiming to improve health outcomes…Successes
                                Infant Mortality                                                                                                                                                                                 Teen Birth Births
                                7% decrease over the past 10 years                                                                                                                              20% decrease over the past 10 years
                                However, a 9.6% increase over 2 years                                                                                                                          However, a 6.9% increase over 2 years




                                                                                                                        Rate Per 1000 Population
                                                                                                                                                                                       60
Rate Per 1000 Live Births




                                              9.0
                                                                                                                                                                                       50
                                              8.0
                                                                                                                                                                                       40

                                              7.0                                                                                                                                      30
                                                                                                                                                                                              1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
                                              6.0
                                                     1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
                                                                                                                                                                        Maryland      43.0 42.5 41.2 37.8 35.4 33.3 32.3 31.8 33.6 34.4
                                 Maryland                 8.6    8.3   7.4   8.0    7.6  8.1    8.5   7.3   7.9   8.0
                                                                                                                                                                        United States 51.1 49.6 47.7 45.3 42.9 41.6 41.1 40.5 41.9
                                 United States            7.2    7.1   6.9   6.8    7.0  6.8    6.8   6.9
                                                                                                                                                                                                            Year
                                                                                      Year
                            Source: MD Vital Statistics
                                                                         Maryland        United States                                                               Source: MD Vital Statistics               Maryland          United States



                              Childhood Lead Poisoning                                                                                                                                                 Heart Disease / Cancer Mortality

                              84% decrease in elevated blood lead                                                                      23% decrease in heart disease mortality
                              over the past 10 years                                                                    16% decrease in cancer mortality over the past 10 years
                                                                                                                                       Rate Per 100,000 Population
                                                                                                                                                                                     300
                                                10000

                                                  8000
                                                                                                                                                                                     250
   Number




                                                  6000

                                                  4000                                                                                                                               200

                                                  2000
                                                                                                                                                                                     150
                                                          0                                                                                                                                   1997   1998   1999   2000   2001   2002   2003   2004   2005   2006
                                                                1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
                                                                                                                                                                          Heart Disease 266.8 258.6 258.5 260.1 254.5 238.4 233.8 211.0 209.8 204.3
                                 Elevated Blood Lead 7763 5068 3904 3402 2841 2297 1719 1811 1331 1274
                                                                                                                                                                          Cancer        220.9 218.7 211 208.8 204.3 201.4 194.3 188.1 187.9 186.5
                                                                                         Year
                                                                                                                                                                                                                            Year

                              Source: MDE Lead Registry
                                                                                   Elevated Blood Lead
                                                                                                                                                                     Source: MD Vital Statistics
                                                                                                                                                                                                                   Heart Disease        Cancer           7
                                                                                           Family Health Administration (FHA)
                                                                              Aiming to improve health outcomes…Successes
                                                                                    Hospital-specific VLBW-specific neonatal mortality rates have
                                                                                    improved by 22% for Level III facilities over the past 10 years

                                                                    1994-1995                                                                                      2005-2006
                                                 Birthweight-adjusted neonatal mortality rates by hospital
                                                of birth for Maryland resident infants with birth weights of
                                                500-1499 grams born in Maryland III/IV hospitals, 1994-1995

                                              ALL                                  142.2
                                                Z                                                               257.5
                                               K1                                                             249.8
                                                T                                                            241.1
                          Hospital of birth




                                                X                                                    209.3
                                                F1                                           178.6
                                               D1                                    147
                                               G1                             134.3
                                               H1                            130.2
                                               C1                          121.3
                                               A1                          117.7
                                               B1                   89.6
                                                E1           63.5


                                                     0       50            100         150            200            250      300
                                                             Neonatal mortality rate per 1000 live births




                                              Tobacco use reduction (2000-2006) of 48.6% (middle school), 36.1% (high school), 15.4% (adults), and 26.1% (pregnant women) over 6 years
                                                                                                                               2000         2002         2006

                                 25.0                                                                        23.0
Percent Current Smokers




                                 20.0                                                                                  18.7
                                                                                                                                                      17.5
                                                                                                                               14.7                             15.4     14.8
                                 15.0
                                                                                                                                                                                                     9.2
                                 10.0                        7.2                                                                                                                                           8.0
                                                                                                                                                                                                                 6.8
                                                                       5.2
                                              5.0                                   3.7

                                              0.0
                                                         Underage Middle School                       Underage High School                                Adults 18+                           Pregnant Women
                                                                                           Source s: Ma ryla nd Youth a nd Adult Toba cco Surve ys, Vita l Sta tistics - Birth Ce rtifica te Da ta                 8
                                                                              Family Health Administration (FHA)
                                                                 Aiming to improve health outcomes…Challenges
                                     Infant Mortality Disparities                                                                                                                                      Late Prenatal Care
                                     Black/white disparity of 3:1 persists                                                62% increase in late prenatal care rate over the past 10 years
             Rate Per 1000 Live Births




                                             20.0
                                                                                                                                                               5
                                             15.0
                                             10.0                                                                                                              4




