MCH EPIDEMIOLOGY: LESSONS LEARNED FROM CDCHRSA MCHEP AND UNIVERSITY OF ILLINOIS ENHANCED ANALYTIC SK - PowerPoint PPT Presentation

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MCH EPIDEMIOLOGY: LESSONS LEARNED FROM CDCHRSA MCHEP AND UNIVERSITY OF ILLINOIS ENHANCED ANALYTIC SK

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Title: MCH EPIDEMIOLOGY: LESSONS LEARNED FROM CDCHRSA MCHEP AND UNIVERSITY OF ILLINOIS ENHANCED ANALYTIC SK


1
MCH 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

2
Background
  • 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

3
Background 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

4
Part 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?

5
What 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

6
What 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

7
What 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

8
What 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

9
What 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

10
Part 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

11
The 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

12
The 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

13
The 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

14
The 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

15
The 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

16
The 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

17
The 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

18
The 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

19
The 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

20
The 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?

21
The 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?

22
The 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

23
The 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

24
The 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

25
The 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

26
The 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

27
The 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

28
Part 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

29
Strategies 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

30
Strategies 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

31
Strategies 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

32
Strategies 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

33
Strategies 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

34
Strategies 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

35
Strategies 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?

36
Part 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

37
Factors that Promote Effective MCH Epidemiology
in States contd
  • The organizational structure of the state health
    agency- no one ideal placement for MCH
    epidemiologic efforts

38
Factors 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

39
Factors 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

40
Factors 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

41
Factors 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

42
Factors 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

43
Conclusions
  • 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

44
Conclusions 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
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