building the best environments for families and children citymatch meeting august, 2007
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
Building the Best Environments
for Families and ChildrenCityMatCH Meeting
August, 2007US Department of Health and Human ServicesHealth Resources And Services Administration
Maternal And Child Health Bureau
Peter C. van Dyck, M.D., M.P.H.
AUGUST 2007 2
MCH BUREAU
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 ofHealth Insurance, Case Management, Coordination with
Medicaid, WIC and Education
POPULATION--BASED SERVICES
Examples:
Newborn Screening, Lead Screening, Immunization, Sudden Infant DeathCounseling, 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
MCH
EPSDT
CHC SCHIP
AUGUST 2007 4
Numbers Served In MCH Block Grant Program, 1997 And 2005
INDIVIDUALS SERVED 1997
SERVED 2005
% OF ALL SERVED 2005
PREGNANT WOMEN
1,963,797 2,468,776 62%
INFANTS
2,907,840 3,875,149 97%
CHILDREN 16,456,435 22,543,966 32%
CSHCN 875,648 1,370,947 13%
OTHER 1,810,999 2,855,171 N/A
TOTAL 24,014,719 33,114,009 N/A
SOURCE: TITLE V INFORMATION SYSTEM
AUGUST 2007 5
MCHB
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
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
FY2007
2008(PB)
1-numbers may not add due to rounding
2008(H) 2008(S)
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
FY2007
2008(PB)
1-numbers may not add due to rounding
2008(H) 2008(S)
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)
AUGUST 2007 10
MCH BUREAU
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.
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)
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
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
AUGUST 2007 15
Detection of Depression
Only one-half of depressions in
primary care patients are detected
and even fewer postpartum
depressions are detected
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]
AUGUST 2007 17
DEPRESSION DURING AND AFTER PREGNANCY: A Resource for Women,
Their Families and Friends
www.mchb.hrsa.gov/pregnancyandbeyond/depression
AUGUST 2007 18
MCH BUREAU
AUGUST 2007 19
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
AUGUST 2007 21
AUGUST 2007 22
MCH BUREAU
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
AUGUST 2007 24
National Survey ofChildren’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
AUGUST 2007 25
National Survey ofChildren’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
AUGUST 2007 26
Nat. Survey of Children’s Health
HOMEPAGE
www.nschdata.org
Data Resource Center for Child & Adolescent Health
www.childhealthdata.org
Nat. Survey of Children w/ Special Health
Care NeedsHOMEPAGE
www.cshcndata.org
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
AUGUST 2007 28
SELECT
● GEOGRAPHIC AREA
● TOPIC to search
SELECT
● QUESTION within topic area
COMPARE SUBGROUPS
to view question results by age, gender, race, type of special
need, etc.
Data Search“RECIPE”
STEP 1
STEP 2
STEP 3
COMPARE results with other
STATES
OPTIONAL
COMPARE results with other
STATES
OPTIONAL
AUGUST 2007 29
The Children’s Health Survey
Percentage Ever Breastfed by State, NSCH, 2003
45.0-64.0
64.0-67.3
67.3-73.0
73.0-80.0
80.0-88.0
AK
HI
AUGUST 2007 30
The Children’s Health Survey
AK
HI
Percentage Breastfeeding for At least 6 Months, NSCH, 2003
17.3-28.9
28.9-32.9
32.9-38.0
38.0-46.0
46.0-56.0
AK
HI
AUGUST 2007 31
The National Survey of Children’s Health
AUGUST 2007 32
MCH BUREAU
AUGUST 2007 33
0
2
4
6
8
10
12
14
16
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
Rat
es p
er 1
,000
live
bir
ths Non-Hispanic Black
American Indian or Alaska Native
US Total
Asian/or Pacif ic Islander
Non-Hispanic White
Hispanic
HP 2010 Target
Infant Death Rates by Race and Ethnicity, 1995 - 2004
Source: NVSS, NCHS, CDC.
AUGUST 2007 34
Per 1,000 live births N
(4)(8)
(11)(16)(12)
9.0 or more 8.0 - 8.97.0 – 7.96.0 – 6.9Less than 6.0
Infant Mortality Rateby State, 2002-2004
D.C.
Obj. 16-1cSource: NVSS, NCHS, CDC.
2010 Target = 4.5
AUGUST 2007 35
Total and Preterm Infant Mortality Rates by Race and Ethnicity of Mother, 2004
13.6
6.29
8.45
1.89
7.82
3.19
6.78
2.48
5.66
1.82
5.47
1.46
4.67
1.65
0
2
4
6
8
10
12
14
Rat
e pe
r 1,0
00 li
ve b
irths
Non-Hispanic
Black
AmericanIndian orAlaskaNative
PuertoRican
US Total Non-Hispanic
White
Mexican Asian/orPacific
Islander
Race and Ethnicity
Total
Preterm Related
Source: NVSS, NCHS, CDC.
AUGUST 2007 36
Percentage N
(13)(18) (9)
(11)
9.0 or more 8.0 - 8.97.0 – 7.96.0 – 6.9
Percent Low Birthweight
by State, 2004-2005
D.C.
Source: NVSS, NCHS, CDC.
US LBW= 8.15%
AUGUST 2007 37
Economic Burden Associated with Preterm Birth, 2005
($26.2 Billion )
$16.90$1.70
$1.90
$5.70
Medical Care Education
Delivery Lost Productivity
Source: IOM
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
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.
AUGUST 2007 40
Economic Cost of Low Birth Weight
<28 weeks 67.428-31 weeks 44.432-36 weeks 6.737-40 weeks 1.5
Mean Length of Stay for Hospitalization
Gestational Length of Stay Age Days
IOM, Preterm Births, 2007IHC data
AUGUST 2007 41
Economic Cost of Low Birth Weight
<28 weeks $190,467 $12,172 $4,94428-31 weeks $94,785 $7,715 $2,53432-36 weeks $13,621 $1,736 $81437-40 weeks $3,325 $1,328 $661
Total Annual Medical Costs, U.S., 2005Birth Year Year 2 Year 3-4
IOM, Preterm Births, 2007
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, 2007Russell, 2005
AUGUST 2007 43
Economic Cost of Low Birth Weight
Mental Retardation $123,205Cerebral Palsy $83,169Vision Impairment $32,058Hearing Loss $23,209
Medical Costs by Developmental Disability
Developmental Medical Costs Disability
IOM, Preterm Births, 2007Honeycutt, et.al.
AUGUST 2007 44
Economic Cost of Low Birth Weight
<28 weeks 2,785 176 63.228-31 weeks 6,281 171 27.232-36 weeks 31,568 407 12.937-40 weeks 293,949 1988 6.8
Mental Retardation
3 Year CasesPrevalence
Survivors per 1000
IOM, Preterm Births, 2007MADDSP data
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)
AUGUST 2007 46
MCH BUREAU
AUGUST 2007 47
www.mchb.hrsa.gov/timeline
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
AUGUST 2007 49
MCH Timeline- Historical Markers
AUGUST 2007 50
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
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
AUGUST 2007 53
AUGUST 2007 54
Peter C. van Dyck, M.D., M.P.H.
HRSA/MCHBhttp://mchb.hrsa.gov/
Contact