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Maternal and Child Health Historical Perspective of Maternal and Child Health October, 2007

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Title: Maternal and Child Health Historical Perspective of Maternal and Child Health October, 2007


1
Maternal and Child Health Historical
Perspective of Maternal and Child Health
October, 2007
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  • Health Resources And Services Administration
  • Maternal And Child Health Bureau
  • Peter C. Van Dyck, MD, MPH

2
MCHB
LEADERSHIP
3
MCHB Strategic Plan Mission
  • To provide national leadership and to work, in
    partnership with states, communities,
    public-private partners, and families to
    strengthen the MCH infrastructure, assure the
    availability and use of medical homes, and build
    the knowledge and human resources, in order to
    assure continued improvement in the health,
    safety and well-being of the MCH population

4
MCHB Strategic Plan Mission
  • The MCH population includes all Americas women,
    infants, children, adolescents and their
    families, including women of reproductive age,
    fathers, and children with special health care
    needs(CSHCN)

5
MCHB Values Statement
  • To achieve its mission, the Bureau relies on
    personal, population-based, systems and resource
    building approaches to promote the health,
    safety, and well being of the Nations MCH
    population. Bureau efforts are driven by a
    commitment to the following values

6
MCHB Values Statement
  • Affordable and accessible high quality care for
    all
  • Accountable, regularly monitored and evaluated
    evidence-based quality care
  • Preventive, protective health care that address
    individuals physical, psychological, and social
    needs

7
MCHB Values Statement
  • Comprehensive, coordinated care in medical homes
    that includes direct and enabling services
  • Consumer-oriented, family-centered and
    culturally-competent care linked to community
    services
  • Continually improving health care based on
    research, evaluation, training/education,
    technical assistance, and the dissemination of
    up-to-date information

8
MCHB Strategic Plan Goals
  • Provide National Leadership for Maternal and
    Child Health by creating a shared vision and
    goals for MCH, informing the public about MCH
    needs and issues, modeling new approaches to
    strengthen MCH, forging strong collaborative
    partnerships, and fostering a respectful
    environment that supports creativity, action, and
    accountability for MCH issues.

9
MCHB Strategic Plan Goals
  • Eliminate health disparities in health status
    outcomes, through the removal of economic, social
    and cultural barriers to receiving comprehensive
    timely and appropriate health care

10
MCHB Strategic Plan Goals
  • To assure the highest quality of care through the
    development of practice guidance, data
    monitoring, and evaluation tools the utilization
    of evidence-based research and the availability
    of a well-trained, culturally diverse workforce

11
MCHB Strategic Plan Goals
  • To facilitate access to care through the
    development and improvement of the MCH health
    infrastructure and systems of care to enhance the
    provision of the necessary coordinated, quality
    health care

12
MCH BUREAU
PERFORMANCE
13
CORE PUBLIC HEALTH SERVICES DELIVERED BY
MCH AGENCIES
DIRECT HEALTH CARE SERVICES (GAP
FILLING) Examples Basic Health Services and
Health Services for CSHCN
MCH
EPSDT
CHC
SCHIP
ENABLING SERVICES Examples Transportation,
Translation, Outreach, Respite Care, Health
Education, Family Support Services, Purchase
of Health Insurance, Case Management,
Coordination with Medicaid, WIC and Education
POPULATION--BASED SERVICES Examples Newborn
Screening, Lead Screening, Immunization, Sudden
Infant Death Counseling, 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
14
MCH Bureau Performance Measurement System
MCHB PROGRAM AND RESOURCE ALLOCATION
MCHB PERFORMANCE MEASURES
MCHB OUTCOME MEASURES
MCHB PRIORITIES AND GOALS
MCHB NEEDS ASSESSMENT HEALTH STATUS INDICATORS
PERINATAL MORTALITY
STATE BLOCK GRANT
STATE/ NATIONAL INDICATORS
I. DECREASE DISPARITIES
INFANT MORTALITY
DIRECT HEALTH
SPRANS
HEALTHY PEOPLE 2010
NEONATAL MORTALITY
ENABLING SERVICES
II. INCREASE QUALITY
HEALTHY START
POSTNEONATAL MORTALITY
LEGISLATIVE PRIORITIES
POPULATION BASED
EMERGENCY SERVICES FOR CHILDREN
CHILD MORTALITY
III. IMPROVE INFRASTRUCTURE
PARTNERSHIPS INPUT
TRAUMATIC BRAIN INJURY
INFRASTRUCTURE SERVICES
INFANT DEATH DISPARITY
15
Discretionary Grants--Levels of Performance Data
  • Standardized family of 30-35 national performance
    measures
  • Set of standardized forms similar to those in the
    block grant
  • Minimal data set for each Division beyond that in
    performance measures
  • Selected grantee performance measures from large
    grantee programs
  • Otheradministrative or leadership data
  • Standardized application and guidance

