The Changing Needs of Mothers_ Children and Families

The Changing Needs of Mothers, Children and Families A Review of Needs Assessments of MCH Block Grantees Victoria A. Freeman, RN, DrPH Priscilla A. Guild, MSPH Cecil G. Sheps Center for Health Services Research University of North Carolina at Chapel Hill AMCHP • March 2, 2008 A review in three parts  How did priority needs change from 2000 to 2005?  What other needs were identified by grantees?  How are States measuring success in meeting these needs? Change in Priority Needs: 2000 and 2005  Some areas are a new focus  Some areas remain constant  Some areas are “replaced” Change in Priority Needs: 2000 and 2005 Some areas are a new focus… Obesity and overweight 2000 10 states 2005 33 states 2000 9 states 2005 15 states 2000 14 states 2005 30 states 2000 17 states 2005 28 states Nutrition and physical exercise Mental health and mental health care Medical home / care coordination Change in Priority Needs: 2000 and 2005 Some areas are constant… Health improvement & access to care 2000 2005 2000 2005 2000 2005 2000 2005 36 states 38 states 34 states 35 states 28 states 26 states 28 states 26 states Oral health and oral health care Pregnancy outcomes Disparity reduction Change in Priority Needs: 2000 and 2005 Or a mix of new and constant… Prenatal care 2000 16 states 2005 14 states 2000 3 states 2005 13 states Preconceptional/interconceptional care Change in Priority Needs: 2000 and 2005 Some areas are “replaced”… Injury prevention (includes suicide child abuse, domestic violence) 2000 41 states 2005 33 states Legal and illegal substance abuse 2000 34 states 2005 26 states 2000 35 states 2005 25 states Pregnancy, fertility, and birth rates Using Needs Assessment to Look at Other Needs  Reviewed 30 Needs Assessment documents  60% included preliminary priority lists An example from California… S e le c t e d L i s t s fr o m Ca lif or nia ’s 2005 Ca t ego rica l- Le vel Prio rities as Ranked Pro blem s as Ranked by St akeh older by Loc al Juri sd icti ons Me e tin g Participant s (p2 2 ) (p12 5 ) 1 Health Cond itions 1 Over weigh t 2 Ac cess t o 2 Ac cess t o Care Care /S e rvices 3 Birth 3 Sub st an ce Abuse Ou tc om es / Mor ta 4 Pren at al Care lity 5 Spe cial 4 Men t al Health Pop ulati ons 5 Sub st an ce Abuse 6 Oral He alth 6 Uninte n ti on al 6 Birth Out com es Injuries 6 Brea s tf eed in g 7 As thm a 7 Violence 8 Dom estic 8 Men t al Health Violence 9 Injuries 9 Te en Bi rths 10 Othe r Topics 10 Pren at al Care 11 Morta lity 11 Chlam ydia 12 Basic Needs Infe ctions 13 Edu ca ti on 12 Oral He alth 13 Brea s tf eed in g Ne e ds Asse ss me nt D o c u m e n t Califo rnia’s 10 Prio rity Ne eds ( p15 1 ) Prio rities as Ranked b y Childr en with Spe cial He alth Care Nee ds St akeh old ers (p 14 8 ) 1 Exp and the n um ber of qu alified pr o viders pa rti cip a t ing in the CCS progr am , e. g., m e dic al speci alists, au diologi s ts, oc cup a tion al a nd phy sical thera pists, and nutr itioni sts. 2 Coor din a te t o d e velop and im ple m en t a s y st em of t im ely referral b et ween m en t al he alth, d ev e lo pm en t al se rvices, s o cial se rvices, sp e cial e duc a ti on se rvice s and CCS. 3 Increase th e n um ber of fam ilyce nt ered m e dic al ho m es for CSHCN and the n um ber / % of CCS child ren who h a ve a desi gn a ted m e dic al h om e. 4 Inc rease acc es s o f CCS child ren to pr e ve n tiv e health care se r vice s (e .g., p rim ary care pr o viders,… 4 Increase fa m ily acce ss to educ a ti on al in fo rm ati on and in fo rm ati on ab ou t acc ess ing CCS se rvices, in clu din g a vailability o f and acc es s t o s e rvices o ffere d by h ealth plan s. 4 Increase acc es s to se rvices for CCS yo u th, 1 7- 21 y ears o f age. 5 D e creas e the t im e b et we en referral to CCS and re ceip t o f CCS se r vices. 