Title: MCH EPIDEMIOLOGY: LESSONS LEARNED FROM CDCHRSA MCHEP AND UNIVERSITY OF ILLINOIS ENHANCED ANALYTIC SK
1MCH EPIDEMIOLOGY LESSONS LEARNED FROM CDC/HRSA
MCHEP AND UNIVERSITY OF ILLINOIS ENHANCED
ANALYTIC SKILLS PROGRAM (EASP)
- Arden Handler, DrPH
- Joan Kennelly, RN, MPH
- Deborah Rosenberg, PhD
- Stacie Geller, PhD
- University of Illinois at Chicago School of
Public Health
2Background
- University of Illinois School of Public Health
(UIC-SPH) developed and implemented an Enhanced
Analytic Skills Training Certificate Program
(EASP) for MCH professionals in state health
agencies 1990-1997 - UIC-SPH involved in a variety of grants and
contracts promoting data-based decision-making in
states - UIC-SPH developed a competency-based curriculum
for MPH students as a partial outgrowth of the
EASP program - UIC-SPH conducted an evaluation of the CDC/HRSA
Maternal and Child Health Epidemiology Program
1996
3Background contd
- These experiences offer insights into
- what is MCH epidemiology?
- the role of the MCH epidemiologist in providing
analytic leadership - the training of MCH epidemiologists and others
engaged in MCH epidemiologic activity - the factors which contribute to effective MCH
epidemiology in state health agencies
4Part I What is MCH Epidemiology?
- Epidemiology study of the distribution,
determinants, and occurrence of disease and
health related-conditions in populations - Is MCH epidemiology the study of the
distribution, determinants, and occurrence of
disease and health related-conditions in the
maternal and child health population?
5What is MCH Epidemiology contd?
- If the answer was this simple, we wouldnt be
asking the question!!! - MCH epidemiology is described in part by the
classic definition, but it has a broader
conceptual framework
6What is MCH Epidemiology contd?
- The definition of MCH epidemiology comes from
public health practice rather than from academe
where disease etiology has historically been the
primary focus of training and research
7What is MCH Epidemiology contd?
- CDC/HRSAs MCH epidemiologists were placed in the
field beginning in 1986 to support state efforts
to develop their analytic capabilities, thereby
giving state program managers the tools and
long-term capacity to make improved decisions for
MCH activities - Shortly thereafter, HRSA/MCHB began investing in
a variety of strategies to enhance the analytic
skills of MCH state and local health agency staff
8What is MCH Epidemiology contd?
- The definition of MCH epidemiology springs from
the work of these individuals - In state and local health agencies, the
distribution and determinants of MCH
disease/health conditions are studied for the
direct and immediate purpose of carrying out the
activities of the MCH planning cycle-- surveillan
ce and monitoring, assessment, program planning,
evaluation, policy development and advocacy - In state and local health agencies, production of
knowledge alone is not sufficient
9What is MCH Epidemiology contd?
- A proposed definition
- The systematic analysis and interpretation of
population-based and program-specific health and
related data in order to assess the distribution
and determinants of the health status and needs
of the maternal and child population, for the
purpose of implementing effective interventions
and promoting appropriate policy development
10Part II The MCH Epidemiologist
- Uses the tools, framework and population-based
focus of epidemiology to enable state or local
health agencies to carry out surveillance and
monitoring, assessment, planning, evaluation,
policy development, and advocacy - Provides analytic leadership to enhance ability
of MCH programs to carry out core functions of
public health
11The MCH Epidemiologist contd
- CDC/HRSA MCHEP assignees
- In non-MCHEP states and in large and/or urban
locales, a variety of individuals are engaged in
Maternal and Child Health focused epidemiologic
activities
12The MCH Epidemiologist contd
- Profiles of EASP Participants 1990-1997
- Individuals engaged in MCH epidemiologic activity
at the state level have a variety of titles
including - health information systems specialist
- program evaluation consultant
- research analyst
- program planner
- program analyst
- statistical analyst
- statistician
13The MCH Epidemiologist contd
- Profiles of EASP Participants, 1990-1997
- Individuals engaged in MCH epidemiologic activity
at the state level often have no formal training
in public health or epidemiology - Many have background and training in sociology,
psychology, demography, statistics, health
administration, nursing, medicine, nutrition,
social work
14The MCH Epidemiologist contd
- Some of these individuals have sufficient public
health experience and epidemiologic expertise to
be considered MCH epidemiologists - However, many of those engaged in MCH
epidemiologic activities would not be considered
MCH epidemiologists as currently defined/funded
by CDC/HRSA because they are not analytic leaders - Through an evaluation of the CDC/HRSA MCHEP
program, the importance of having analytic
leadership for effective MCH epidemiology was
demonstrated
15The MCH Epidemiologist contd
- CDC/HRSA MCHEP Evaluation
- conducted in 1996 by UIC-SPH
- Objectives
- Provide states with information to support their
respective MCHEP and epidemiologic efforts - Provide insights into whether/how the presence of
