santa barbara 2019 title v community assessment maternal ... › sites › fhop.ucsf.edu ›...
TRANSCRIPT
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.
Santa Barbara County
Maternal Child and Adolescent Health
2020-2025 Title V Community Assessment
Kelley Barragan, MCAH Program Coordinator
Mitchell Hee, Epidemiology Intern
Michelle Wehmer, Epidemiologist
PHD Mission: To improve the health of our communities by preventing disease, promoting wellness, ensuring access to needed
health care, and maintaining a safe and healthy environment.
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Objectives
Define Title V requirements
Examine local worsening and improving indicators
Identify priority problems
Discuss current solutions and how we, as a community, can create change
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Title V Maternal & Child Health Block Grant
Reporting requirements mandate completion of a State annual report that specify:
Needs of the State MCAH population
Programs and policies implemented to meet those needs
Monitor progress toward achieving federal and state performance outcome measures
Management/expenditure of funding
Every 5 years a comprehensive statewide needs assessment must be conducted of the MCH population
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Title V Maternal & Child Health Block Grant
In California - Decentralized statewide needs assessment process - each local health jurisdiction (LHJ) conducts a needs assessment
Key Objectives
Identify local needs and capacity Obtain stakeholder input at the local level Focus local MCAH efforts by having each LHJ
identify priority areas they will focus on during the next 5 years
Develop a local five-year action plan
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Methodology for 2020-2025 SBC Title V Needs Assessment
Analyzed FHOP (Family Health Outcomes Project) Databooks and other local epi data reports on various MCAH health indicators
Incorporated data from various community needs assessments Santa Barbara County Public Health Department Community
Needs Assessment 2016
Cottage Health Community Needs Assessment 2016
Dignity Health Community Needs Assessment 2016
Santa Barbara County Children’s Scorecard 2017
Santa Barbara County First 5 Strategic Plan 2017-2021
Santa Barbara County Oral Health Needs Assessment 2019
Administered web-based survey to stakeholders on priority issues, causes, intervention/strategies, and partners
Obtained feedback from community at Stakeholder Meeting via roundtable discussions
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2015-2020 Community Assessment MCAH priorities
Increase health care and insurance access to low-income women and children in Santa Barbara County
Increase community-wide knowledge, access and linkage of children to a dental home where possible to ensure preventive care and increase access to fluoride varnish.
Increase number of health care providers who routinely screen pregnant women and mothers of children under 2 years of age for Perinatal Mood and Anxiety Disorder (PMAD) and refer as needed.
Increased number of health care providers who routinely screen pregnant women and mothers of children under 2 years of age for Substance Use and refer as needed.
To reduce the number of SIDS/SUID events by promoting optimal sleep environments.
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Highlights of success from 2015-2020 Needs Assessment Action Plans
• MCAH Field Nursing Unit updated policies and implemented CQI activities to ensure all eligible children, pregnant ,and postpartum women are enrolled in Medi-Cal, had access to timely care, and received dental resources and information.
• Local Oral Health Collaborative developed an oral health campaign focusing on children 0-5.
• Perinatal Wellness Coalition worked to update resource guide of local Substance Abuse treatment services.
• MCAH Program surveyed local CPSP providers on PMAD and SA screening practices and provided current recommendations and resources.
• Partnership with Marian Regional Medical Center and other local partners to address PMADs through creation of a web-based resource directory with 211, community/provider trainings, and development of a tool-kit.
• Collaboration with SBHCC and Sansum Diabetes Research Institute to develop a pilot project with a “Centering-Like” model for GDM clients.
• MCAH Program provided SIDS/Safe Sleep presentations to numerous local organizations that interact with pregnant women/0-1 y/o.
