Maternal and Child Health Public Health Across the Lifespan October, 2005

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Maternal and Child HealthPublic Health
Acrossthe Lifespan October, 2005

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• Health Resources And Services Administration
• Maternal And Child Health Bureau
• Peter C. Van Dyck, MD, MPH

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MCHB
LEADERSHIP
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The Power of Partnership Goals

• To communicate a shared vision, and to present
  new and critical information relevant to
  performance measurement, policy, program and
  administrative changes
• To generate MCH partners through increased
  awarenessto provide opportunities for working
  together

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The Power of Partnership Goals

• To identify critical issues facing the MCH
  population and opportunities for collaborative
  effort that can move effectively to meet the
  needs of the MCH population

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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

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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)

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MCHB Vision Statement

• MCHB believes in a future America in which the
  right to grow to ones full potential is
  universally assured through attention to the
  comprehensive physical, psychological, and social
  needs of the MCH population. We strive for a
  society where children are wanted and born with
  optimal health, receive quality care, and are
  nurtured lovingly and sensitively as they mature
  into healthy, productive adults.

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MCHB Vision Statement

• The Bureau seeks a Nation where there is equal
  access for all to quality health care in a
  supportive, culturally competent, family and
  community setting.

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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

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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

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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

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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.

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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

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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

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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

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MCH BUREAU
PERFORMANCE
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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
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MCH BUREAU
ACCOUNTABILITY
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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

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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

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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)

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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
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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

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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
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Numbers Served In MCH Block Grant Program, 1997
And 2003
SOURCE TITLE V INFORMATION SYSTEM
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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

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Accountability

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

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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

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MCHB
BUDGET 2006
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The MCH Bureau Authorizing Legislation

• MCH Services Block Grant (Title V, Social
  Security Act)
• Traumatic Brain Injury (Section 1252, Public
  Health Service Act)
• Healthy Start (Title III, Public Health Service
  Act, Section 330H)

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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)

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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

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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

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MCH Budget for 2005, and 2006(millions)
FY2005
2006(PB)
2006(S)
2006(H)

• MCHBG723.9...723.9...710.0.700.0
• State.591.1....601.9..579.1573.0
• SPRANS..102.7....106.2.....102.2101.2
• CISS...14.6...15.8.. 11.7....... 10.8
• Earmark...15.5.....0.0.. 17.0....... 15.0

1-numbers may not add due to rounding
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MCH Budget for 2005, and 2006(millions)
FY2005
2006(PB)
2006(S)
2006(H)

• Healthy Start102.5..97.7104.097.9
• Hearing.... 9.8 .. 0.0... 9.810.0
• EMSC..19.8.0.0 20.019.0
• TBI 9.3..0.0 9.3 9.0
• Sickle Cell .. 0.2.....0.0 0.5 0.0

1-numbers may not add due to rounding
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MCH Budget for 2005, and 2006(millions)
2005
2006(PB)
2006(S)
2006(H)

• SPRANS Earmarks
• Oral Health..4.96 ..0.0..5.0.5.0
• Sickle Cell.3.97...0.0..4.0.4.0
• Epilepsy....2.98...0.0..3.0.3.0
• Genetics.1.98......0.0..2.0.3.0
• Mental Health.1.59...0.0...1.0...0.0
• Fetal Alcohol..-----.-----1.00.0

1-numbers may not add due to rounding
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MCH BUREAU
HISTORY
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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

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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

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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

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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

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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

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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

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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, data and
  evaluation, training strategic plan

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MCH BUREAU
LAW
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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 mortalitypreventable diseases
  and handicapping conditions among
  childrenincrease number of...Immunized
  children

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The MCH Block Grant (Title V) States Program
501(a)(1)(a-d)

• To increase low income children receiving health
  assessments anddiagnosis and treatment services
• Promote healthby providing prenatal, delivery,
  and postpartum care
• Promote health of children by providing
  preventive and primary care services

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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 extentit is not provided
  under Title XIX
• To provide and promote family-centered,
  community-based, coordinated carefor children
  with special health care needsand facilitate
  community based systems of services for such
  children and their families

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Contact
Peter C. van Dyck, M.D., M.P.H. HRSA/MCHB http/
/mchb.hrsa.gov/