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The Changing Needs of Mothers_ Children and Families

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					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

36 states 38 states
34 states 35 states

Oral health and oral health care

Pregnancy outcomes

2000 2005
2000 2005

28 states 26 states
28 states 26 states

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)
Legal and illegal substance abuse

2000 41 states 2005 33 states
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 l e c t e d Lis t s fr o m Ca lif or nia ’s 2005 Ca t ego rica l- Le vel Prio rities as Ranked Pro blems as Ranked by St akeh ol der by Loc al Juri sd ictions Me e t ing Par ticipant s (p2 2 ) (p12 5 ) 1 He alth Cond itions 1 Over weigh t 2 Ac cess t o 2 Ac cess t o Care Care /S e rvices 3 Bir th 3 Sub st an ce Abuse Ou tc omes / Mor ta 4 Pren at al Care lity 5 Spe ci al 4 Men t al He alth Pop ulati ons 5 Sub st an ce Abuse 6 Oral He alth 6 Uni nte n tion al 6 Birth Out comes Injuri es 6 Brea s tf eed ing 7 As thma 7 Viol ence 8 Do mestic 8 Men t al He alth Viol ence 9 Injuri es 9 Te en Bi r ths 10 Othe r Topics 10 Pren at al Care 11 Morta lity 11 Chlamy dia 12 Basic Needs Infe ctions 13 Edu ca ti on 12 Oral He alth 13 Brea s tf eed ing 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 ci al He alth Care Nee ds St akeh ol d ers (p 14 8 ) 1 Exp and the n um ber of qu alifi ed pr o viders pa rti cip a ting in the CCS progr am , e. g., me dical speci alists, au diologi s ts, oc cup a tion al a nd physical thera pists, and nutr itioni sts. 2 Coor din a te t o d e vel op and imple m en t a s yst em of t im ely referral b et ween men t al he alth, d ev e lo pm en t al se r vices, s o ci al se r vices, sp e ci al e duc a tion se r vice s and CCS. 3 Increase th e n um ber of fa mi lyce nt ered me dical ho mes for CSHCN and the n um ber / % of CCS child ren who h a ve a desi gn a ted me dical h om e. 4 Inc rease acc es s o f CCS child ren to pr e ve n t ive health care se r vice s (e .g., p rim ar y c are pr o viders,… 4 Increase fa mi ly acce ss to educ a ti on al info rmati on and info rmati on ab ou t acc ess ing CCS se r vices, in cl u din g a va ilab ility o f and acc es s t o s e r vices o ffere d by h ealth plan s. 4 Increase acc es s to se r vices for yo u th, 1 7- 21 ye ars o f age. CCS 1 Enhanc e pr e con ce p ti on c are and wo rk toward dis pa rities in inf ant and m a tern al m orta lit y. eli min at ing 2 P rom o te he alt h y life st yle 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 hil dr 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 infe c ti ons. 4 Imp 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 t ing wom en . 5 Coor din a te t o d e vel op and im pleme n t a s ys t em of ti me ly referral b e tw e en m en t al he alth, d ev e lo pm en t al se r vices , soci al services, sp e ci al e duc a tion se r vice s and CCS. 6 Imp ro ve acce ss t o me dical and d en tal se r vices, in cl u ding redu cti on of d ispa rities. 7 Exp and the n um ber of qu alifi ed p ro viders pa r ti cip a t in g i n t he CCS progra m , e.g ., me dical speci alis ts, au diol o gis ts, o ccup a ti on al and ph ysical thera pis ts, and nu t riti onis ts. 8 Increase th e n um ber of fa mi ly- cen tered me dical h om es for CSHCN and the n um ber / % of CCS child ren who h ave a de sign a ted me dical h om e. 9 De creas e in t e n ti on al a nd uni nte n t ion al injuri es and violence, in cl u ding fa m ily and int ima t e pa r tner vi ole nce. 1 0 Increase br e astf eed ing initia ti on and dur a ti on .