• MCAH Field Nursing Unit incorporated the NEAR@Home Framework to address ACEs with distribution of training materials to other local partners
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Conceptual Framework Public Health System 10 Essential Functions
Source: CDC Website
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Conceptual Framework Life Course Model
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Conceptual Framework PHD Focus Area: Social Determinants of Health (SDOH)
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Conceptual Framework PHD Focus Area: Health Equity
Source: Robert Wood Johnson Foundation https://www.rwjf.org/en/library/infographics/visualizing-health-equity.html#/download
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Conceptual Framework PHD Focus Area: Adverse Childhood Experiences (ACEs)
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Overview of SBC Demographics
Add picture of SBC
Source: visitcalifornia.com
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SBC Population by City, 2016 (N = 447,073)
Santa Maria 23.9%
Guadalupe 1.6%
Lompoc 9.8%
Solvang 1.2%
Buellton 1.1%
Santa Barbara 21.1%
Goleta 7.0%
Carpinteria 3.1%
Balance Of County 31.2%
Source: California Department of Finance, Population Estimates, 2016
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SBC Population by Race and Ethnicity, 2016
Hispanic 44.4%, 44.4
White 45.9%, 45.9
Black 1.7%, 1.7
American Indian 0.3%, 0.3
Asian 5.1%, 5.1 API 0.1%, 0.1 Multi-Race 2.4%, 2.4
Source: Census Data 2016
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SBC Population Race and Ethnicity by City, 2016
Lompoc
Hispanic 52.8%
White 34.1%
Black 5.3%
American Indian 0.5%
Asian 3%
API 0.4%
Multi-Race 3.8%
Other 0.1%
Source: Census Data 2016
Santa Maria
Hispanic 73.4%
White 19.5%
Black 0.8%
American Indian 0.1%
Asian 5.1%
API 0.1%
Multi-Race 0.9%
Other 0.1%
Santa Barbara
Hispanic 38.2%
White 54.5%
Black 1.4%
American Indian 0.3%
Asian 3.5%
API 0%
Multi-Race 2%
Other 0.1%
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SBC Population by Age Group, 2016
<5 6.5%
5-24 32.0%
25-44 24.6%
45-64 22.9%
65+ 14.0%
Source: Census Data 2016
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SBC Population Age Groups by City, 2016
8.7%
29.0%
27.6%
24.3%
10.5%
Lompoc
<5 5-24 25-44 45-64 65+
Source: Census Data 2016
9.5%
33.7%
28.3%
18.7%
9.8%
Santa Maria
5.5%
26.0%
27.2%
24.2%
17.1%
Santa Barbara
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SBC Birth Rate, 2007-2016
52.0
54.0
56.0
58.0
60.0
62.0
64.0
66.0
68.0
70.0
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Bir
th R
ate
(p
er
1,0
00 p
op
ula
tio
n)
Source: SBC PHD Vital Records; State of California, Department of Finance, State and County Population
Projections by Race/Ethnicity, Detailed Age, and Gender, 2010-2060. Sacramento, California, January 2018.
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Race and Ethnicity of Mothers who gave Birth in 2016, N=5501
Hispanic 65%
White 28%
Asian 5%
Unknown 1%
Black 1% American
Indian 0%
Source: CA Birth Statistical Master File, 2016
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Santa Barbara County Medi-Cal Clients
Source: 2017 Santa Barbara County Children’s Scorecard, p.33
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Medi-Cal Delivery Rates by Local vs. State and Ethnicity
Highlights:
Hispanics have a higher rate of Medi-Cal deliveries than Whites Locally and in CA.
Source: CA Birth Statistical Master File,
43.4
58.4
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Rate
of
Deli
ve
ry w
ith
M
ed
iCa
l
Local Versus State
CA SBC
23.1
20.1
63.0
78.0
0.0
20.0
40.0
60.0
80.0
100.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Rate
of
Deli
ve
ry w
ith
M
ed
iCa
l
By Ethnicity
CA White SBC White CA Hispanic SBC Hispanic
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Education Level and Public Assistance, 2016
Education level:
The percentage of births to mothers with an education level below GED (does not include 17 births where an address was withheld and removes births where mother education was not answered):
North County 50.3% (1224/2431)
Middle County 20.4% (187/915)
South County 14.0% (213/1521)
Public Assistance:
Medi-Cal Births by SBC Geographic Area (5,501 births in 2016) show that 61.1% of births are to women on Medi-Cal county-wide.
79.4% of births in North County were to Medi-Cal recipients.
Source: Vital Records Birth Stat Master File, 2016.
Highlights: North County mothers have less formal education than Mid or South County mothers.
North County has a higher percentage of births to Medi-Cal recipients than Mid or South County
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Poverty
44.7
47.0
36.0
38.0
40.0
42.0
44.0
46.0
48.0
50.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Rate
of
Ind
ivid
ua
ls i
n
Po
ve
rty
SBC Population by Age 0-18
CA SBC
Highlights:
The rate of Children and Females living in poverty is higher in SBC than CA.