16
Title V SPRANS Performance Measurement System
SPRANS PROGRAM AND RESOURCE ALLOCATION
SPRANS PERFORMANCE MEASURES
SPRANS OUTCOME MEASURES
SPRANS PRIORITIES AND GOALS
SPRANS NEEDS ASSESSMENT HEALTH STATUS INDICATORS
PERINATAL MORTALITY
DSCSHCN
STATE/ NATIONAL INDICATORS
I. DECREASE DISPARITIES
INFANT MORTALITY
DIRECT HEALTH
DCAFH
HEALTHY PEOPLE 2010
NEONATAL MORTALITY
ENABLING SERVICES
DRTE
II. INCREASE QUALITY
POSTNEONATAL MORTALITY
DPSWH
LEGISLATIVE PRIORITIES
POPULATION BASED
CHILD MORTALITY
DSCH
III. IMPROVE INFRASTRUCTURE
PARTNERSHIPS INPUT
INFRASTRUCTURE SERVICES
ODIM
INFANT DEATH DISPARITY
17
Numbers Served In MCH Block Grant Program, 1997
And 2003
SOURCE TITLE V INFORMATION SYSTEM
18
Numbers Served In MCH Block Grant Program, 1997
And 2004
SOURCE TITLE V INFORMATION SYSTEM
19
Numbers Served In MCH Block Grant Program, 1997
And 2005
SOURCE TITLE V INFORMATION SYSTEM
20
MCH BUREAU
ACCOUNTABILITY
21
MCHB Program Strengths
  • Genuine partnership between Federal government,
    states, and communities
  • Statement of priorities consistent with the
    Healthy People 2000 and 2010 goals
  • Commitment to both Federal and State financing
    evidenced by match of 4 Federal to 3 State
    dollars

22
MCHB Program Strengths
  • 5 year needs assessment planning
  • Framework that targets states expenditures to
    the entire MCH population--infants, children,
    adolescents, women, pregnant women, CSHCN
  • Flexibility for States to tailor programs
  • Commitment for coordination with all other major
    childrens programs--idea, WIC, Medicaid, SCHIP,
    nutrition, Headstart, early intervention

23
MCHB Program Strengths
  • Special Federal project grant authorities
  • SPRANS--enhance major purposes of State formula
    grants

    (15 set aside of the total Title V
    appropriation)
  • CISS--enhance State and local communities ability
    to increase the comprehensiveness of local
    service delivery systems

    (12 3/4 set aside of the total Title V
    appropriation over 600 million)

24
Accountability
  • Face-to-face reviews with Federal staff, outside
    experts, and State staff
  • An extensive narrative description of State MCH
    services with special attention to each
    performance and outcome measure
  • Completion of a set of program and financial data
    tables

25
Accountability
  • Budget and expenditures for the four levels of
    the pyramid
  • Progress towards successful achievement of
    performance measures
  • Positive impact on the outcome measures

26
Accountability
  • Implementation of the electronic reporting
    package (ERP) with which all States must report
  • Sharing of data with States and other
    constituencies
  • Preparation of special data reports
  • Timely data on the internet

27
MCHB
BUDGET 2008
28
The MCH Bureau Authorizing Legislation
  • MCH Services Block Grant (Title V, Social
    Security Act)
  • Traumatic Brain Injury (Section 1252 and 1253
    Public Health Service Act)
  • Healthy Start (Title III, Public Health Service
    Act, Section 330H)

29
The MCH Bureau Authorizing Legislation
  • Emergency Medical Services Children (Section
    1910, Public Health Service Act)
  • Newborn Hearing Screening (Title III, Public
    Health Service Act, Section 399M)

