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Early Intervention: Federal Requirements and Model
ProgramsUsing Title V to Improve
Outcomes for Young Children and Their Families
Deborah Klein Walker, EdDPrincipal Associate
Health Services Research and EvaluationAbt Associates
ABCD II Consortium NetworkAugust 2004
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Outline of Presentation
• Review Public Health Model Guiding Principles and System of Care
• Outline Components of Title V (Maternal and Child Health Block Grant)
• Examples of Early Childhood Services and Links to Title V
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GOAL
Develop and enhance systems of care in neighborhoods and communities which promote:
Healthy Children in Healthy Families in Healthy Communities
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MCH PUBLIC HEALTH FOCUS
• Communicable Diseases
• “New Morbidity”
• “New Social Problems”
• Healthy Communities
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HEALTHY PEOPLE 2010 GOALS:
• Promoting Healthy Behaviors
• Promote Health and Safe Communities
• Improve Systems for Personal and Public Health
• Prevent and Reduce Diseases and Disorders
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OUTCOMES
• Infant Mortality
• Immunization
• Child Fatalities
• Teen Births
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OUTCOMES
• Children in Poverty
• Low Birth weight
• Child Abuse
• Single Parents
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The Public Health (and MCH)
Focus on Improved Health
Outcomes Assumes a System
of Care Must Be in Place
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Early Childhood System Sectors
• Health
• Education
• Social Services
• Child Care
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PUBLIC HEALTH (MCH) GOALS FOR A SYSTEM OF CARE
• Community-Based• Family Centered• Consumers Engaged as Partners With
Professionals• Coordinated • Comprehensive• Prevention-Oriented• Early and Continuous Availability
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PUBLIC HEALTH (MCH) GOALS FOR A SYSTEM OF CARE
• Cultural, Language and Socioeconomic Sensitivity
• Non-Categorical Approach• Quality of Care Standards• Flexible and Adaptable• Integration with Criminal Justice,
Employment, Housing, etc.
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HEALTH FINANCING IS
NECESSARY BUT NOT
SUFFICIENT
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SYSTEMS DEVELOPMENT AT ALL
GOVERNMENT LEVELS
KEY PUBLIC HEALTH (MCH) ROLE
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PUBLIC HEALTH CORE FUNCTIONS
• ASSESSMENT
• POLICY DEVELOPMENT
• ASSURANCE
Future of Public Health, Institute of Medicine, 1988
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ASSESSMENT STRATEGIES
• Monitor Health Status• Needs Assessment• Surveillance• Diagnosis and Investigation• Program Monitoring and Evaluation• Quality Improvement Systems
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POLICY DEVELOPMENT STRATEGIES
• Leadership and Advocacy
• Planning
• Collaborative Partnerships
• Ensure Financing
• Ensure Public/community Participation
• Legislation
• Innovations
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ASSURANCE STRATEGIES
• Education and Training
• Direct Services
• Public Information, Education, Referrals
• Community Mobilization
• Licensing, Regulation, Certification
• Standards Setting and Guidelines
• Program Monitoring and Evaluation
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TITLE V BLOCK GRANT
• Social Security Act - 1935
• Amended in 1960’s, 1981, 1989, 1996
• Federal/State/Local Partnership
• Point of Accountability for ALL “MCH Population”
• Available in All States
• Core Public Health Functions Used for Systems Development
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MATERNAL AND CHILD HEALTH TITLE V SOCIAL SECURITY ACT
1935 Enacted
1960’s - 70’s Expansion
1981 Block Grant
1989 OBRA
1996 Welfare Reform
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TITLE V PURPOSE
• To improve the health of ALL mothers and childrenProvide and assure access to quality maternal and
child health services…Reduce infant mortality, preventable diseases…
promote health of low income children...Provide rehabilitation services to those <16 who
receive SSI (Title XVI) benefits to the extent such services are not provided under Title XIX…
Promote family-centered, community-based , coordinated care for children with special health care needs
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MAJOR STATE / FEDERAL MCH/Title V ROLES
• Promote MCH through public health core functions
• Support development of community-based child and family systems
• Coordinate child health care and administer supplemental health services
• Enable access for MCH underserved populations
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What Title V Agencies are Called
• Maternal and Child Health
• Maternal, Child and Family Health
• Child and Family Health
• Youth and Family Health
• Family Health
• Family and Community Health
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Title V Conditions
• 85% to state block grant; 15% for SPRANS (Special Projects of Regional and National Significance)
• States must provide a $3 match for every $4 federal dollars
• Must conduct a statewide needs assessment every 5 years
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Title V Conditions
• Maintenance of effort required to be level at least equal to the level provided in FY1989
• States must use:At least 30% of MCH Block Grant
funds for preventive and primary care services for children
At least 30% for services for children with special health care needs
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MCH PYRAMID OF HEALTH SERVICES
Direct Health Care Services
Enabling Services
Population-Based Services
Infrastructure Building Services:
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MCH REPORTING SYSTEMS
• National MCH Outcome Measures
• National MCH Performance Measures
• State-determined MCH Performance Measures
• National Health Status Indicators
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MCH TITLE V PERFORMANCE MEASURES SYSTEM• Implemented for FY99 Application to the
MCH Block Grant (July 1998)• Determined by State / Federal Process• 18 Core Performance Measures in 4 Areas:
Direct Health Care Services (Gap Filling)Enabling ServicesPopulation-Based ServicesInfrastructure Building Services
• 6 Core Outcome Measures• Up to 10 State Negotiated Measures
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MCH OUTCOME MEASURES
• Infant Mortality Rate (IMR) per 1,000 live births.