33.7
36.4
0.0
10.0
20.0
30.0
40.0
50.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Rate
of
Ind
ivid
ua
ls i
n
Po
ve
rty
SBC Females by Age 18-64
CA SBC
Source: Small Area Health Insurance Estimates
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Unemployment per 100 People in the Employment Market
6.2
5.3
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Un
em
plo
ym
en
t R
ate
CA SBC
Highlight:
Unemployment rates have been decreasing the past several years and SB is doing better than CA.
Source: Office of Attorney General ; CA Department of Finance
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MCAH Health Indicators
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79% of pregnant women received prenatal care beginning
the first trimester in Santa Barbara County in 2016.
Source: https://scorecard.childrennow.org/?ind=earlyPrenatalCare&yr=1
CA Avg:
84%
78.1
73.9
70.9
73.3
75.2
76.8 76.8
77.7
79.6 79.3
65
70
75
80
85
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Pe
rce
nt
per
10
0 L
ive
Bir
ths
Prenatal Care Received During the First Trimester Santa Barbara County, 2007-2016
SBC
HP 2020 Target 77.9%
Source: PHD Birth Statistical Master Files, 2007-2016
- unknown responses removed from data.
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Prenatal Care in the first trimester by ethnicity, SBC, 2007-2016
85.6% 83.4%
84.8% 86.4% 85.0% 87.5%
85.4% 86.9% 87.5% 87.0%
70.1%
65.1% 62.1%
67.2% 70.2% 71.0% 72.1% 73.2% 73.0% 74.1%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Pe
rce
nta
ge
of
Pre
gn
an
t W
om
en
Whites
Latinas
Source: PHD Birth Statistical Master Files, 2007-2016.
Highlight:
Consistently lower rate of prenatal care among Latinas than Whites
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Tdap Vaccination
Tdap Immunizations during pregnancy per 100 females
delivering a live birth (2015-2016).
SBC Rate: 57.5
CA Rate: 50.4
Highlight:
Local Tdap immunization rates during pregnancy are greater than CA rates, but room for improvement when compared to other 20 counties with highest number of births.
Source: FHOP Community Health Status Report, 2017
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Gestational Diabetes Rates by Local vs. State and Ethnicity
0.0
2.0
4.0
6.0
8.0
10.0
12.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Rate
of
Ge
sta
tio
nal
Dia
bete
s
Local Versus State
CA SBC
Highlight:
Hispanic women have higher rates of GDM than Whites both locally and in CA.
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Rate
of
Ge
sta
tio
nal D
iab
ete
s
By Ethnicity
CA White SBC White CA Hispanic SBC Hispanic
Source: Office of Statewide Health Planning and Development. Hospital Discharge Data.
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Diabetes in Pregnancy
In the United States, about 1% to 2% of pregnant women have type 1 or type 2 diabetes and about 6% to 9% of pregnant women develop gestational diabetes (Source: CDC).
In 2018, 8.9% of postpartum women in the WIC program (211/2376) reported having GDM in the past.
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Perinatal Mental Health
One in five California women who recently gave birth experienced symptoms of depression during or after pregnancy, according to the MIHA survey. That translates to about 100,000 women a year.
All women are at risk for symptoms of perinatal depression; however, Black or Latina women, teens, women who have low incomes or those who have experienced hardships in their childhood or during pregnancy are at heightened risk of having symptoms of depression.
Highlights: 20% of California women experience symptoms of depression during or after pregnancy
Women of certain racial/ethnic groups, in lower social economic levels, that are younger, and /or who experience hardships in childhood are at greater risk
Source: “Symptoms of Depression During and After Pregnancy” MIHA Issue Brief https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/Communications/Data-Brief-MIHA-2018-01.pdf
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Perinatal Depression
Highlight:
Local rates are not statistically significant when compared to CA Rates
Prenatal depressive symptoms per 100 females delivering a
live birth (2013-2015).
SBC Rate: 17.3
CA Rate: 14.1
Postpartum depressive symptoms per 100 females delivering
a live birth (2013-2015).
SBC Rate: 15.2
CA Rate: 13.5
Source: FHOP Community Health Status Report, 2017
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Substance Abuse Hospitalizations of Pregnant Women
21.0
17.3
0.0
5.0
10.0
15.0
20.0
25.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015Ra
te o
f P
reg
na
nt
Wo
me
n
Ad
mit
s
All 15-44 year olds
CA SBC
Highlight:
Substance Abuse Hospitalizations of Pregnant Women has been trending up locally.
