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Annual Meeting of Association of State and Territorial Public Health Nutrition Directors June, 2007

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Title: Annual Meeting of Association of State and Territorial Public Health Nutrition Directors June, 2007


1
Annual MeetingofAssociation of State and
Territorial Public Health Nutrition
DirectorsJune, 2007
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  • Peter C. van Dyck, MD, MPH
  • Associate Administrator for Maternal and Child
    Health

2
MCHB
BUDGET 2008
3
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

4
MCH Budget for 2005, 2006, 2007, and
2008(PB)(millions)
FY2005
2006
2007
2008(PB)
  • MCHBG723.9....692.5.693.0.693.0
  • State.591.0....566.1..566.5...578.9
  • SPRANS..102.7......99.9....99.9102.2
  • CISS...14.6.10.6...10.611.9
  • Earmark...15.5.15.9.16.0------

1-numbers may not add due to rounding
5
MCH Budget for 2005, 2006, 2007, and
2008(PB)(millions)
FY2005
2006
2007
2008(PB)
  • Healthy Start102.5101.4101.5.100.5
  • Hearing...9.8 ..9.8.9.8..-----
  • EMSC..19.8.19.8..19.8..-----
  • TBI..9.3..8.9...8.9...-----
  • Sickle Cell...0.22.2...2.22.2
  • Family to Family..0...0.0...3.0..4.0

1-numbers may not add due to rounding
6
MCH Budget for 2005, 2006, 2007, and
2008(PB)(millions)
2005
2006
2007
2008(PB)
  • SPRANS Earmarks
  • Oral Health..4.96...4.804.800.0
  • Sickle Cell.3.97...3.843.840.0
  • Epilepsy....2.98...2.882.880.0
  • Genetics.1.98...1.92..1.920.0
  • Mental Health.1.59...1.54...1.540.0
  • Fetal Alcohol..----..0.99..0.99.0.0

1-numbers may not add due to rounding
7
Numbers Served In MCH Block Grant Program, 1997
And 2005
SOURCE TITLE V INFORMATION SYSTEM
8
MCH Bureau
DATA
9
Most Common Needs Identified in 2005 Preliminary
Findings
Priority Need Number of States 2005 vs 2000
Healthy lifestyles ? 44 vs 21
Health improvement Access to health care ? 37 vs 36
Oral health improvement Access to oral health care ? 34 vs 33
Injury prevention ß 33 vs 41
Mental health improvement Access to mental health care ? 27 vs 14
10
Most Common Needs Identified in 2005 Preliminary
Findings
Priority Need Number of States 2005 vs 2000
Medical home / care coordination ? 27 vs 17
Legal and illegal substance use ß 26 vs 34
Pregnancy outcomes ß 26 vs 28
Disparity reduction ß 26 vs 28
Pregnancy, fertility, birth rates ß 25 vs 35
Prenatal, preconceptional, interconceptional care ? 21 vs 19
11
Most Common Needs Identified in 2005 Preliminary
Findings
Healthy Lifestyles
  • 44 States in 2005 vs 21 in 2000
  • Healthy lifestyles - general
  • Reduce obesity and overweight
  • 25 States vs 10 States
  • Promote nutrition and/or exercise
  • 17 States vs 7 States

12
18 National Performance Measures
  • 11) The percent of mothers who breastfeed their
    infants at 6 months of age. (Revised in 2006
    from The percent of mothers who breastfeed their
    infants at hospital discharge.)
  • 14) Percentage of children, ages 2 to 5 years,
    receiving WIC services with a Body Mass Index
    (BMI) at or above the 85th percentile. (New
    performance measure beginning in 2006.)

13
The 37 Discretionary Performance Measures
  • 08) Percent of graduates of MCHB long-term
    training programs that demonstrate field
    leadership after graduation
  • 33) The degree to which a State system for
    nutrition services has been established for MCH
    populations

14
State Performance Measures Keyword Search
  • Nutrition/Physical Activity
  • 50 States with 84 Performance Measures
  • In 2000, 41 States with 60 Performance Measures
  • Obesity
  • 39 States with 48 Performance Measures
  • In 2000, a total of 20 State Performance Measures
    related to overweight/obesity in children and
    adolescents (no keyword search for obesity).