1 Enhanc e pr e con ce p ti on c are and wo rk toward eli m in at in g dispa rities in inf ant and m a tern al m orta lit y . 2 P rom o te he alth y life st y le pr a c ti ces am ong MCAH po pul a ti ons and re duc e t h e ra te o f ov erwei gh t c hildr en and ad olesce n ts. 3 P rom o te respon si ble s exu al b eh a vior in order to d ec re ase t he ra te o f te enage pregnan cy and s ex u ally t rans m it t ed in fe c ti ons. 4 Im p ro ve m en tal he alth and decr e as e sub s ta n ce abuse am on g childr en , ad olesce n ts, and pregn an t or p are n ting wom en . 5 Coor din a te t o d e velop and im plem e n t a s ys t em of ti m e ly referral b e tw e en m en t al he alth, d ev e lo pm en t al se rvices , soci al services, sp e cial e duc a ti on se rvice s and CCS. 6 Im p ro ve acce ss to m e dic al and d en tal se rvices, in clu ding redu cti on of d ispa rities. 7 Exp and the n um ber of qu alified p ro viders pa rti cip a tin g i n t he CCS progra m , e.g ., m e dic al speci alis ts, au diol o gis ts, o ccup a ti on al and ph ysical thera pis ts, and nu triti onis ts. 8 Increase th e n um ber of fam ily- cen tered m e dical h om es for CSHCN and the n um ber / % of CCS child ren who h ave a de sign a ted m e dic al h om e. 9 D e creas e in t e n ti on al a nd uni nte n tio n al injuri es and violence, in clu ding fam ily and int im a t e pa r tner vi ole nce. 1 0 Increase br e astf eed ing initia ti on and dur a ti on . Using Needs Assessment to Look at Other Needs Why were some needs not included? Already a National or State Performance Measure Another organization has responsibility Too broad, needs a statewide effort Some unlisted needs were “new”…  Insurance  Child care and parenting support  Basic needs - housing, transportation, education Some were needs we have seen before…  Oral health  Mental health  Injury  Pregnancy and maternal health  Substance abuse  Childhood morbidity and mortality  Needs of Children with Special Health Care Needs How are States measuring success in meeting their priority needs? With multiple National and State Performance Measures Alabama Priority Need Assure appropriate primary care, including prenatal care, for all Title V populations – including low income, immigrant, and minority groups. Performance Measures   NPM #1, 3, 5, 6, 7, 9, 12, 13, 18 SPM #1 – Of 0-9 year old children enrolled in AL Medicaid’s EPSDT Program, % who received care coordination in the reporting year. SPM #2 – Of children and youth enrolled in AL Medicaid’s EPSDT Program, % who received any dental services in the reporting year.   