29.5
22.5
15.8
15.3
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Rate
of
Pre
gn
an
t W
om
en
A
dm
its
By race and ethnicity
CA White SBC White CA Hispanic SBC Hispanic
Source: Office of Statewide Health Planning and Development. Hospital Discharge Data
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Substance Use In SBC
According to 2013-15 MIHA data:
13.5% of SBC women had any binge drinking during
the 3 months before they knew they were pregnant
8.8% of SBC women had any alcohol use in the 3rd Trimester
-No data for <High School -5.9% High School Graduate/GED -8.3% Any College -20.5% College Graduate
In FY 17/18, 13% (193/1455) of families served by MCAH Field Nursing Unit were identified with current or past substance use.
Highlight:
A higher percentage of college-educated mothers used alcohol in the 3rd trimester than those with less formal education.
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Percentage of Mothers Breastfeeding In-Hospital, 2010-2017
2010 2011 2012 2013 2014 2015 2016 2017
SBC - Any 95.2 95.5 95.0 95.2 95.7 95.4 95.9 96.2
CA - Any 90.8 91.7 92.3 93.0 93.6 93.9 94.0 94.0
SBC - Exclusive 60.9 56.3 54.8 56.5 59.0 57.8 59.3 61.6
CA - Exclusive 56.8 60.6 62.6 64.8 66.8 68.6 69.6 69.8
HP 2020 - Target 81.9 81.9 81.9 81.9 81.9 81.9 81.9 81.9 81.9
96.2
94.0
61.6
69.8
HP 2020 'Any BF', 81.9%
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Bre
ast
fee
din
g P
erc
en
tag
e
Highlight:
Local percentage of any breastfeeding is greater than CA and HP 2020 Target
Local percentage of exclusive breastfeeding is lower than CA
Source: California In-Hospital Breastfeeding as Indicated on the Newborn Screening
Test Form Statewide and Maternal County of Residence, 2010-2017.
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59% of newborns were exclusively breastfed while
in the hospital in Santa Barbara County in 2016.
Source: https://childrennow-scorecard.netlify.com/?ind=breastFeeding&yr=1
CA Avg:
70%
69.6% 69.80%
59.3%
61.60%
54.0%
56.0%
58.0%
60.0%
62.0%
64.0%
66.0%
68.0%
70.0%
72.0%
2016 2017
Pe
rce
nta
ge
of
Ex
clu
siv
e B
rea
stf
ee
din
g
Exclusive In-Hospital Breastfeeding per 100 Females Delivering a Live Birth
CA SBC
Source: California In-Hospital Breastfeeding as Indicated on the Newborn Screening
Test Form Statewide and Maternal County of Residence, 2016-2017.
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Exclusive In-Hospital Breastfeeding by Hospital, SBC, 2016
42.8%
49.6%
60.3%
47.3% 46.8%
76.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Lompoc Valley MedicalCenter
Marian Medical Center Santa Barbara CottageHospital
Pe
rce
nta
ge
of
Ex
clu
siv
e B
rea
stf
ee
din
g
Santa Barbara County, 2012 (Left Bar), 2016 (Right Bar)
Source: California In-Hospital Breastfeeding as Indicated on the Newborn Screening Test Form
Statewide, County and Hospital of Occurrence: 2016.
Highlight:
Cottage and Lompoc have increased exclusive in-hospital breastfeeding rates, while Marian has decreased.
Cottage received Baby Friendly designation in 2018 and Marian is working toward their designation.
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Breastfeeding Ethnic Disparities Exclusive Breastfeeding 3 Months After Delivery
79.9% Women of Caucasian ethnicity exclusively breastfed in-hospital, while 50% of Hispanic women exclusively breastfed in
hospital (SBC 2016).
SBC’s average breastfeeding rate 3 months after delivery 33.5%;
the state’s average is 29.1% Comparison is not significant
Source: California In-Hospital Breastfeeding as Indicated on the Newborn Screening Test Form
Statewide, County and Hospital of Occurrence: 2016.
FHOP Community Health Status Report, 2017
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Teen Birth Rate, SBC, 2007-2016
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
Bir
th R
ate
(p
er
1,0
00
po
pu
lati
on
)
Santa Barbara County**
California
* Teenage mothers are defined as 15-19 years of age at time of childbirth.
