Author(s)

Date

2014 Title V Needs Assessment of

Maternal, Child, Adolescent Health in XXX County:

How are we doing?

Insert Local MCAH/Health Department Logo

1. Provide a brief overview of the Title V Maternal and Child Health Program

2. Discuss the Title V 5-year Needs Assessment Requirement

3. Review community composition and local context related to health and well-being

4. Present local data highlights, including bright spots, areas for improvement and data of interest

5. Provide a summary list of areas for improvement

Objectives of this presentation

Enacted in 1935 as a part of the Social Security Act, the Title V Maternal and Child Health (MCH) Program is a Federal-State partnership.

The Federal Title V Maternal and Child Health Program has provided a foundation for ensuring the health of the Nation’s mothers, women, children, and youth, including children and youth with special health care needs, and their families.

Title V converted to a Block Grant Program in 1981.

What is the Title V MCH Program?

1. Assure access to quality care, especially for those

with low-incomes or limited access to care

2. Reduce infant mortality

3. Provide and ensure access to comprehensive

prenatal and postnatal care, especially for low-

income and at-risk pregnant women

4. Increase the number of children receiving health

assessments and follow-up diagnostic and

treatment services

4

Title V Maternal and Child Health Program seeks to:

5. Provide and ensure access to preventive and child

care services as well as rehabilitative services for

certain children

6. Implement family-centered, community-based

systems of coordinated care for children with

special healthcare needs

7. Provide toll-free hotlines and assistance in

applying for services to pregnant women with

infants and children who are eligible for Title XIX

(Medicaid – known as Medi-Cal in CA).5

Title V Maternal and Child Health Program seeks to (cont.):

Source: http://mchb.hrsa.gov/programs/titlevgrants/

State Title V programs: required to conduct a statewide, comprehensive Needs Assessment every five years

California: decentralized the statewide needs assessment process and each local health jurisdiction conducts a needs assessment of their population of women and children

Key Goals -

1. Build local health jurisdiction needs assessment capacity

2. Obtain extensive stakeholder input at the local level

3. Identify “needs” and issues that would be missed by only analyzing state-level information

4. Focus local MCAH efforts by having each jurisdiction identify priority areas they will focus on during the next 5 years

6

Title V Maternal, Child Adolescent Health Needs Assessment

7

Our Community Residents

County StateTotal Population 37,570,307 Total Population African American 2,195,986 Total Population American Indian/Alaska Native 163,262 Total Population Asian/Pacific Islander 4,994,232 Total Population Hispanic 14,277,952 Total Population White 14,995,619 Total Live Births 501,994

Source: California Department of Finance Population Estimates, 2011

Socio-Ecological Models

Lifecourse Model

10

Health Happens where we

LIVELEARNWORK

and PLAY

11

About our CommunityCount

yStat

e

Poverty rate for people age 18 to 64 (0-200% FPL)Source: Small Area Health Insurance Estimates (SAHIE), 2009-2011

33.8

Poverty rate for children age 0 to 64 (0-200% FPL)Source: Small Area Health Insurance Estimates (SAHIE), 2009-2011

45.4

Children in foster care per 1,000 children age 0 to 17Source: California Child Welfare Indicators Project, UCB, 2009-2011

6.7

% of Single mothers living in poverty (0-100% FPL)Source: American Community Survey 1-Year Estimates, 2012

39.4

Unemployment rateSource: State of California Employment Development Department., 2009-2011

12.3

% of Children receiving free or reduced price meals at schoolSource: As cited on kidsdata.org, California Dept. of Education, Free/Reduced Price Meals Program & CalWORKS Data Files, 2012

57.5

High school dropout rate in grades 9-12Source: California Dept. of Education, California Basic Educational Data System (CBEDS), 2009-2011

14.7

Number of days with ozone above regulatory standardsSource: Centers for Disease Control and Prevention, National Environmental Public Health Tracking Network (Jul. 2013), 2011

16

Bright spots - where we are doing significantly better than the State, have met Healthy People (HP) 2020 goals, or have improved over time

Areas for improvement – where we are doing significantly worse than the State, have gotten worse over time, or are not meeting HP 2020 goals

Additional data of interest – indicators that are of particular concern or interest even though comparisons with the State or previous points in time might not be possible

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Data Highlights

Bright spots –

Our % of Uninsured children1 ages 0 to 18 is lower than the state rate {or the 2000-2002 rate} (insert local rate vs. State rate or rate from before)

Our % of Uninsured women1 ages 18 to 64 is lower than the state rate {or the 2000-2002 rate} (insert local rate vs. State rate or rate from before)

Areas for improvement –

Significantly fewer women are accessing prenatal care in their first trimester2 than in 2000-2002 (insert current local rate vs. previous local rate)

African American women have lower rates of first trimester2 prenatal care than White women (insert AA rate vs. White rate)

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Indicators of Access to and Utilization of Care

Source: 1Small Area Health Insurance Estimates (SAHIE), 2009-2011, 2California Center for Health Statistics, Vital Statistics, Births

Statistical Master File, 2009-2011

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6.4%

15.5%9.3%

22.1%

CountyState

Bright Spot: Children and Women without Health Insurance

Source: Small Area Health Insurance Estimates (SAHIE), 2009-2011

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Childen 0 - 17 Women 18 and over