SPM #5 – The degree to which the state CSHCN program assures that all CYSHCN have adequate access to primary and specialty care and allied health and other related services With one NPM or SPM as a proxy measure Indiana Priority Need To decrease tobacco use in Indiana Performance Measure SPM #3 - The percent of live births to mothers who smoke To reduce obesity in Indiana SPM #8 - The percentage of high school students who are overweight or obese. With one NPM or SPM as an “exact” measure Pennsylvania Priority Need Decrease alcohol-related driving morbidity and mortality among teens Performance Measure SPM #2 - Rate of motor vehicle crashes due to drinking for 17-19 year olds State Performance Measure Focus for Majority of States             Primary/preventive care Morbidity and mortality Obesity and overweight or nutrition and exercise Reproductive health Substance abuse (incl tobacco) Health screening Mental health Access to health care Health promotion Intentional/unintentional injury Birth outcomes Oral health 53 states 51 states 48 states 43 states 40 states 37 states 37 states 34 states 34 states 34 states 33 states 30 states State Performance Measure Data Sources       Vital records - 41 states Pregnancy Risk Assessment Monitoring System (PRAMS) - 25 states Youth Risk Behavior Survey (YRBS) - 27 states Behavioral Risk Factor Surveillance System (BRFSS) - 12 states Medicaid Program Data - 25 states Hospital Discharge Data - 11 states   Other national programs State data - issue-specific surveys, program data, school-based data States with a Priority Need Addressing… Obesity and Overweight Map 1. State and Jurisdictional MCH Agencies with Obesity and Overweight as a Priority Need in Their 2005 Needs Assessment WA ME ND REGION 8 ID WY IA NV UT CA CO REGION 9 KS MO KY NC TN AZ OK NM AR REGION 6 TX MS LA REGION 4 AL GA SC NE REGION 7 IL REGION 5 IN OH REGION 3 WV VA DE MD Washington,DC SD MN WI MI NY REGION 2 VT NH MA RI PA NJ CT REGION 1 REGION 10 OR MT Legend State or J ur is dic tion has an Obe s ity or Ov er w eig ht Pr iority Ne ed FL Northern Mariana Islands REGION 9 Pa c i fi c Oc ean Guam HI AK Marshall Islands HI Puerto Rico (U.S.) Virgin Islands (U.S.) REGION 10 REGION 9 REGION 2 Palau Federated States of Micr onesia Am erican Sam oa P roduced by the N orth C arolina R ural H ealth R esearch and P olicynalysis C ente C ecil G. S heps C enter for H ealth S ervices R esearch, U niversity of N orth C arolina at C hapel H ill. A r, States with a Priority Need Addressing… Nutrition and Exercise Map 2. State and Jurisdictional MCH Agencies with Nutrition and Exercise as a Priority Need in Their 2005 Needs Assessment WA ME ND REGION 8 ID WY IA REGION 7 IL CO REGION 9 KS MO KY NC TN AZ OK NM AR REGION 6 TX MS LA REGION 4 AL GA SC REGION 5 IN OH REGION 3 WV VA DE MD Washington,DC SD MN WI MI NY REGION 2 PA NJ VT NH MA RI CT REGION 1 REGION 10 OR MT NV UT CA NE Legend State or J ur is dic tion has a N utrition and Ex e rc is e Pr ior ity N eed FL Northern Mariana Islands REGION 9 Pa ci fi c Oc ean Guam HI AK Marshall Islands HI Puerto Rico (U.S.) Virgin Islands (U.S.) REGION 10 REGION 9 REGION 2 Palau Federated States of Micr onesia Am erican Sam oa P roduced by the N orth C arolina R ural H ealth R esearch and P olicynalysis C ente C ecil G. S heps C enter for H ealth S ervices R esearch, U niversity of N orth C arolina at C hapel H ill. A r, States with a Priority Need Addressing… Obesity/overweight OR nutrition/physical exercise… State and Jurisdictional MCH Agencies with Obesity & Overweight and Nutrition & Exercise as Priority Needs in Their 2005 Needs Assessment WA ME ND REGION 8 ID WY IA REGION 7 IL CO REGION 9 KS MO KY NC TN AZ NM REGION 6 TX OK AR MS LA REGION 4 AL GA SC REGION 5 IN OH REGION 3 WV VA DE MD Washington,DC SD MN WI MI NY REGION 2 PA