Charlan D. Kroelinger, PhDTeam Lead

Maternal and Child Health Epidemiology Program

June 2011

Integrating Science, Policy, and Practice: The Maternal and Child Health

Epidemiology Program (MCHEP) in States

National Center for Chronic Disease Prevention and Health PromotionDivision of Reproductive Health

Introduction: Data to Support the Evidence

2009 Assessment of Capacity: MCH Epidemiology in States 2004: 43% of states reported at least substantial MCH

epi capacity 2006: 47% reported at least substantial capacity 2009: 55% reported at least substantial capacity

2004: 25% of states reported minimal to no capacity in MCH epidemiology

2006: 23% reported minimal to no capacity 2009: 12% reported minimal to no capacity

MCH Epi capacity in top 3 (Infectious = 92%; Bioterrorism/Emergency Response = 73%)

Introduction: Data to Support the Evidence

MCH Epidemiologists collaborate across disciplines: Chronic disease (63%) Oral health (59%) Injury (53%)

MCH Epidemiologists work to impact science, program, and policy Linking data systems (57%) Translating data findings to program and policy (69%) Priority setting (73%) Performance measurement (67%) Program planning (67%) Needs assessments (82%) Program evaluation (53%)

Maternal and Child Health Epidemiology Program (MCHEP)

MCHEP initiated in 1986 by the Centers for Disease Control and Prevention, and the Health Resources and Services Administration / Maternal and Child Health Bureau

Request for Applications to provide Direct assistance to states Time-limited assignments

Envisioned as a mechanism to promote collaboration between federal agencies and states

35+ senior MCH epidemiologists to more than 33 states and 6 other public health organizations

Maternal and Child Health Epidemiology Program (MCHEP)

Mission:Promote and improve the health and well-being of women, children and families by building MCH epidemiology and data capacity at the state, local, and tribal levels to effectively use information for public health action.

Previous Evaluation of MCHEP 1999, University of Illinois at Chicago

Case-study evaluation of program; N=9 states (5 MCHEP; 4 non-MCHEP)

MCHEP contributed to:• Epi capacity building as a state priority• Adequately trained personnel to support MCH epi activities• Integrated information systems• Analytic leadership for MCH epi activities

2010 MCH epidemiology capacity follow-up study Interview with all 50 states and Washington DC MCH epi capacity contributed to:

• Doctoral level key staff• Agenda-setting by consensus process• Organizational position of MCH epidemiology effort

Methodology: MCHEP Structure Minimum qualifying criteria for applicants

PhD or MD with a MPH in epidemiology or related field Intermediate knowledge or experience in epidemiology,

statistics, and programming Experience working in MCH or on MCH issues Intermediate experience in communicating effectively to

leaders, staff, communities, colleagues, and audiences Experience working on a multi-disciplinary team Potential to become a MCH epidemiology leader Bi-annual submission process:

• Review / Screening• Interview• Matching

Methodology: MCHEP Structure Proposal requirements for a host state /

agency Purpose of the assignment Funding mechanism for the assignment Justification for the assignment Assignment structure First year projects to be completed by the assignee

Proposals are accepted throughout the year, matching occurs two times per year

Maternal Child Health Epidemiology Program: Team Structure

• Atlanta Members (11)

– Provide overall support and leadership in the national context with the field and in connection with partners

• Field Assignees (12)– Lead a state agenda to

develop MCH Epidemiology capacity

– 20% time on CDC activities

MCHEP Sponsored Regions, States, and Public Health Agencies, October 2010

• What we do: Develop MCH Epidemiology Leaders Advance MCH Epidemiology Data and Analytic

Capacity Evaluate, Train, and Educate in the Field of

MCH Create Peer Exchange Opportunities Promote MCH Partnerships

Maternal and Child Health Epidemiology Program (MCHEP) Goals

Results: Assignee Statistics Assignments in place for > 5 years

42% Assignments in place for 1 – 5 years

33% Assignments in place for < 1 year

25%

Develop MCH Epidemiology Leaders• Provide direct assistance to public health agencies