15
NPM 11
16
NPM 14
17
The National Survey of Childrens Health (NSCH)
  • Survey Questions
  • Height and Weight
  • Food allergy or digestive problem
  • Breast feeding (0-5)
  • How concerned are you about eating disorders
    (6-17)

18
The National Survey of Childrens 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

19
The Childrens Health Survey
AK
HI
20
The Childrens Health Survey
AK
AK
HI
HI
21
Breastfeeding Legislation in the U.S.by State
Breastfeeding Initiation Breastfeeding at Six Months
No Law in 2003 63.72 32.11
First Law between 1999 and 2003 69.28 35.82
Single Law before 1999 69.59 36.48
Multiple Laws before 1999 76.22 42.37
(from www.lalecheleague.org)
22
The National Survey of Childrens Health
23
Highlights from the National Survey of
Childrens Health
  • Overall, 84.1 percent of children are reported to
    be reported to be in excellent or very good
    health.
  • The NSCH found that 14.8 percent of 10- to
    17-year olds are considered overweight using
    parent-reported height and weight.
  • Males are more likely than females to be
    overweight.
  • Levels of physical activity and sports
    participation appear to be linked to overweight
    in children. Parental exercise also appears to
    be related.

24
Highlights from the National Childrens Health
Survey
  • As family income rises, overweight falls.
  • The occurrence of overweight declines with age
    (21.9 percent of 10- to 11-year olds compared to
    10.7 percent of 15- to 17-year olds.
  • Rural children are more likely to exercise
    regularly than children in urban areas.
  • Children in both large and small rural areas are
    significantly less likely to be breastfed for at
    least 6 months.

25
MCH Bureau
NUTRITION STRATEGIC PLAN
26
Nutrition Strategic Plan
  • Framework for cross-division collaboration and
    coordination in developing and implementing
    nutrition and breastfeeding activities in MCHB.
  • 5-year plan (FY 2002-2006)
  • Plan to be updated for FY 2007-2011

27
MCHB Cross-Division Nutrition Committee
  • MCHB Nutrition Strategic Plan focuses on four
    major areas
  • Breastfeeding Promotion and Support
  • Overweight/Obesity Prevention and Healthy
    Lifestyle Promotion
  • Public Health Nutrition Leadership and Training
  • Coordination and Collaboration with Federal,
    State and Local Partners

28
MCHB Cross-Division Nutrition Committee
  • MCHB Nutrition Strategic Plan focuses on four
    major areas
  • Breastfeeding Promotion and Support

29
Breastfeeding Support
  • Systems Support
  • Liaison to the U.S. Breastfeeding Committee
  • Strategic Plan for Breastfeeding in the U.S.
  • National Breastfeeding Coalition Workshop (2008)
  • Provider Support
  • Academy of Breastfeeding Medicine
  • Development of protocols and support for annual
    meeting.

30
Breastfeeding Provider Support
  • AAP Breastfeeding Promotion in Physicians Office
    Practices (BPPOP) Project Ending Summer 2007
  • Focused on educating and supporting future and
    practicing physicians and health care
    professionals in culturally effective
    breastfeeding promotion and support directed at
    achievement of Healthy People 2010 goals.
  • Developed breastfeeding curriculum for medical
    residency training programs, which has been
    tested and is currently undergoing evaluation.
  • http//www.aap.org/advocacy/bf/bppopIII.htm

31
Breastfeeding Support
  • Worksite Support
  • New HRSA resource kit developed to improve
    lactation support in the workplace.
  • Goals are to 1) increase awareness among
    employers of the economic benefits of
    breastfeeding 2) outline manageable and flexible
    models for implementing or enhancing a worksite
    breastfeeding support program, and 3) increase
    the number of U.S. employers that utilize a
    worksite breastfeeding support program.