Source: Vital Statistics Query System - cdph.ca.gov
Population: Department of Finance Demographic Unit, 2017 http://www.dof.ca.gov/research/demographic/projections/
** Statewide data: Report 2-2: Birth Rates by Age of Mother 2007-2016,
https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/Data/Adolescent/Adolescent-Birth-
Rates-2016.pdf
Highlight:
Teen birth rates have been decreasing both in CA and SBC.
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Teenage Births by City, SBC, 2009-2016
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
Pe
rce
nta
ge
of
Te
en
ag
e B
irth
s
SBC
Carpinteria
SB City
Lompoc
Guadalupe
Santa Maria
* Teenage mothers are defined as 15-19 years of age at time of childbirth.
* Location is determined by mother's residency
Source: Birth data: Vital Records office of Santa Barbara County and Vital Statistics Query System - cdph.ca.gov
Highlight:
The percentage of teenage births has decreased in all cities between 2009 and 2016.
Santa Maria and Guadalupe have the highest percentages of teen births in the county.
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2005 2011 2016
Santa Barbara County 651/6192 551/5803 321/5501
Carpinteria 30/225 14/192 7/199
Santa Barbara City 118/1915 77/1071 29/1235
Lompoc 96/928 85/876 47/838
Guadalupe 19/170 23/141 8/136
Santa Maria 371/2670 303/2619 204/2527
Numerator: Number of Teen Births by Location
Denominator: Total Number of Births by Location
* Teenage mothers are defined as 15-19 years of age at time of childbirth.
* Location is determined by mother's residency
Source: Birth data: Vital Records office of Santa Barbara County and Vital Statistics Query System - cdph.ca.gov
Highlight:
The percentage of teenage births has decreased in all cities between 2009 and 2016.
Santa Maria and Guadalupe have the highest percentages of teen births in the county.
Teenage Births by City, SBC, 2009-2016
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Teenage Birth by Region, SBC, 2016
North County, 213, 66.6%
Central County, 52,
16.3%
South County, 55, 17.2%
Source: Vital Records Birth Statistical Master File, 2016; 1 birth did not have a zip code identified
Highlight:
There are a higher number of births to teens in North County than South or Mid County.
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Cesarean Births per 100 Low Risk Females
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
2007 2008 2009 2010 2011 2012 2013 2014 2015
Ra
te o
f C
es
are
an
Bir
ths
CA SBC
Source: CA Birth Statistical Master File,
HP 2020 goal = 23.9%
Highlight:
SBC is statistically doing worse than CA in cesarean births of low risk females.
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Percentage of Underweight Births, SBC, 2007-2016
5000
5200
5400
5600
5800
6000
6200
6400
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
Nu
mb
er
of
Bir
ths
Pe
rce
nta
ge
of
To
tal B
irth
s
Total Births LBW HP 2020 LBW 7.8% VLBW HP 2020 VLBW 1.4%
* Low Birth Weight (LBW) is defined as 1500-2499 g
* Very Low Birth Weight (VLBW) is defined as under 1500g
Source: Birth data: Vital Records office of Santa Barbara County and Vital Statistics Query System - cdph.ca.gov
Highlight: There has been a decrease in births in SBC over time. VLBW appears stable, but LBW has slightly increased in the last two yeas.
SBC met the HP 2020 target for both LWB and VLBW from 2007-2016.
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Percentage of Premature Births, SBC, 2007-2016
Highlight:
Between 2010-2016, SBC met or exceeded the HP 2020 target.
In recent years, the percentage of premature births has trended up locally.
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Pe
rce
nta
ge
of
Pre
ma
ture
Bir
ths
Percentage of Prematurebirths
HP 2020 Target 9.4%
Source: State Birth Statistical Master files, 2007-2016
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Unintended Pregnancies
Highlight:
While the SBC rate is not statistically different than CA, 30% of pregnancies are miss-timed or unwanted.
Mis-timed or unwanted pregnancy per 100 females delivering a
live birth (2013-2015).
SBC Rate: 30.8
CA Rate: 30.5
Source: FHOP Community Health Status Report, 2017
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Births Occurring Within 18 Months of a Previous Live Birth
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
2007 2008 2009 2010 2011 2012 2013 2014 2015
Bir
th R
ate
CA SBC
Highlight:
While the SBC rate is not statistically different than CA, 25% of women are conceiving before the recommended time.
Source: CA Birth Statistical Master File,
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Sexually Transmitted Diseases (STDs)
Highlight:
Chlamydia (CT) remains the most common reportable disease in CA and is at its highest recorded level since 1990.
