Application for 2017 and Report for 2015

BRIAN SANDOVALGovernor

RICHARD WHITLEY, MSDirector, DHHS

CODY L. PHINNEY, MPHAdministrator, DPBH

JOHN M. DiMuro, DOChief Medical Officer

Division of Public and Behavioral Health

Outline

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• Introduction1

• Requirements for States2

• Update on Performance Measures3

• Questions4

Division of Public and Behavioral Health

Title V MCH Block GrantBegan in 1935 as part of the Social Security

Act.

Only federal program devoted to improving the health of women, children, and families.

Each year state Maternal and Child Health agencies apply for and receive a formula grant.

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Division of Public and Behavioral Health

Title V MCH Vision and Mission

Vision of Title V• A nation where all mothers, children and

youth, including CSHCN, and their families are healthy and thriving.

Mission of Title V• To improve the health and well-being of the

nation’s mothers, infants, children and youth, including children and youth with special health care needs, and their families.

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Division of Public and Behavioral Health

MCH Pyramid of Health Services

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Division of Public and Behavioral Health

Block Grant Requirements for States

• 30/30/10– 30% of total Block Grant funds must be allocated

to child/adolescent population– 30% to Children and Youth with Special Health

Care Needs– No greater than 10% administrative cost

• Administer a state hotline for MCH health info– 1-800-429-2669 or Nevada 2-1-1

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Division of Public and Behavioral Health

Block Grant Requirements for States

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Address 8 national performance measures with at least one from the six federal populationdomains

NPM # National Performance Priority Areas MCH Population domains1 Well woman visit Women/maternal health 2 Low risk cesarean delivery Women/maternal health 3 Perinatal regionalization Perinatal/infant health4 Breastfeeding Perinatal/infant health5 Safe Sleep Perinatal/infant health6 Developmental screening Child Health7 Injury Child Health and/or adolescent health8 Physical activity Child Health and/or adolescent health9 Bullying Adolescent health

10 Adolescent well-visit Adolescent health11 Medical home Children with special health care needs12 Transition Children with special health care needs13 Oral Health Cross-cutting/lifespan14 Smoking Cross-cutting/lifespan15 Adequate insurance coverage Cross-cutting/lifespan

Division of Public and Behavioral Health

Nevada National Performance Measures1. Percent of women with a past year preventive medical visit2. A) Percent of infants who are ever breastfed and B) Percent of infants

breastfed exclusively through 6 months3. Percent of children, ages 10 through 71 months, receiving a

developmental screening using a parent-completed screening tool4. Percent of children ages 6 through 11 and adolescents 12 through 17

who are physically active at least 60 minutes per day5. Percent of adolescents, ages 12 through 17, with a preventive medical

visit in the past year.6. Percent of children with and without special health care needs having a

medical home7. A) Percent of women who smoke during pregnancy and B) Percent of

children who live in households where someone smokes8. Percent of children ages 0 through 17 who are adequately insured

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Division of Public and Behavioral Health

Block Grant Requirements for StatesIdentify and address 3-5 state performance measures

Nevada State Performance Measures1. Percent of women with late or no prenatal

care2. Percent of repeat teen births3. Percent of women who use substances

during pregnancy

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Division of Public and Behavioral Health

Block Grant Requirements for StatesDevelop and Implement a five year state action plan

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See hand out

Division of Public and Behavioral Health

Update on Nevada’s National and State Performance

Measures

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Division of Public and Behavioral Health 12

58.6154.19 55.74

59.02 60.08 61.13

0

10

20

30

40

50

60

70

80

90

100

2009 2010 2011 2012 2013 2014

NPM #1- Percent of Women with a Past Year Preventive Medical Visit: Nevada BRFSS, 2009-2014

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

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80.5 78.2 80.2 78.0 80.9 80.1

0

10

20

30

40

50

60

70

80

90

100

2007 2008 2009 2010 2011 2012

NPM #4A - Percent of Infants who are ever Breastfed

Data Source: National Immunization Survey (NIS)Notes: Starting with 2009 births, the survey switched from a landline-only sample to a dual-frame sample including landlines and cell phones. Therefore, estimates from 2007 and 2008 may not be comparable to subsequent estimates