30
The MCH Bureau Authorizing Legislation
  • Sickle Cell Service Demonstration Program
    (Section 712(c) of the American Jobs Creation Act
    of 2004)
  • Family to Family Health Information Centers
    (Section 501(c)(1)(A) of the Social Security Act)

31
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

32
MCH Formula and Allocation
  • The amounts appropriated for States are allocated
    as follows
  • Funds appropriated up to 422,050,000 are
    distributed on the basis of the amount awarded in
    FY 1983
  • Above 422,050,000 are distributed on the basis
    of the number of low-income children (under 18)
    in each State in relation to the total number of
    such children nationally

33
MCH Budget for 2007 and 2008(PB), (H), and
(S)(millions)
FY2007
2008(PB)
2008(H)
2008(S)
  • 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

1-numbers may not add due to rounding
34
MCH Budget for 2007 and 2008(PB), (H), and
(S)(millions)
FY2007
2008(PB)
2008(H)
2008(S)
  • 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

1-numbers may not add due to rounding
35
MCH Budget for 2007 and 2008(PB), (H), and
(S)(millions)
2007
2008(PB)
2008(H)
2008(S)
  • 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…….-----

1-numbers may not add due to rounding
36
MCH BUREAU
HISTORY
37
The MCH Block Grant (Title V) history
  • 1912--Creation of the Childrens Bureau
  • to investigate and report on the status of
    children and on their common as well as special
    needs
  • 1913Prenatal Care published
  • 1914Infant Care published
  • 1921--Sheppard-Towner Act
  • First federal grant-in-aid program to States for
    health, to promote the welfare and hygiene of
    maternity and infancy
  • 1930American Academy of Pediatrics

38
The MCH Block Grant (Title V) history
  • 1935--Title V of the Social Security Act
  • Grants-in-aid to States for MCH programs,
    services for crippled children, and child welfare
    services
  • 1943Autism is officially described by Dr. Leo
    Kanner
  • 1950disposable diapers are invented by Marion
    Donovan

39
The MCH Block Grant (Title V) history
  • 1957Mental retardation programs
  • Congress earmarked 1M for demonstration clinical
    programs for children with mental retardation
  • 1962St. Judes founded by Danny Thomas
  • 1963-5MIC and C Y programs
  • Three new grants NICU, family planning, dental
    care
  • 1968electronic fetal monitoring first used
  • 1969--Administration transferred to the Public
    Health Service

40
The MCH Block Grant (Title V) history
  • 1981 (OBRA 81)--Converted Title V to a block
    grant by combining seven categorical programs
  • MCH/CSHCN
  • SSI
  • Lead screening
  • Genetic diseases
  • SIDS counseling programs OBRA 81
  • Hemophilia treatment centers
  • Adolescent program grant

41
(No Transcript)
42
The MCH Block Grant (Title V) history
  • 1982Prenatal test for sickle cell disease
  • 1984Emergency medical services for children
    enacted
  • 1989 (OBRA 89)--Introduced major changes
  • Application with needs assessment and priorities
  • Measurable objectives
  • Budget accountability
  • Documentation of match
  • Maintenance of effort

43
The MCH Block Grant (Title V) history
  • 1991Healthy start enacted
  • 1996Abstinence education program begun
  • 2000Performance measures, CSHCN survey,
    www.mchdata.net, newborn screening, abstinence,
    poison control, bioterrorism

44
The MCH Block Grant (Title V) history
  • 2004Performance measures, CSHCN survey, child
    health survey, anti-bullying campaign, early
    childhood, newborn screening, womens health,
    discretionary grants reporting system(DGIS), data
    and evaluation, training strategic plan

45
The MCH Block Grant (Title V) history
  • 2006Childrens and CSHCNs survey reports and
    special publications, MCH strategic plan
    revision, MCHB survey websites, MCH history web
    site, womens health grants

46
MCH BUREAU
LAW
47
The MCH Block Grant (Title V) States Program
501(a)(1)(a-d)
  • Title V authorizes appropriations to states to
    improve the health of all mothers and children
  • To provide and assure mothers and children...
    Access to quality maternal and child health
    services
  • To reduce infant mortality…preventable diseases
    and handicapping conditions among
    children…increase number of...Immunized
    children…