– In collaboration with HRSA/MCHB

• State assignments• National, state, regional training• Academic training grants

• Foster the next generation of MCH Epidemiologists– Council of State and Territorial Epidemiologists

• 7 current MCH CDC/CSTE Fellows– HI, OH, OR, PA, SD, TX, US/Mexico

• 6 new MCH CDC/CSTE Fellows for 2010 – WI, VA, LA, MA, MO, MI

– Epidemic Intelligence Service (EIS) Officers• 1 Atlanta-based, 2 Field-based (FL, TX)

• Data Capacity– Data assessment and quality improvement– Developing surveillance systems – Data linkage projects– GIS

• Analytic Capacity– Year long distance-based advanced

epidemiology analysis • University of Illinois at Chicago (UIC)

– Harvard/CDC Evaluation Practicum– CDC/HRSA Epidemiology Training

• Regional training• MCHEPI preconference training• MCH Certificate training

Advance Data and Analytic Capacity

• State Title V MCH Needs Assessment– Facilitated by preconference trainings

(AMCHP) • MCH Data Tools

– Perinatal Periods of Risk (PPOR) • CityMatch Urban MCH DaTA Institute

– CSTE MCH Epidemiology Capacity Assessment– State Infant Mortality Toolkit

• Leadership Training– CityMatCH City Leaders– CityMatCH Data Use Institute

Evaluate, Educate, and Train

• Annual MCH Epi Conference– More than 500 MCH professionals – National MCH Epidemiology Awards– National Best Manuscript Award

• Regional MCH Epi Conference– More than 200 MCH professionals

• MCH Epi List Serve– Over 400 members nationally/ internationally

• MCH Epi Grand Rounds – 7 interactive Web casts per year

• DataSpeak– Web conferences on MCH related topics

Create Peer Exchange Opportunities

Promote Partnerships Among Over 20 MCH Agencies

In order to: Appropriately provide evidence-based

data to those providing direct services Effectively translate research into policy

to improve health Develop relevant research

Integrating Science, Policy and Program – State Examples

Supporting data linkage MA Pregnancy to Early Life Longitudinal (PELL) database DE Registry for Improving Birth Outcomes

Investigating trends in infant mortality WI focus on differing trends in IM regionally

Increasing research capacity DE Center for Family Health Research and Epidemiology

Integrating Science, Policy and Program – State Examples

Developing a strategic plan OH Statewide Strategic Planning in MCH

Examining regionalized systems of care GA focus on volume of births in Level I, II, and III

hospitals Collaborating across disciplines

WY integration of MCH, injury, and diabetes program analyses

CDC Programs for Full-time Field Staff Epidemiologists

• Career Epidemiology Field Officer (CEFO) Program Strengthen state, local, and territorial epidemiologic capability for public health preparedness and response Office of Science and Public Health Practice / Office of Public Health Preparedness and Response

• Maternal & Child Health Epidemiology Program (MCHEP)Build capacity and increase infrastructure in maternal and child health epidemiology in states, localities, and tribesDivision of Reproductive Health / National Center for Chronic Disease Prevention and Health Promotion

• State-Based Epidemiology for Public Health Program Support (STEPPS) ProgramJump-start the process of building chronic disease epidemiology capacity by providing health departments with resources (funding and/or FTE) to secure the full-time services of a fully trained chronic disease epidemiologist for a period of about four yearsDivision of Adult and Community Health / National Center for Chronic Disease Prevention and Health Promotion

Conclusion Decreasing resources in states Decreasing resources at federal agencies

How do we continue to increase capacity? Partnership, collaboration, and leverage of

resources (in-kind) – to include CSTE fellowships; co-sponsorship of activities – joint trainings, pre-conference trainings, access to data

Questions• MCHEP

http://www.cdc.gov/reproductivehealth/MCHEpi/index.htm

• Annual MCH Epi Conference http://www.cdc.gov/reproductivehealth/MCHEpi/2008/

AboutConference.htm• MCH Epi Grand Rounds http://www.uic.edu/sph/cade/mchepi/index.htm• DRH Website

http://www.cdc.gov/reproductivehealth/index.htm