a CDC/HRSA MCH epidemiologist enhances state MCH
analytic capacity - Identify and characterize factors which promote
and inhibit the institutionalization of
state-based MCH epidemiology
16The MCH Epidemiologist contd
- CDC/HRSA MCHEP Evaluation
- conducted in 1996 by UIC-SPH
- Methods
- Participatory case-study design with 9 states
- 1 pilot SC
- 4 MCHEP CA, GA, WA, DC
- 4 Comparison AZ, FL, MD, OR--to account for
natural development of enhanced analytic capacity - located in same US PHS region as MCHEP state
- past participation in Univ. of Illinois, EASP
training
17The MCH Epidemiologist contd
- CDC/HRSA MCHEP Evaluation
- conducted in 1996 by UIC-SPH
- Evaluation Components
- Components I and II--MCHEP states only
- self-administered questionnaire based on
workplans - key informant interviews
- Components III and IV--all states
- self-administered benchmark questionnaire
- key informant and stakeholder interviews
18The MCH Epidemiologist contd
- CDC/HRSA MCHEP Evaluation
- conducted in 1996 by UIC-SPH
- Benchmarks
- Developed for this evaluation
- Reflect four domains adapted from previous work
of CDCs Chronic Disease Surveillance Branch - Provide profiles of states epidemiologic
activities at two points 1990 and 1996 - Not designed to make quantitative comparisons
across states
19The MCH Epidemiologist contd
- CDC/HRSA MCHEP Evaluation
- conducted in 1996 by UIC-SPH
- Benchmarks contd Four Domains
- Vision and Planning
- Infrastructure
- Analysis and Utilization
- Translation and Dissemination
20The MCH Epidemiologist contd
- CDC/HRSA MCHEP Evaluation
- conducted in 1996 by UIC-SPH
- Benchmarks contd Sample Questions
- Vision and Planning
- Does the state use data-based decision-making?
- Infrastructure
- Does the state have an integrated information
system using common definitions and uniform
demographic and geographic categories?
21The MCH Epidemiologist contd
- CDC/HRSA MCHEP Evaluation
- conducted in 1996 by UIC-SPH
- Benchmarks contd Sample Questions
- Analysis and Utilization
- Does the state use relevant national, state, and
local data for program planning? - Translation and Dissemination
- Is legislative action initiated or halted as
appropriate after analysis and interpretation of
MCH data?
22The MCH Epidemiologist contd
- CDC/HRSA MCHEP Evaluation
- conducted in 1996 by UIC-SPH
- Site Visits 2-3 days
- Visits by two team members
- Meetings with key informants and stakeholders to
review responses to workplan questionnaires
(MCHEP states only) and benchmark questionnaires
(all states) - Audiotaped / simultaneously transcribed onto
laptop
23The MCH Epidemiologist contd
- CDC/HRSA MCHEP Evaluation
- conducted in 1996 by UIC-SPH
- Analysis State-specific Reports
- Developed from transcriptions, field notes, state
documents - Described each states analytic capacity and
major factors promoting and inhibiting effective
maternal and child health epidemiology
24The MCH Epidemiologist contd
- CDC/HRSA MCHEP Evaluation
- conducted in 1996 by UIC-SPH
- Analysis contd State-specific Reports
- Provided basis for discerning differences in
analytic capacity between MCHEP and non-MCHEP
states - Provided basis for developing comprehensive list
of factors which promote or inhibit effective
MCH epidemiology
25The MCH Epidemiologist contd
- CDC/HRSA MCHEP Evaluation
- conducted in 1996 by UIC-SPH
- Analysis contd Promoting / Inhibiting Factors
- Validity checked against individual state
findings - Not equally prominent in all states, but had a
universal quality--generally applicable to all
states efforts to increase MCH epidemiologic
capacity
26The MCH Epidemiologist contd
- CDC/HRSA MCHEP Evaluation
- conducted in 1996 by UIC-SPH
- Results Role of MCHEP
- In general, states with MCHEP as compared to
states without MCHEP have the analytic leadership
and focus to more effectively engage in
data-based decision-making throughout the MCH
planning cycle
27The MCH Epidemiologist contd
- CDC/HRSA MCHEP Evaluation
- conducted in 1996 by UIC-SPH
- Results contd Role of MCHEP
- In comparison states, the lack of a designated
MCH epidemiologist was the factor most inhibiting
analytic capacity development - 3 out of the 4 non-MCHEP states had applied at
various times to become an MCHEP state
28Part III Strategies for Increasing the Pool of
MCH Epidemiologists
- How do we increase the pool of MCH
epidemiologists and provide state and local
health agencies with the analytic leadership they
require? - School of Public Health Strategies
- Non-School of Public Health Strategies
29Strategies for Increasing the Pool of MCH
Epidemiologists contd
- Lessons from EASP
- University of Illinois 1990-1997 and MCHEP
Evaluation - Training of MCH epidemiologists requires Schools
of Public Health to develop competency-based
programs which promote the use of epidemiology
(skills, framework, population-based focus) to
carry out MCH planning cycle activities - surveillance and monitoring
- needs assessment
- program planning
- program evaluation
- policy analysis/policy development
30Strategies for Increasing the Pool of MCH
Epidemiologists contd
- Lessons from EASP
- University of Illinois 1990-1997 and MCHEP
Evaluation - MPH Training of individuals who can work under
the leadership of an MCH epidemiologist - Students take MCH content courses, MCH planning
cycle skills courses, plus epi courses (beyond