Gonorrhea (GC) cases continued to increase sharply across all regions.
Early syphilis (ES) cases continued to increase across all regions.
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Syphilis and Congenital Syphilis
Highlight:
Over the last several years, CA has experienced a steep increase in syphilis among women and congenital syphilis
Santa Barbara
County
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Source: MIHA, 2013-2014
Infant Sleep Practices
Highlight:
The percentage of women always or often sharing a bed with an infant is higher in SBC than CA.
Mothers with less formal education share a bed more often than those with higher levels of education.
Mothers enrolled in Medi-Cal share a bed more often than those with private insurance.
44.8%
34.1%
65.1%
30.3%
52.9%
31.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
SBC CA WithoutHigh
SchoolDiploma
Graduatedfrom
College
With Medi-Cal
WithPrivate
Insurance
Percentage of Women Always or Often Sharing a Bed with an Infant
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Uninsured per 100 Females Aged 18-64 Years Old
Highlight:
In 2011, “1 in 4” women were uninsured, whereas in 2015, “1 in 10” women were uninsured in SBC.
In recent years, SBC has statistically been doing worse than CA 0.0
5.0
10.0
15.0
20.0
25.0
30.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Ra
te o
f U
nin
su
red
Fe
ma
les
CA
SBC
HP 2020 Target
Source: Small Area Health Insurance Estimates
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Uninsured per 100 Individuals Aged 0-18
Highlight:
The Affordable Care Act (2014) and SB75 (2016) have significantly impacted the number of SBC children with medical insurance. However, between 2013-2015, SBC was statistically doing worse than CA.
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Ra
te o
f U
nin
su
red
In
div
idu
als
CA
SBC
HP 2020 Target
Source: Small Area Health Insurance Estimates
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Children’s Oral Health (CA vs. SBC) 74.0%
13.0%
4.1%
8.9%
76.3%
22.1%
1.5% 0.0% 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
< 6 months ago 6-12 months ago > 12 months ago Never
Estimated Percentage of Children Ages 2-11, by Length of Time Since Their Last Dental Visit
CA SBC
Highlight:
Of the parents surveyed locally, the majority reported their children saw a dentist less than 6 months ago.
Source: SB Oral Health Needs Assessment (2018) p.16-17
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Children’s Oral Health
646
737
582
477 463
345
0
100
200
300
400
500
600
700
800
2012 2013 2014 2015 2016 2017
Figure 9. Untreated Tooth Decay in Kindergarteners, Santa Barbara County. 2012-2017
Source: SBC Oral Health Needs Assessment (2018) p. 18
Highlight:
In SBC, the number of untreated tooth decay in kindergarteners has generally decreased from 2012 to 2017.
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Dental Access in SBC
Santa Barbara County Residents who qualify and are enrolled in the Medi-Cal program receive dental insurance through the Medi-Cal Dental program.
Santa Barbara County is home to 352 dentists. Out of those dentists, only 20 are accepting new patients.
Highlight:
Medi-cal clients in SBC who need to establish care have limited access.
Source: SBC Oral Health Needs Assessment p. 23
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SBC School Immunization Rates
Highlight:
Vaccination rates have been increasing for children in Childcare Centers and Kindergartens in SBC.
88.17% 87.16% 87.61% 88.02%
89.79% 89.10%
94.60% 95.90%
93.23% 93.63% 92.10% 92.10%
94.40% 94.90% 96.40% 96.50%
80.0%
85.0%
90.0%
95.0%
100.0%
2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19
Percent Fully Vaccinated
Childcare Centers Kindergartens
5.24% 6.04%
5.57% 5.92%
4.76% 4.40%
2.60%
1.20% 3.21% 2.89%
4.27% 4.72%
2.94% 3.60%
0.70% 0.00% 0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19
Percent PBE Students
Childcare Centers Kindergartens
Source: CDPH Immunization Branch
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Childhood Obesity
mid north south
2010 11.32% 14.25% 8.86%
2018 14.3% 15.98% 10.08%
Highlight: There are higher rates of obesity in North and Mid County than South amongst 2-5 year olds enrolled in WIC.
Source: SBC WIC
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Childhood Obesity
Highlight:
Although local percentages for 7th and 9th graders is similar to CA, a greater proportion of SBC 5th graders are overweight/obese compared to their CA peers.