48
The MCH Block Grant (Title V) States Program
501(a)(1)(a-d)
  • To increase low income children receiving health
    assessments and…diagnosis and treatment services
  • Promote health…by providing prenatal, delivery,
    and postpartum care…
  • Promote health of children by providing
    preventive and primary care services…

49
The MCH Block Grant (Title V) States Program
501(a)(1)(a-d)
  • To provide rehabilitation services for blind and
    disabled individuals under 16 receiving benefits
    under Title XVI, to the extent…it is not provided
    under Title XIX
  • To provide and promote family-centered,
    community-based, coordinated care…for children
    with special health care needs…and facilitate…
    community based systems of services for such
    children and their families

50
The MCH Block Grant (Title V) SPRANS
501(a)(2)
  • To provide for SPRANS, research, and training
    for MCH and CSHCN, for genetic disease testing,
    counseling, and information development and
    dissemination programs, for grants (including
    funding for comprehensive hemophilia diagnostic
    treatment centers) relating to hemophilia without
    regard to age, and for the screening of newborns
    for sickle cell anemia, and other genetic
    disorders and follow-up services

51
The MCH Block Grant (Title V) CISS
501(a)(3)
  • To provide for maternal and infant health home
    visiting programs
  • Increase participation of obstetricians and
    pediatricians under Title V and Title XIX

52
The MCH Block Grant (Title V) CISS
501(a)(3)
  • Develop integrated MCH delivery systems and use
    the model application form
  • Develop MCH centers which provide prenatal,
    delivery, and postpartum care for pregnant women
    and preventive and primary care services for
    infants up to age one

53
The MCH Block Grant (Title V) CISS
501(a)(3)
  • Develop MCH projects to serve rural populations
  • Develop outpatient and community based services
    programs (including day care centers) for CSHCN
    whose medical services are provided primarily
    through inpatient institutional care

54
The MCH Block Grant (Title V) Restrictions
504(b)(1-5)
  • cannot pay for inpatient services, other than
    for services to CSHCN or to high-risk pregnant
    women and infants
  • cannot make cash payments to intended recipients
    of health services

55
The MCH Block Grant (Title V) Restrictions
504(b)(1-5)
  • cannot purchase or improve land, buildings, or
    other major medical equipment
  • cannot use for satisfying the requirement for
    expenditure of non-federal funds
  • cannot pay for research or training other than
    to a public or nonprofit private entity

56
The MCH Block Grant The State Shall
505(a)(5)(A,D,E)
  • establish a fair method for allocating funds
    among such individuals, areas, and localities who
    need MCH services
  • apply guidelines for content of health care
    assessments and services and for assuring their
    quality

57
The MCH Block Grant The State Shall
505(a)(5)(A,D,E)
  • assure charges, if imposed, will be public, are
    not for low income mothers and children, and will
    be adjusted to reflect income, resources, and
    family size
  • provide for a toll-free hotline for use of
    parents to access information about providers for
    Title V and XIX and about other relevant health
    care providers

58
The MCH Block Grant The State Shall
505(a)(5)(F)(i-iv)
  • coordinate activities with EPSDT including
    periodicity and content standards and ensure no
    duplication
  • arrange and carry out coordination agreements for
    care and services with Title XIX

59
The MCH Block Grant The State Shall
505(a)(5)(F)(i-iv)
  • coordinate activities with other related
    Federal programs--WIC, education, other health,
    developmental disability, and family planning
  • provide for services to identify pregnant women
    and infants eligible for Medicaid and assist them
    in applying for assistance

60
The MCH Block Grant The State Shall
505(a)(5)(F)
  • make the application public within the State to
    facilitate comment from any person (including any
    Federal or other public agency) during its
    development and after its development

61
The MCH Block Grant Administration 509(b)
  • The State health agency shall be responsible for
    the administration (or supervision of the
    administration) of programs carried out under
    this Title, except that for a State which on July
    1, 1967, administered CSHCN by another Sate
    agency, it still complies

62
(No Transcript)
63
Contact
Peter C. van Dyck, M.D., M.P.H. HRSA/MCHB http/
/mchb.hrsa.gov/
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