Division of Public and Behavioral Health 14

11.9 12.511.2

18.7 18

14.8

0

5

10

15

20

25

30

2007 2008 2009 2010 2011 2012

NPM #4B- Percent of infants breastfed exclusively through 6 months: Nevada, 2007-2012

Data Source: National Immunization Survey (NIS)Notes: Starting with 2009 births, the survey switched from a landline-only sample to a dual-frame sample including landlines and cell phones. Therefore, estimates from 2007 and 2008 may not be comparable to subsequent estimates

Division of Public and Behavioral Health 15

18.6

21.9

0

5

10

15

20

25

2007 2011_2012

NPM #6- Percent of children, ages 10 through 71 months, receiving a developmental screening using a parent-completed screening tool

Data Source: National Survey of Children's Health (NSCH) Notes: The developmental screening measure was added in 2007 and is only available at two time points. In 2011-2012, the survey changed from a landline-only sample to a dual-frame sample including landlines and cell phones. Therefore, estimates may not be comparable over time.

Division of Public and Behavioral Health 16

Data National Survey of Children's Health (NSCH)Notes: The revised NSCH will capture physical activity of at least 60 minutes per day with baseline NSCH data reflecting at least 20 minutes per day.In 2011-2012, the survey changed from a landline-only sample to a dual-frame sample including landlines and cell phones. Therefore, estimates may not be comparable over time.

33.72

29.89 29.79

0

5

10

15

20

25

30

35

40

2003 2007 2011_2012

NPM #8 - Percent of Children ages 6 through 11 who are Physically Active At least 60 Minutes per day

Division of Public and Behavioral Health 17

22.624.9 24.0

0

5

10

15

20

25

30

35

2007 2009 2013

NPM #8 - Percent of Adolescents Ages 12 through 17 who are Physically Active At least 60 Minutes per day

Data Source: Youth Risk Behavior Surveillance System (YRBSS) Notes: YRBSS data are self-reported by students in grades 9 through 12. The estimates, numerators, and denominators presented are weighted to account for the probability of selection and non-response, and are adjusted to reflect the total population of high school students by sex, grade, and race/ethnicity for the United States and for each state.

Division of Public and Behavioral Health 18

60.26

71.3067.32

0

10

20

30

40

50

60

70

80

90

100

2003 2007 2011_2012

NPM #10 - Percent of Adolescents Ages 12 through 17, with a Preventive Medical Visit in the Past Year

Data National Survey of Children's Health (NSCH)Notes: In 2011-2012, the survey changed from a landline-only sample to a dual-frame sample including landlines and cell phones. Therefore, estimates may not be comparable over time.

Division of Public and Behavioral Health 19

46.844.8

0

5

10

15

20

25

30

35

40

45

50

2007 2011 2012

NPM #11 - Percent of Children Without Special Health Care Needs Having a Medical Home

Data Source: National Survey of Children's Health (NSCH) – NONCSHCN.Notes: Medical Home items were substantially revised in 2007 and are only comparable at two time points. In 2011-2012, the survey changed from a landline-only sample to a dual-frame sample including landlines and cell phones. Therefore, estimates may not be comparable over time.

Division of Public and Behavioral Health 20

37.2

43.3

0

5

10

15

20

25

30

35

40

45

50

2007 2011_2012

NPM #11 - Percent of Children with Special Health Care Needs Having a Medical Home

Data Source: National Survey of Children's Health (NSCH) Notes: Medical Home items were substantially revised in 2007 and are only comparable at two time points. In 2011-2012, the survey changed from a landline-only sample to a dual-frame sample including landlines and cell phones. Therefore, estimates may not be comparable over time.

Division of Public and Behavioral Health 21

5.2%6.0%

5.7%5.1% 4.7%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

2010 2012 2013 2014 2015

NPM #14A- Percent of Mothers who Reported Smoking During Pregnancy: Nevada, 2010-2015

Data Source: Nevada vital records (birth certificate data).Notes: Tobacco use in pregnancy was modified in the 2003 revision of the U.S. Standard Certificate of Live Birth. Nevada implemented the 2003 version of the birth certificate in mid 2009.