Students Who Are Overweight or Obese, by Grade Level, 2017
Source: Kids Data
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Children and Youth with Special Health Care Needs (CYSHN)
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Intimate Partner Violence
0.0
100.0
200.0
300.0
400.0
500.0
600.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Ra
te o
f D
om
es
tic
Vio
len
ce
Ca
lls
CA SBC
Highlight:
In recent years (2013-2015), SBC’s rate of calls to police for violent or aggressive behavior within the home is statistically better than CA.
However, we are not fully sure what this data may be telling us.
Source: Office of the Attorney General. CA Department of Finance.
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Local Domestic Violence Solutions data on clients receiving shelter services
Highlight: While it is difficult to assess the incidence of domestic violence in SBC, domestic violence solutions has numbers of those receiving emergency services through the shelter system.
Source: 2017 Santa Barbara County Children’s Scorecard
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Intimate Partner Violence
2013-14 MIHA data shows that 10.6% of women in SBC compared to 7.1% of women in CA had some form of physical or psychological intimate partner violence (IPV) during pregnancy.
In FY 17/18, 11% (152/1455) of participants in the MCAH Field Nursing Unit, self-identified with current or history of Intimate Partner Violence.
Highlight:
The percentage of women experiencing some form of physical or psychological intimate partner violence during pregnancy is higher in SBC than CA.
Source: MIHA; 2013-2014 and SBC MCAH Health Indicator Data
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0.0
50.0
100.0
150.0
200.0
250.0
300.0
350.0
400.0
450.0
500.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Ra
te o
f E
D V
isit
s
CA
SBC
HP 2020 Target 461.2
Assault Hospitalizations of Females aged 15-44 years old
Highlight:
In recent years (2013-2015), SBC’s rate of assault hospitalizations for women is statistically better than CA.
However, we are not fully sure what this data may be telling us.
Source: Office of Statewide Health Planning and Development. Hospital Discharge Data.
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Substance Abuse Diagnosis of 15-24 year olds
0.0
200.0
400.0
600.0
800.0
1,000.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Su
bsta
nc
e A
bu
se
D
iag
no
sis
Rate
All 15-24 Year Olds
CA SBC
Highlight:
The rate of substance abuse diagnosis for 15-24 year olds may be better in SBC than CA, but it is increasing locally.
Whites in both SBC and CA have higher rates of substance use diagnosis than Hispanics.
Source: Office of Statewide Health Planning and Development. Hospital Discharge Data.
0.0
200.0
400.0
600.0
800.0
1,000.0
1,200.0
1,400.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Su
bsta
nc
e A
bu
se
D
iag
no
sis
Rate
15-24 Year Olds by Race and Ethnicity
CA White SBC White CA Hispanic SBC Hispanic
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0.0
500.0
1,000.0
1,500.0
2,000.0
2,500.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015Me
nta
l H
ea
lth
Dia
gn
osis
R
ate
15-24 Year Olds by Race and Ethnicity
CA White SBC White CA Hispanic SBC Hispanic
Mental Health Diagnosis of 15-24 Year Olds
0.0
500.0
1,000.0
1,500.0
2,000.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Me
nta
l H
ea
lth
Dia
gn
os
is
Ra
te
All 15-24 Year Olds
CA SBC
Highlight:
While the rate of mental health diagnosis for 15-24 year olds in SBC is better than CA, we are not certain about the meaning of this data.
Source: Office of Statewide Health Planning and Development. Hospital Discharge Data.
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Youth Served by Behavioral Wellness
Highlight: Each year, the SBC Department of Behavioral Wellness serves over 3,000 children and youth diagnosed with severe mental illness and/or substance use disorders.
Numbers have remained steady for mental health programs, while there has been a decrease in youth receiving treatment for severe drug and alcohol disorders. Source: 2017 Santa Barbara County Children’s Scorecard
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Alcohol and Drug Use amongst children/ adolescents
Highlight:
Youth educated in NT settings have a higher reported usage of alcohol and drugs compared to their traditionally educated peers.
Source: 2017 Santa Barbara County Children’s Scorecard
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SBC CWS Referrals
Highlight:
Since 2008, the number of referrals to SBC Child Welfare Services (CWS) has increased, but the percentage of substantiated allegations has decreased.
Children < 1 year old have the highest rate of abuse and neglect.
General Neglect is consistently the number one cause of substantiated cases.