NJ VT NH MA RI CT NE UT CA REGION 1 REGION 10 OR MT NV Legend Has an Obesity or Overweight Priority Need Has a Nutrition or Exercise Priority Need Northern Mariana Islands REGION 9 FL Pacific Ocean Guam HI AK Marshall Islands HI Puerto Rico (U.S.) Virgin Islands (U.S.) REGION 10 REGION 9 REGION 2 Palau Federated States of Micronesia Produced by the North Carolina Rural Health Research and Policy American Samoa Analysis Cente r, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill. States with a Priority Need Addressing… Mental Health Map 3. State and Jurisdictional MCH Agencies with Mental Health as a Priority Need in Their 2005 Needs Assessment WA ME ND REGION 8 ID WY IA NV UT CA CO REGION 9 KS MO KY NC TN AZ OK NM AR REGION 6 TX MS LA REGION 4 AL GA SC NE REGION 7 IL REGION 5 IN OH REGION 3 WV VA SD MN WI MI NY REGION 2 VT NH MA CT RI PA NJ MD DE REGION 1 REGION 10 OR MT Washington,DC Legend State or J ur is dic tion has a Mental H ealth Pr io rity N ee d FL Northern Mariana Islands REGION 9 Pa c i fi c Oc ean Guam HI AK Marshall Islands HI Puerto Rico (U.S.) Virgin Islands (U.S.) REGION 10 REGION 9 REGION 2 Palau Federated States of Micr onesia Am erican Sam oa P roduced by the N orth C arolina R ural H ealth R esearch and P olicynalysis C ente C ecil G. S heps C enter for H ealth S ervices R esearch, U niversity of N orth C arolina at C hapel H ill. A r, States with a Priority Need Addressing… Prenatal Care - 2000 and 2005 Map 6. State and Jurisdictional MCH Agencies with Prenatal Care as a Priority Need in T heir 2000 and/or 2005 Needs Assessment WA ME ND RE GION 8 ID WY IA RE GION 7 IL CO RE GION 9 KS MO KY NC TN AZ NM OK AR RE GION 6 TX MS LA RE GION 4 AL GA SC RE GION 5 IN OH RE GION 3 WV VA DE MD Washington,DC SD MN WI MI NY RE GION 2 RI PA NJ CT NE UT CA VT NH MA RE GION 1 RE GION 10 OR MT NV Nor ther n Mar iana Islands RE GION 9 Legend State or Jurisdiction has a Prenatal Care Priority Need in Year 2000 FL 2005 Pa c i fic Oc ean Guam HI AK Mar shall Islands HI P uerto Rico (U.S .) Virgin Islands (U.S .) P alau Feder ated S tates of Micr onesia Am er ican S am oa RE GION 10 RE GION 9 RE GION 2 Produc ed by the North Carolina Rural Health Res earc h and Polic y Analys is Cente Cec il G Sheps Center for Health Services Research, Univers ity of North Carolina at Chapel Hill. r, . States with a Priority Need Addressing… Pre or Interconceptional Care - 2000 and 2005 Map 5. State and Jurisdictional MCH Agencies with Preconceptional & Interconceptional Care as a Priority Need in T heir 2000 and/or 2005 Needs Assessment WA ME ND RE GION 8 ID WY IA RE GION 7 IL CO RE GION 9 KS MO KY NC TN AZ NM OK AR RE GION 6 TX MS LA RE GION 4 AL GA SC RE GION 5 IN OH RE GION 3 WV VA DE MD Washington,DC SD MN WI MI NY RE GION 2 RI PA NJ CT NE UT CA VT NH MA RE GION 1 RE GION 10 OR MT NV Nor ther n RE GION 9 Mar iana Islands Pa c i fic Oc ean Legend State or Jurisdiction has a Preconceptional & Interconceptional Care Priority Need in Year 2000 FL 2005 Guam HI AK Mar shall Islands HI P uerto Rico (U.S .) Virgin Islands (U.S .) RE GION 10 RE GION 9 RE GION 2 P alau Feder ated S tates of Micr onesia Am er ican S am oa Produc ed by the North Carolina Rural Health Res earc h and Polic y Analys is Cente Cec il G Sheps Center for Health Services Research, Univers ity of North Carolina at Chapel Hill. r, . For more information: Victoria A. Freeman, RN, DrPH victoria_freeman@unc.edu