                                                                                                                                 Percent
                                              5.0
                                                                                                                                                               3
                                              0.0
                                                     1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
                                         All Races 8.6    8.3    7.4      8.0   7.6  8.1     8.5     7.3      7.9    8.0                                       2
                                                                                                                                                                     1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
                                         White     5.5    5.1    4.7      5.5   5.4  5.4     5.6     4.7      5.7    4.6
                                                                                                                                                    Maryland         2.9    3.1    3.1     3.7    3.6 3.8           3.9     4.3     4.3     4.7
                                         Black     15.4   14.7   13.0    13.6   12.7 14.7    14.9    12.7    12.7    14.0
                                                                                                                                                    United States    3.9    3.8    3.9     3.7    3.6 3.5           3.6
                                                                                  Year
                                                                                                                                                                                                    Year
          Source: MD Vital Statistics                                  All Races     White        Black
                                                                                                                                           Source: MD Vital Statistics                   Maryland           United States


                    Low Birth Weight                                                                                                                                                             Overweight and Obesity

                    5% increase in low birth weight rate over the past 10 years                                                                          42% increase in obesity over the past 10 years
                                             10
                                                                                                                                                               40.0
                                              9                                                                                            Percentage
Percent




                                                                                                                                                               30.0
                                              8
                                                                                                                                                               20.0
                                              7
                                                                                                                                                               10.0
                                              6
                                                    1998 1999 2000 2001 2002 2003 2004 2005 2006 2007                                                              0.0
                                                                                                                                                                         1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
                          Maryland                  8.7   9.1    8.7      9      9   9.1    9.4     9.2     9.4     9.1                                   Overw eight    35.9   35.0   37.2   36.5   36.5    38.5    37.2    34.6    36.7    35.8
                          United States             7.6   7.6    7.6     7.6    7.8 7.9     8.1     8.2                                                   Obese          17.5   20.5   18.2   20.2   20.5    19.4    21.9    23.9    24.4    24.9
                                                                                  Year                                                                                                            Calendar Year
                                                                       Maryland      United States
                         Source: MD Vital Statistics
                                                                                                                                           Source: BRFSS                                                                                    9
                             Family Health Administration (FHA)
A diverse array of public health services that cover the life span

   Maryland Family Planning Program                          Maryland WIC Program
        130,000 family planning & reproductive health            Each month 130,000 pregnant, postpartum
        visits for 75,000 low income, uninsured clients per      and breastfeeding women and children up to
        year – served through a network of 80 sites              age 5 receive nutrition services through a
        statewide.                                               network of 85 sites statewide – with a 35%
   Clinical Genetics Services                                    increase in clients served since WIC’s 2002
                                                                 launch of its model MIS system.
        7,000 individuals received counseling and case
        management services last year.                      Newborn Screening Program
                                                                75,000 newborns screened and followed up for
   Kids in Safety Seats (KISS)                                  hereditary disorders and hearing impairments.
        2,000 child safety seats distributed and/or         Oral Health
        inspected each year.
                                                                7,700 children and 1,700 adults received dental
   Tobacco Use Prevention                                       sealants last year.
        64,000 students received tobacco use                Sexual Assault Prevention
        prevention education – and another 26,000               235,591 students received sexual assault
        individuals received smoking cessation                  prevention education.
        services.
   Chronic Disease Prevention                               Breast & Cervical Cancer Services
        11,000 clients received blood pressure and              Screening program serves 13,000/year.
        cardiovascular risk screenings.                         Diagnosis and treatment program serves
                                                                4,200/year.                                 10
                             Family Health Administration (FHA)
A diverse array of public health services that cover the life span
 FHA Chronic Rehabilitative Care Facilities –
 • Provide chronic hospital care and treatment to patients requiring acute rehabilitation, as well as complex medical
    management for respiratory, coma, traumatic brain injury, spinal cord injury, wound management, and quarantined
    tuberculosis;
 • Long-term comprehensive care for patients no longer in need of hospital level care but whose needs require services
    that are beyond those typically offered in private sector nursing homes;
 • Inpatient and outpatient renal dialysis services.           Deer’s Head Hospital Center
                                                               Salisbury, Maryland
                                                               • Mission – To provide compassionate
                                                                    interdisciplinary care to meet the needs of the
                                                                    community.
                                                               • FY 2009 Budget – $23 million
                                                               • FY 2007 ADC – 81
 Western Maryland Hospital Center
                                                               • FY 2007 Kidney Dialysis – 183
 Hagerstown, Maryland
 • Mission – To give Marylanders a second chance for a
    quality of life through exceptional rehabilitation and
    healthcare services in a healing environment.
 • FY 2009 Budget – $23 million
 • FY 2007 ADC – 85
 • FY 2007 Kidney Dialysis – 37
                                                                                                                11
                                        Family Health Administration (FHA)
                                  A population health focus on systems of care