introductory course required by CEPH) - Potential for integration of MCH planning cycle
courses and epi courses - Field placement in state or local health agency
required
31Strategies for increasing the pool of MCH
epidemiologists contd
- Lessons from EASP
- University of Illinois 1990-1997 and MCHEP
Evaluation - Doctoral Level Training of individuals who can
become state or local MCH epidemiologists - MCH planning cycle skills still core, plus
advanced epidemiology, biostatistics and
quantitative and qualitative methods courses - Emphasis on application of analytic skills to
problem-solving - Field placement (6-12 months) in state or local
health agency - Possible requirement of post-graduate placement
in state or local health agency
32Strategies for increasing the pool of MCH
epidemiologists contd
- Lessons from EASP
- University of Illinois 1990-1997
- Continuing education approaches
- can be intensive or non-intensive
- can be face-to-face or use distance methods
- must use a competency-based approach
- demonstration
- practice
- reinforcement of newly acquired skills and
knowledge - hands-on exercises, interactive case scenarios
33Strategies for increasing pool of MCH
epidemiologists contd
- Lessons from EASP
- University of Illinois 1990-1997
- Content included in a competency based analytic
skills training program for MCH professionals - Information-based decision-making as foundation
- Planning cycle framework
- Epidemiology and biostatistics as building blocks
- Advanced skill areas- e.g., trend analysis, small
area analysis, economic analysis - Key data-sets
34Strategies for increasing the pool of MCH
epidemiologists contd
- Continuing education efforts will not produce MCH
epidemiologists but can - provide refresher and enhancement of skills to
MCH epidemiologists officially hired by HRSA/CDC
or state or local health agencies - sharpen and fine-tune the skills of those who
have emerged as de facto MCH epidemiologists
through their experience on the job (without the
title) - increase the analytic skills of those who work
with or under official or de facto MCH
epidemiologists
35Strategies for increasing the pool of MCH
epidemiologists contd
- Non-School of Public Health approaches
- EIS
- Preventive Medicine Residency
- Individuals trained through these approaches need
to be acculturated to MCH/Title V (data
requirements and planning cycle) - Might EIS draw recruits from MCH programs in
state or local health agencies?
36Part IV Factors that Promote Effective MCH
Epidemiology in States
- CDC/HRSA MCHEP evaluation provided information
about the factors which promote and inhibit
effective MCH epidemiology efforts in state
health agencies - It is likely that many of these factors also
apply to local health agencies
37Factors that Promote Effective MCH Epidemiology
in States contd
- The organizational structure of the state health
agency- no one ideal placement for MCH
epidemiologic efforts
38Factors that Promote Effective MCH Epidemiology
in States contd
- Relationship with the Title V/MCH program
- regardless of funding source, MCH epidemiology
efforts most successful when driven by the MCH
priorities and needs of the state - Relationship with the state epidemiology unit
- approach of the epidemiology unit to use of
epidemiology for planning cycle activities - Relationship with other relevant data units
within and external to the state health agency
39Factors that Promote Effective MCH Epidemiology
in States contd
- State support for information-based
decision-making at multiple levels is key - at a minimum, commitment to information-based
decision-making at level of state MCH director is
essential
40Factors that Promote Effective MCH Epidemiology
in States contd
- Adequate infrastructure is essential
- Data collection and analysis personnel
- Appreciation of use of data by program staff
- Adequate hardware and software
- MIS systems which generate quality and timely
program data - Vision/actual integrated information system
41Factors that Promote Effective MCH Epidemiology
in States contd
- Collaboration is another critical ingredient
- two-way relationship with local health
agencies--generation and utilization of data - external partners essential universities,
not-for-profit organizations, advocacy groups
42Factors that Promote Effective MCH Epidemiology
in States contd
- Factors relevant to MCHEP states only
- Characteristics and background of the MCHEP
assignee--high-level analytic skills, CDC/Title V
acculturation, leadership and management ability - Longevity of the assignment--need to develop and
nurture relationships over the long-term - Relationship among MCHEP assignee, CDC, HRSA, the
state
43Conclusions
- Consensus is needed on the definition of MCH
epidemiology - Based on this consensus, the pool of MCH
epidemiologists can be expanded - Schools of Public Health have a variety of
mechanisms to assist in this expansion - Non-school mechanisms can also be utilized
44Conclusions contd
- MCHEP should be viewed as one vital arm of a
comprehensive strategy to increase the ability of
state and local MCH programs to carry out the
core functions of public health - Effective MCH epidemiology in state and local
health agencies is contingent on a variety of
factors which must be considered when expanding
MCH epidemiologic efforts