5 De creas e the t ime b et we en referral to CCS and re cei p t o f CCS se r vices.

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 w ith Obesity and Ov erw eight 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 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

MS LA

Legend State or Jurisdiction has an Obesity or Overweight Priority Need
FL

Northern Mariana Islands

REGION 9

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

American Samoa

Produc ed by the N or th C arolina R ural H ealth R es earch and Polic y s is C ente C ecil G. Sheps C enter for H ealth Serv ic es R es earc h, U nivers ity of N orth C arolina at C hapel H ill. Analy r,

States with a Priority Need Addressing… Nutrition and Exercise
Map 2. State and Jurisdictional MCH Agencies w ith 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 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

MS LA

Legend State or Jurisdiction has a Nutrition and Exercise Priority Need
FL

Northern Mariana Islands

REGION 9

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

American Samoa

Produc ed by the N or th C arolina R ural H ealth R es earch and Polic y s is C ente C ecil G. Sheps C enter for H ealth Serv ic es R es earc h, U nivers ity of N orth C arolina at C hapel H ill. Analy r,

States with a Priority Need Addressing…
Obesity/overweight OR nutrition/physical exercise…
State and Jurisdictional MCHAgencies 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

Lege nd Has an Obesity or Overw eight 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 w ith 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 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

MS LA

Legend State or Jurisdiction has a Mental Health Priority Need
FL

Northern Mariana Islands

REGION 9

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

American Samoa

Produc ed by the N or th C arolina R ural H ealth R es earch and Polic y s is C ente C ecil G. Sheps C enter for H ealth Serv ic es R es earc h, U nivers ity of N orth C arolina at C hapel H ill. Analy r,

States with a Priority Need Addressing… Prenatal Care - 2000 and 2005
M ap 6. State and Jurisdictional M CH Agencies w ith Prenatal Care as a Priority Need in Their 2000 and/or 2005 Needs Assessment
WA ME ND REGION 8 ID WY IA REGION 7 IL CO REGION 9 KS MO KY NC TN AZ NM OK 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 RI PA NJ CT NE UT CA VT NH MA REGION 1 REGION 10 OR MT

NV

Northern REGION 9 Mariana Islands
P acific Ocean

Legen d State or Jurisdiction has a Prenatal Care Priority Need in Year 2000
FL

2005

Guam
HI

AK Marshall Islands HI Puerto R ic o (U.S.) Virgin Is lands (U.S.)

Palau

Federated States of Micronesia

American Samoa

REGION 10

REGION 9

REGION 2

Pr od uc e d by th e N or th C a r olin a R u r a l H ea lth R e s e a r c h a nd Po lic y C e nte e c il G. She ps C en te r fo r H e a lth Se r v ic es R es ea r c h, U n iv e r s ity o f N o r th C ar o lina at C h a pe l H ill. Ana ly s is r, C

States with a Priority Need Addressing…
Pre or Interconceptional Care - 2000 and 2005
M ap 5. State and Jurisdictional M CH Agencies w ith Preconceptional & Interconceptional Care as a Priority Need in Their 2000 and/or 2005 Needs Assessment
WA ME ND REGION 8 ID WY IA REGION 7 IL CO REGION 9 KS MO KY NC TN AZ NM OK 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 RI PA NJ CT NE UT CA VT NH MA REGION 1 REGION 10 OR MT

NV

Northern Mariana Islands

REGION 9

Legen d State or Jurisdiction has a Preconceptional & Interconceptional Care Priority Need in Year 2000
FL

2005

P acific Ocean

Guam
HI

AK Marshall Islands HI Puerto R ic o (U.S.) Virgin Is lands (U.S.) REGION 10 REGION 9 REGION 2

Palau

Federated States of Micronesia

American Samoa

Pr od uc e d by th e N or th C a r olin a R u r a l H ea lth R e s e a r c h a nd Po lic y C e nte e c il G. She ps C en te r fo r H e a lth Se r v ic es R es ea r c h, U n iv e r s ity o f N o r th C ar o lina at C h a pe l H ill. Ana ly s is r, C

For more information: Victoria A. Freeman, RN, DrPH victoria_freeman@unc.edu


				
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