91.1%

86.5%89.4%

85.9%

CountyState

Data of interest: Children and women who visited a doctor in the last year

Source: CHIS (California Health Interview Survey), 2011-2012

Areas for improvement -

Births within 24 months of a previous pregnancy1 per 100 females age 15 to 44 delivering a live birth (County = 24.2 vs. CA = 21.0)

Substance use diagnoses2 per 1,000 hospitalizations of pregnant females age 15 to 44 (County = 69.8 vs. CA = 13.8)

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Health Indicators for Women and Mothers

Sources: 1California Center for Health Statistics, Vital Statistics, Births Statistical Master File, 2009-2011; 2Office of Statewide Health Planning and Development

(OSHPD). Hospital discharge data, 2009-2011

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Smoking during the 1st or 3rd trimester per 100 females with live

births

28.3%

8.1%County+State

Area for improvement: Smoking during 1st or 3rd Trimester of Pregnancy

+ Regional Data

Source: MIHA (Maternal Infant Health Assessment Survey), 2011

Data of interest -

Rate of Domestic Violence1 per 100,000 population in higher than state rate (County = 674 vs. State = 439)

Rate of mood disorder hospitalizations2 per 100,000 female population age 15 to 44 in 2009-2011 is higher than state rate (County= 1,763 vs. State = 1,030), and higher than it was in 2000-2002 (County = 1,602)

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Health Indicators for Women and Mothers

Sources: 1California State Department of Justice, Office of the Attorney General, Domestic Violence-Related Calls for Assistance, 2009-2011; 2Office of Statewide Health Planning and

Development (OSHPD). Hospital discharge data, 2009-2011

Bright spots -

Rate of live births weighing less than 2,500 grams at birth is lower than the state (County = 6.0% vs. CA = 6.8%)

HP 2020 Objectives achieved for:

Low birth weight (6.0%)

Very low birth weight (1.0%)

Premature births - less than 37 weeks (8.2%)

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Indicators of Infant Health

Source: California Center for Health Statistics, Vital Statistics, Births Statistical Master File, 2009-2011

Bright spot -

Exclusive in-hospital breastfeeding – better than the state (County = 85.6% vs. CA = 62.6%)

Source: California Department of Public Health, Center for Family Health, Genetic Disease Screening Program, Newborn Screening Data, 2012

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Nutrition and Physical Activity Indicators

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Public school students in grades 5, 7, 9, & 11

Females age 15 to 44

34.1%

54.5%

Data of interest: Overweight and obesity among students and women

Source (Students): Babey, S. H., et al. (2011). A patchwork of progress: Changes in overweight and obesity among California 5th-, 7th-, and 9th-graders, 2005-2010.Source (Women): CHIS (California Health Interview Survey), 2011-2012

Bright Spot -

Teen births

Births per 1,000 females age 15 to 17 in 2009-2011 are lower than the State (County = 13.5 vs. CA = 16.8), HP2020 Objective achieved

Births declined from 19.9 per 1,000 females age 15 to 17 in 2000-2002 to 13.5 in 2009-2011

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Child and Adolescent Health Indicators

Source: California Center for Health Statistics, Vital Statistics, Births Statistical Master File, 2009-2011

Areas for improvement -

Births within 24 months of a previous birth per 100 females under 20 years old delivering a live birth

Increased from 51.2% in 2000-2002 to 67.0% in 2009-2011

Significant increasing trend for White females under 20 to giving birth within 24 months of a previously giving birth

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Child and Adolescent Health Indicators

Source: California Center for Health Statistics, Vital Statistics, Births Statistical Master File, 2009-2011

Areas for improvement -

Substance abuse hospitalizations per 100,000 population age 15 to 24 higher than State rate (County = 1055 vs. CA = 638.9)

Data of interest -

Mental health hospitalizations per 100,000 population age 15 to 24 higher than state rate (County = 1,734 vs. CA = 1,282)

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Child and Adolescent Health Indicators

Source: Office of Statewide Health Planning and Development (OSHPD). Hospital discharge data, 2009-2011

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69.0

129.8

41.7070.30

CountyState

Area for Improvement: Death Rates

Source: Death Statistical Master files, 2009-2011

Summary of Potential Bright Spots

• Accessing prenatal care in their first trimester

• Births within 24 months of a previous birth per 100 females age 15 to 44 delivering a live birth

• Births within 24 months of a previous birth per 100 females under 20 years old delivering a live birth

• Substance use diagnoses per 1,000 hospitalizations of pregnant females age 15 to 44

• Smoking during 1st or 3rd Trimester of Pregnancy

• Overweight and obesity among public school students

• Overweight and obesity among females ages 15-44

• Substance abuse hospitalizations per 100,000 population age 15 to 24

• Deaths per 100,000 population age 15 to 19

• Deaths per 100,000 population age 20 to 24

Summary of Potential Areas for Improvement

• Accessing prenatal care in their first trimester

• Births within 24 months of a previous birth per 100 females age 15 to 44 delivering a live birth

• Births within 24 months of a previous birth per 100 females under 20 years old delivering a live birth

• Substance use diagnoses per 1,000 hospitalizations of pregnant females age 15 to 44

• Smoking during 1st or 3rd Trimester of Pregnancy

• Overweight and obesity among public school students

• Overweight and obesity among females ages 15-44

• Substance abuse hospitalizations per 100,000 population age 15 to 24

• Deaths per 100,000 population age 15 to 19

• Deaths per 100,000 population age 20 to 24