• Ratio of black IMR to the white IMR
• Neonatal Mortality Rate per 1,000 live births
• Post-neonatal Mortality Rate per 1,000 live births
• Perinatal Mortality Rate per 1,000 births
• Child Death Rate per 100,000 children aged 1-14
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MCH eGOV VISION PRINCIPLES
• Maximize user-friendly access to all MCH information systems
• Assure data subject confidentiality within a public health context
• Coordinate or integrate information systems where possible and appropriate, while utilizing shared national standards.
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MCH POPULATION-BASED POTENTIAL DATA SOURCES
• Surveys (YRBS, BRFS, SLAITS, PRAMS, etc.)
• Vital Statistics
• Surveillance Systems / Disease Registries (e.g., Birth Defects, Immunization, Cancer, etc.)
• Program / Service Management Information Systems
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State and Local Area Integrated Telephone Survey (SLAITS)
• Developed by National Center of Health Statistics (CDC)
• Random-digit-dial telephone survey conducted by Abt Associates
• CSHCN module sponsored by MCHB to assess prevalence and monitor indicators of care for CSHCN in all 50 states and DC
• Child health module sponsored by MCHB to document child health access and outcomes in all 50 states and DC
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What Does It Mean To “Assure”?
• Guarantee• Pledge• Promise• Vow• Confirm• Insure• Comfort• Console • Reassure
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Assurance Functions of MCH
“ public health agencies assure their constituents that services necessary to achieve agreed upon goals are provided, either by encouraging actions by other entities (public or private), by requiring such action through regulation or by providing services directly ”
(Institute of Medicine, The Future of Public Health, 1988)
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CHARACTERISTICS OFMCH ASSURANCE ROLES
• Prevention focused• Applies to the entire MCH population• Depends on the success of assessment
efforts• Relies on sound policy development• Relates to MCH systems development role• Implies advocacy and leadership• Implies accountability for the outcome
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MCH ASSURANCE EXAMPLES
• Direct provision of the service
• Payment or contracting for the service
• Set voluntary standards
• Legislative required standards
• Provide education and training to providers
• Evaluate effectiveness of services
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MCH ASSURANCE EXAMPLES
• Active regulation of the services
• Quality assurance mechanisms
• Monitor system compliance
• Monitor compliance with service standards
• Education of the public about services
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MCH ASSURANCE EXAMPLES
• Facilitate public accountability
• Population-based data gathering and reporting
• Facilitate active public/private partnerships towards shared accountability for MCH outcomes
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EXAMPLES OF MCH PARTNERS OUTSIDE OF HEALTH AGENCY
• Consumers/Families
• Researchers
• Advocacy Groups
• Policymakers
• Business/Industry
• Public and Private Agencies
• Providers
• Professional Groups
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EARLY CHILDHOOD STATE INITIATIVES
• CHIP - Child Health Insurance Expansions
• Home Visiting Expansions
• Education Reform
• Child Care Expansions
• Social Services Changes
• Welfare Reform
• Planning/Integration Efforts
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STARTING POINTS
• Promote Responsible Parenthood
• Guarantee Quality Child Care Choices
• Ensure Good Health and Protection
• Mobilize Communities to Support Young Children and Their Families
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CHALLENGES
Coordination and LinkageFederal-state-localCross systemsAcademia to practice
CapacityCommunityProvider
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CHALLENGES
FinancingHealthEducationChild careJobs
Attitudes and CommitmentPublicBusinessParents
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IMPLEMENTATION OF PUBLIC POLICY NEEDS
• Knowledge Base
• Political Will
• Social Strategies
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KEY FEDERAL LEGISLATION
• SSA Title V - MCH Block Grant
• SSA Title IV - Welfare, Child Support, Foster Care
• SSA Title XVI - Supplemental Security Income (SSI)
• SSA Title XIX - Medicaid
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KEY FEDERAL LEGISLATION
• SSA Title XXI - SCHIP
• OBRA ‘93 Family Preservation
• Child Care Block Grant
• Individuals with Disabilities Education Act (IDEA)
• Head Start
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KEY FEDERAL LEGISLATION
• Supplemental Nutrition Program for Women, Infants and Children (WIC)
• Public Health Service ActCommunity and Migrant Health Centers
(Sections 329 & 330)Family Planning (Title X)
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• Parents and Families
• Providers
• Purchasers and Insurers
CRITICAL PARTNERS FOR IMPROVING MCH OUTCOMES
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FUTURE GOALS FOR TITLE V
• Funded to Meet All Goals
• Recognized as Point of Accountability at State and Federal Levels
• Linked to All Child and Family Service Sectors
• Supported by General Public
• Supported by Local, State and National Organizations