32
Breastfeeding Worksite Support
  • (in process)
  • Resource Kit for
  • Employers
  • Human Resource Managers
  • Lactation Consultants
  • Employees

DRAFT
33
Breastfeeding Worksite Support

34
Proposed Resource Kit Components
  • An outreach marketing guide for advocates.
  • Return on investment other key considerations
    for employers.
  • General steps to building a lactation support
    program for workplace managers.
  • Template documents.
  • An employees guide to breastfeeding working.

35
MCHB Cross-Division Nutrition Committee
  • MCHB Nutrition Strategic Plan focuses on four
    major areas
  • Breastfeeding Promotion and Support
  • Overweight/Obesity Prevention and Healthy
    Lifestyle Promotion

36
Overweight and Obesity
  • May 2006 workshop convened by NRC and IOM, NAS
  • Report (released in February 2007) summarizes
    research discussed and reviews U.S. trends in
    maternal weight prior to, during and after
    pregnancy among different populations of women.

37
Influence of Pregnancy Weight on MCH
  • Workshop presentations indicated that almost 30
    percent of women of childbearing age are obese,
    and the prevalence of obesity is higher among
    Mexican American and non-Hispanic black women.
  • Over 15 percent of adolescent girls are
    overweight, with higher prevalence rates among
    non-Hispanic black adolescents.
  • Based on limited data from 1983-2004,
    prepregnancy underweight declined, while the
    prevalence of prepregnancy overweight increased.
  • Only about one-third of women gain within the
    1990 IOM-specified ranges during their
    pregnancies.

38
Influence of Pregnancy Weight on MCH
  • Past efforts to advise women on weight for
    pregnancy (before, during and after) focused
    primarily on insufficient gestational weight
    gains and concerns about low birth weight.
  • Data are limited on the individual, psychosocial,
    community-based , and health care and health care
    system factors that may help women comply with
    recommended weight and gestational weight
    guidelines during and after pregnancy.
  • Key social predictors of gestational weight gain
    include smoking, SES, education, use of illegal
    substances, diet, physical activity, unintended
    pregnancy, domestic violence, eating disorders,
    and provider advice.

39
Influence of Pregnancy Weight on MCH
  • Key Messages
  • Absence of Adequate Data Systems - no national
    surveillance system exists to adequately monitor
    maternal weight prior to, during and after
    pregnancy. There is a need for improved data
    collection systems to monitor maternal weight and
    weight gain during pregnancy. When race/ethnicity
    is considered in the literature, major groups
    (e.g., Asian, American Indian and Hispanic
    groups) are underrepresented.

40
Influence of Pregnancy Weight on MCH
  • Key Messages (continued)
  • Recognize Research Advances as well as Gaps
    Differentiate among diverse components of
    gestational weight gain and patterns and timing
    of weight gain. New data on predictors of
    gestational weight gain remain limited in scope.
    There is a need to consider important sub-groups
    (e.g., racial/ethnic groups, women who are obese
    prior to pregnancy, and adolescents.)

41
Influence of Pregnancy Weight on MCH
  • Key Messages (continued)
  • Achieve and Maintain Appropriate Weight Gain Few
    studies can be found in the literature that
    describe interventions for achieving appropriate
    weight before, during and after pregnancy. The
    impacts of pre-pregnancy and post-partum weight
    patterns on maternal and child health outcomes
    need to be explored.

42
Influence of Pregnancy Weight on MCH
  • Key Messages (continued)
  • Update 1990 Recommendations most commonly
    expressed view at the workshop was that the 1990
    recommendations need to be updated, specifically
    for obese women and adolescents. Any effort to
    update the recommendations should strive to link
    new recommendations directly to specific, and
    more diverse, pregnancy outcomes. The changing
    demographics (age, race and ethnicity) of the
    childbearing population also need to be
    recognized.

43
Child and Adolescent Overweight and Obesity
  • Expert Panel Convened in February 2005 to Develop
    Recommendations for the Prevention, Assessment,
    and Treatment of Child and Adolescent
    Overweight/Obesity (AMA in
    collaboration with HRSA and CDC)
  • Committees recommendations will be released in
    Pediatrics Journal supplement in 2007.