Perinatal Collaboratives
                                                           Children with Special Health Care Needs –
    House Bill 535 (2008) strengthens these                    Centers of Excellence
    collaborative efforts involving local health
    departments, community providers, hospitals,               Public health infrastructure for CSHCN is
    academic centers, MIEMSS, Maryland Hospital                supported by this network of academic center
    Association, Maryland Patient Safety Center, and           based pediatric specialists.
    others to improve the perinatal system of care.
Early Childhood Comprehensive System                       Child Abuse and Neglect – Centers of Excellence
     Statewide partnerships with MSDE, DHR, MDE,               Senate Bill 782 (2005) established this initiative
     community and faith-based organizations to                to develop regional centers of pediatric
     develop an infrastructure that promotes the health        expertise to assist clinicians in the accurate
     and well-being of children and ensures children           diagnosis of child abuse and neglect.
     entering school ready to learn.
                                                           Community-Based Primary Prevention
Provider Capacity Building
                                                              Public information, education, peer support,
    Multiple strategies designed to recruit primary care      coalition building, care coordination and
    physicians, dentists and other health care                community based strategic planning efforts
    professionals through Loan Assistance Repayment           (including the Maryland Comprehensive Cancer
    Programs (LARP), National Health Service Corps,           Plan, Maryland Asthma Plan, Maryland Nutrition
    J-1 Visa Waiver Program, National Rural                   and Physical Activity Plan, and Maryland Rural
    Recruitment and Retention Network (3RNet) and             Health Plan) that promote healthy behaviors.
    through designation of Medically Underserved
    Areas (MUAs) and Health Professional Shortage                                                           12
    Areas (HPSAs).
                                       Family Health Administration (FHA)
                                  Moving toward data-based decision-making
Pregnancy Risk Assessment Monitoring System              Behavioral Risk Factor Surveillance System (BRFSS)
    (PRAMS)                                                 Ongoing CDC telephone surveillance program
    Ongoing, population-based CDC risk factor               designed to collect data on the behaviors and
    surveillance system designed to identify and            conditions that place Marylanders at risk for chronic
    monitor selected maternal behaviors that occur          disease, injury, and disability. Findings can be used
    before and during pregnancy. Findings enhance           to characterize health behaviors, ascertain the
    the understanding of maternal behaviors and their       prevalence of risk factors, and target demographic
    relationship to pregnancy outcomes.                     groups with increased needs.
 Birth Defects Reporting and Information System
      (BDRIS)                                            Youth and Adult Tobacco Surveys
      Collects data for establishing incidence rates,        Maryland’s only source of county level data on
      monitoring of trends in incidence with reference       youth and adult tobacco use and tobacco-related
      to possible preventable environmental causes           health behaviors. Data collected is used in statutory
      and distribution of information on the defects         allocation of CRF funds to local health departments,
      and available services to families of affected         is consistent with CDC best practices, and is an
      infants.                                               instrumental component of evaluation.
 National Violent Death Reporting System                 Maryland Cancer Registry
      (NVDRS)                                                Collects, maintains and reports information about
      Maryland was 1 of the first 6 states to be             Marylanders who develop cancer – through
      awarded the CDC NVDRS grant to examine all             submission of all incident cancer reports by
      incidents of violent deaths in Maryland,               hospitals, radiation therapy centers, cancer
      including homicides, suicides, accidental              diagnostic labs, freestanding ambulatory care
      firearm deaths, and undetermined deaths.               facilities, surgical centers and physicians. 13
                                             Family Health Administration (FHA)
                                                       Future Issues – FY 2010
Oral Health
    In response to Maryland’s dental crisis, DHMH convened a Dental Action Committee (DAC) in 2007 to
    assess the state of dental access and make recommendations for achieving a dental home for Maryland’s
    children. DAC recommendations focused on Medicaid financing and systems changes, public health
    initiatives, education initiatives, and scope of practice changes needed to strengthen the dental health
    delivery system. This has led to a $16 million Governor’s fiscal 2009 dental initiative, with $2 million targeted
    to strengthening the dental public health infrastructure. FHA’s Office of Oral Health will take the public health
    lead by establishing new dental clinics in underserved communities and expanding school-based dental
    health services.

Babies Born Healthy
    In collaboration with multiple partners, FHA is committed to improving the State’s perinatal outcomes through
    its Babies Born Healthy Initiative. This initiative focuses on prevention services, quality improvement, and
    perinatal data systems. Partnerships including those with the Maryland Patient Safety Center Perinatal
    Collaborative and the MIEMSS Maternal-Neonatal Transport System are of special interest and warrant
    continued support.

Federal Funding – Chronic Disease Prevention
    Family Health Administration depends on multiple federal funding sources in order to advance its mission.
    The Preventive Health and Health Services (PHHS) Block Grant is of particular concern because these
    dollars have been repeatedly cut at the federal level in recent years and are critical for sustaining Maryland’s
    cardiovascular, injury and violence prevention, and water fluoridation programs. Other federal funding
    sources critical to FHA’s mission include the Title V Maternal-Child Health Block Grant, Title X Federal
    Family Planning Program, WIC, and CDC categorical grants. Advocating for increased federal funding 14      and
    new State general dollars is needed to support these important public health prevention programs.

				
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