Division of Public and Behavioral Health 22

29.3

25.4 26.0

0

5

10

15

20

25

30

35

2003 2007 2011_2012

NPM #14B - Percent of Children who Live in Households Where Someone Smokes

Data Source: National Survey of Children's Health (NSCH)Notes: In 2011-2012, the survey changed from a landline-only sample to a dual-frame sample including landlines and cell phones. Therefore, estimates may not be comparable over time.

Division of Public and Behavioral Health 23

73.1 73.0

0

10

20

30

40

50

60

70

80

90

100

2007 2011_2012

NPM #15 - Percent of Children Ages 0 through 17 who are Adequately Insured

Data Source: National Survey of Children's Health (NSCH)Notes: Survey items on insurance adequacy were added in 2007 and are only available at two time points. In 2011-2012, the survey changed from a landline-only sample to a dual-frame sample including landlines and cell phones. Therefore, estimates may not be comparable over time.

Division of Public and Behavioral Health 24

61.6 63.7 65.3 65.9 68.7

77.9 77.9 77.9 77.9 77.9

0

20

40

60

80

100

2010 2011 2012 2013 2014

Percent of Births with Prenatal Care Beginning in the First Trimester: Nevada, 2010-2014

Nevada HP 2020Data Source: Nevada vital records (birth certificate data).Healthy People 2020. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion Accessed June 22, 2016. Available from: https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives Timing of prenatal care is the timing of the mother's entry into prenatal care and is divided into three categories. 1. "Early prenatal care," which is care started in the 1st trimester (1-3 months); 2. "Second trimester care" (4-6 months); and 3. "Late/no prenatal care," which is care started in the 3rd trimester (7-9 months) or no care received.

Division of Public and Behavioral Health 25

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

2010 2011 2012 2013 2014 2015

SPM #1- Percent of Mothers Reporting Late or no Prenatal Care : Nevada & U.S., 2010 to 2015

Carson City Clark Washoe Rest of State Nevada U.S.

U.S.

Nevada

Nevada data source: Nevada vital records (birth certificate data).National data source: National Vital Statistics System (NVSS)Notes: Late or no prenatal care is care received only in the third trimester of pregnancy or no prenatal care received at all.

Division of Public and Behavioral Health 26

0.0%2.0%4.0%6.0%8.0%

10.0%12.0%14.0%16.0%18.0%20.0%

2010 2011 2012 2013 2014 2015

Percent of Mothers Reporting Late or no Prenatal Care by Race/Ethnicity: Nevada, 2010-2015

White Black Native American Asian Hispanic State

Nevada

Data Source: Nevada vital records (birth certificate data).Notes: Late or no prenatal care is care received only in the third trimester of pregnancy or no prenatal care received at all.

Division of Public and Behavioral Health 27

05

10152025303540

2010 2011 2012 2013 2014 2015

SPM #2- Percent of Repeat Teen Births by Age Group: Nevada, 2010-2015

15-17 18-19 15-19

15-19

Data Source: Nevada vital records (birth certificate data).

Division of Public and Behavioral Health 28

0

5

10

15

20

25

30

35

2010 2011 2012 2013 2014 2015

Percent of Repeat Teen Births by Race/Ethnicity: Nevada, 2010-2015

White (non-Hispanic) Black (non-Hispanic)

American Indian, Eskimo, or Aleut (non-Hispanic) Asian or Pacific Islander (non-Hispanic)

Hispanic (any race)

Data Source: Nevada vital records (birth certificate data).

Division of Public and Behavioral Health 29

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

2010 2011 2012 2013 2014 2015

Percent of Mothers Who Reported Drug Use During Pregnancy by County: Nevada, 2010-2015

Clark Washoe Rest of State

Data Source: Nevada vital records (birth certificate data)Note: Drug use includes over-the-counter drugs, prescription drugs, and/or illegal substance use. Drug use data are self-reported.

Division of Public and Behavioral Health

Questions?

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Division of Public and Behavioral Health

Thank you!

This presentation was produced by the Maternal and Child Health Program of the Nevada Division of Public and Behavioral Health.

31 of [total slides]

Ingrid Mburia, MPHMaternal and Child Health EpidemiologistNevada Division of Public and Behavioral HealthPhone: 775-684-4023Email: imburia@health.nv.gov