44
National Business Group on Health
  • MCHB nutrition staff serve on the Obesity
    Institute, an initiative that encourages members
    to
  • Network with other corporate leaders to raise
    awareness about the health and cost consequences
    of obesity.
  • Identify and test solutions to obesity that have
    a positive return on investment.
  • Advance health plans and vendors efforts to
    implement solutions.

45
National Business Group on Health
  • With MCHB support, developed An Employer Toolkit
    for Addressing Overweight Among Employees and
    Their Children.
  • Toolkit includes
  • Issue Brief
  • PowerPoint Presentation
  • Family Fact Sheets
  • Tip Sheets

46
Overweight and Obesity
  • MCHB Nutrition Strategic Plan supports the
    funding of interdisciplinary training for health
    providers working as a team to
  • 1) treat pediatric overweight/obesity
  • 2) develop intervention/prevention programs.
    (motivational interviewing techniques)
  • (Funding support provided to the University of
    Alabama at Birmingham and University of
    Minnesota.)

47
Innovative Approaches To Promoting a Healthy
Weight in Women
  • Purpose
  • to develop creative, innovative approaches that
    are effective in reducing the prevalence of
    overweight/obesity in women.
  • Efforts must target women in communities with
    limited access to preventive health services,
    particularly women of color, who are
    disproportionately affected by this risk factor.

48
Innovative Approaches to Promoting a Healthy
Weight in Women
  • Approaches must be substantive in nature and
    incorporate nutrition, physical activity and
    health/wellness components.
  • Must also link women, when appropriate, with
    Title V/other relevant services to provide
    comprehensive care.

49
Innovative Approaches to Promoting a Healthy
Weight in Women
  • 12 Grantees have been funded, beginning in
    September 2004 for approximately 150,000/year
    for 3 years
  • Texas State University, San Marcos, TX
  • NorthEast Ohio Neighborhood Health Services
    (NEON), Cleveland, OH
  • Holyoke Health Center, Holyoke, MA

50
Innovative Approaches To Promoting a Healthy
Weight in Women
  • Funded May 2005
  • Mariposa Community Health Center, Nogales, AZ
  • Orange County Health Department, Orlando, FL
  • Bad River Band of Lake Superior Chippewa Indians,
    Odanah, WI
  • Christiana Care Health Services, Inc.,
    Wilmington, DE
  • Funded August 2006
  • Southeast Alaska Regional Health Consortium,
    Sitka, AK
  • White Mountain Apache Tribe, Whiteriver, AZ
  • University of Michigan, School of Social Work,
    Ann Arbor, MI
  • Spectrum Health Hospitals, Grand Rapids, MI
  • Erie Family Health Center, Inc., Chicago, IL

51
Innovative Approaches To Promoting a Healthy
Weight in Women
  • Key commonalities/strengths among the first seven
    grantees
  • Culturally appropriate interventions
  • Accessible times and locations
  • Provision of practical health/physical activity
    information
  • Innovative program design
  • Rewards for enrollment/participation
  • Defining success

52
Innovative Approaches To Promoting a Healthy
Weight in Women
  • Common Threads
  • Importance of social support
  • Provision of child care
  • Increased number of exercise sessions (at the
    request of participants)
  • Screening for risk of depression

53
DEPRESSION DURING AND AFTER PREGNANCY A Resource
for Women, Their Families and Friends
www.mchb.hrsa.gov/pregnancyandbeyond/depression
54
Healthy Tomorrows Partnership for Children Program
  • Promotes child health by encouraging communities
    to
  • Enhance prevention programs and
  • Make health care for every child more accessible.
  • A total of 136 projects have been funded in 44
    States, D.C. and Puerto Rico.
  • 11 innovative, community-based grants awarded in
    2007 which focus on child health issues, such as
    obesity prevention, healthy lifestyle and
    physical activity.

55
MCHB Cross-Division Nutrition Committee
  • MCHB Nutrition Strategic Plan focuses on four
    major areas
  • Breastfeeding Promotion and Support
  • Overweight/Obesity Prevention and Healthy
    Lifestyle Promotion
  • Public Health Nutrition Leadership and Training

56
MCH Nutrition Leadership
  • Development of a National Nutrition Blueprint for
    Action (Collaborated with NIH and CDC)
  • Blueprint for Action. Nutrition and Physical
    Activity Cornerstones of a Healthy Lifestyle
  • Stakeholder consensus document that brings focus
    and urgency to critical goals and strategies that
    will frame nutrition and physical activity for
    the future.