Source: 2017 Santa Barbara County Children’s Scorecard
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Children in Foster Care per 1000 Children Age 0-17
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Ra
te o
f C
hil
dre
n in
Fo
ste
r C
are
CA SBC
Highlight:
The rate of children in foster care is significantly less in recent years than CA.
Source: Office of the Attorney General. CA Department of Finance.
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Adverse Childhood Experiences (ACEs)
Estimated percentage of children ages 0-17 who have
experienced two or more adverse experiences as of their
current age (2016).
SBC: 16.3% percent of children
CA: 16.4% percent of children
Highlight:
1 in 6 Children have experienced two or more ACEs. The rate is not statistically different between CA and SBC.
Source: FHOP Community Health Status Report, 2017
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In Summary Add picture
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Improving Locally
Rate of Mothers Seeking Prenatal Care (overall)
Prevalence of Domestic Violence Calls
Teenage Births
School Immunization Rates
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Better Than CA
Substance Abuse Diagnoses of 15-24 year olds
Substance Abuse Hospitalizations of Pregnant Women
Births Within 18 Months of a Previous Live Birth
Assault Hospitalizations of Females Aged 15-44 Years Old
Prevalence of Domestic Violence Calls
Mental Health Diagnoses of 15-24 Year Olds
Unemployment Rate
Children in Foster Care
Maternal Mortality Rate
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Meeting HP 2020
Percentage of Underweight Births
Infant Mortality
Rate of Mothers Seeking Prenatal Care (Overall)
Assault Hospitalizations of Females Aged 15-44 Years Old
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Worsening Locally
Rate of Uninsured Females Aged 18-64 Years Old
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Worse than CA
Percentage of Women Receiving Prenatal Care in First Trimester (overall)
Teenage Birth Rate
Percentage of Mothers Exclusively Breastfeeding (In-Hospital)
Rate of Cesarean Births from Low Risk Females
Rate of Uninsured Individuals 0-18 Years Old
Rate of Uninsured Females Aged 18-64 Years Old
Poverty Rate of Children and Adolescents
Poverty Rate of Females Aged 18-64 Years Old
Safe Sleep Practices (Bed sharing)
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Not meeting HP 2020
Percentage of Premature Births
Rate of Uninsured Individuals 0-17 Years Old
Rate of Uninsured Females Aged 18-64 Years Old
Rate of Cesarean Births from Low Risk Females
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Results from Stakeholder Survey
25 individuals responded
Sectors represented: State/Local Health Department (28%)
CBOs (20%)
Hospital (16%)
Community Clinic/FQHC (12%)
Family Support Organization (8%)
State of Nationally Affiliated Non-Profit (4%)
Head Start (4%),
Individual or Family (4%)
WIC (4%)
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MCAH Goal 1: Improve maternal* health and increase access to health care. *Women of childbearing age, pregnant, and/or postpartum women
N=25 N=25
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MCAH Goal 2: Improve infant health and increase access to health care.
N=22 N=23
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MCAH Goal 3: Improve child health and increase access to health care.
N=22
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MCAH Goal 4: Improve Children and Youth with Special Health Care Needs* (CYSHCN) health and increase access to health care.
N=20
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MCAH Goal 5: Improve Adolescent health and increase access to health care.
N=20 N=21
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Break (10 min)
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What do we want to do? Santa Barbara County
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Required to address by Title V for 2020-2025
All LHJs must identify at least:
Two problems in the Maternal domain (reproductive age women and pregnant/postpartum women)
Two problems in the Infant domain (one being SIDS)
One problem in the Child domain
One problem in the CYSHCN domain
One problem in the Adolescent domain
If resources allow, LJHJs may also identify additional problems.
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Small Group Breakouts
Break out into 6 groups to discuss key issues, root causes, best practices/interventions, and partner organizations in each domain.
Facilitators will assist each group
Please try to have 4-5 members in each group Reproductive Age Women
Pregnant/Postpartum Women
Infant
Child
CYSHN (Children and Youth with Special Healthcare Needs)
Adolescent
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Next Steps?
Report to State MCAH – Due June 14th, 2019
Stakeholders and Community Partners
Problem Statements, Strategies, and Partners
Capacity Needs
Develop Action Plans – Due March 13th, 2020
Engage partners willing to be involved or collaborate on identified key issues
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Special Thanks
Michelle Wehmer
Mitchell Hee
Ed Tran
Paige Batson
Linda Oh
Judy Savage
Carmen Lemus
Colleen Jensen
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“Alone we can do little, but together we can do much.”
-Helen Keller