57
BLUEPRINT FOR ACTION Nutrition and Physical
Activity Cornerstones of a Healthy Lifestyle
  • Umbrella document that can be adapted to
    reflect local and state needs
  • Document to use at all levels to educate decision
    makers on priority actions.
  • Document that fosters collaborative efforts for
    maximizing impact with existing resources.
  • ASTPHND implementation through sub-grants.

58
The Maternal and Child Health Training Program
  • Supports Nutrition Discipline Training in
  • Public Health
  • Pediatrics
  • FY 2007 Profile
  • Fund 7 MCH Centers of Excellence in Nutrition
  • Grant Awards Range from 120,000 to 210,000 Per
    Year

59
The Maternal and Child Health Training Program
  • Strategic Plan Goals for Training Program
  • MCH Competencies
  • Assure a workforce that possesses the knowledge,
    skills, and attitudes to meet unique MCH
    population needs.
  • Workforce Diversity
  • Prepare and support a diverse MCH workforce that
    is culturally competent and family centered.
  • Ensuring Interdisciplinary Training
  • Improve practice through interdisciplinary
    training in MCH.

60
The Maternal and Child Health Training Program
(cont)
  • MCH Leaders
  • Develop effective MCH leaders.
  • Leadership competencies have been developed
  • Knowledge to Practice
  • Generate, translate, and integrate new knowledge
    to enhance MCH training, inform policy, and
    improve health outcomes.
  • Collaborating with Others 
  • Develop broad-based support for MCH training
  • Nutrition Training Grantees have a collaborative
    project around overweight/obesity. (Website)

61
Coming SoonOctober
  • First complete revision
  • Includes CSHCN
  • Accompanied by Toolkit for
  • clinical implementation
  • Transparency of evidence-base
  • One set of guidelines for health
  • promotion and prevention
  • Replaces AAP guidelines
  • AMA GAPS

Bright Futures and MCHB solicit your ideas for
tools/strategies to facilitate public health
implementation cdegraw_at_hrsa.gov brightfutures_at_aa
p.org
62
Bright Futures Nutrition III
  • Third edition of Bright Futures in Practice
    Nutrition is under development. Update is
    supported through the Cooperative Agreement with
    AAP.
  • Document is expected to be released in 2008.

63
MCHB Cross-Division Nutrition Committee
  • MCHB Nutrition Strategic Plan focuses on four
    major areas
  • Breastfeeding Promotion and Support
  • Overweight/Obesity Prevention and Healthy
    Lifestyle Promotion
  • Public Health Nutrition Leadership and Training
  • Coordination and Collaboration with Federal,
    State and Local Partners

64
MCH BUREAU
MCHB TIMELINE
65
www.mchb.hrsa.gov/timeline
66
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

67
MCH Timeline- Historical Markers
68
(No Transcript)
69
How Can I Use this Site?
  • Orientation for new faculty
  • Orientation for new trainees
  • Preparation for Speaking to Community Groups
  • Personal Rejuvenation and Inspiration

70
MCH Timeline-Planned Features
  • Links to Interviews of MCH Leaders
  • Links to Historical documents from the MCH
    Library
  • New In depth ModulesGenetics

71
Important Information
  • Title V Information System
  • https//performance.hrsa.gov/mchb/mchreports
  • National Survey of Childrens Health
  • http//www.cdc.gov/nchs/about/major/slaits/nsch.ht
    m
  • CSHCN survey easy web site
  • www.cshcndata.org
  • MCH Training Program
  • http//www.mchb.hrsa.gov/training
  • HRSAs Bullying Campaign
  • http//Stopbullyingnow.hrsa.gov

72
Contact
Peter van Dyck, M.D., M.P.H. HRSA/MCHB http//mc
hb.hrsa.gov/
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