Title: Maternal and Child Health Public Health Across the Lifespan October, 2005
1Maternal and Child HealthPublic Health
Acrossthe Lifespan October, 2005
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- Health Resources And Services Administration
- Maternal And Child Health Bureau
- Peter C. Van Dyck, MD, MPH
2 MCHB
LEADERSHIP
3The Power of Partnership Goals
- To communicate a shared vision, and to present
new and critical information relevant to
performance measurement, policy, program and
administrative changes - To generate MCH partners through increased
awarenessto provide opportunities for working
together
4The Power of Partnership Goals
- To identify critical issues facing the MCH
population and opportunities for collaborative
effort that can move effectively to meet the
needs of the MCH population
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6MCHB Strategic Plan Mission
- To provide national leadership and to work, in
partnership with states, communities,
public-private partners, and families to
strengthen the MCH infrastructure, assure the
availability and use of medical homes, and build
the knowledge and human resources, in order to
assure continued improvement in the health,
safety and well-being of the MCH population
7MCHB Strategic Plan Mission
- The MCH population includes all Americas women,
infants, children, adolescents and their
families, including women of reproductive age,
fathers, and children with special health care
needs(CSHCN)
8MCHB Vision Statement
- MCHB believes in a future America in which the
right to grow to ones full potential is
universally assured through attention to the
comprehensive physical, psychological, and social
needs of the MCH population. We strive for a
society where children are wanted and born with
optimal health, receive quality care, and are
nurtured lovingly and sensitively as they mature
into healthy, productive adults.
9MCHB Vision Statement
- The Bureau seeks a Nation where there is equal
access for all to quality health care in a
supportive, culturally competent, family and
community setting.
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11MCHB Values Statement
- To achieve its mission, the Bureau relies on
personal, population-based, systems and resource
building approaches to promote the health,
safety, and well being of the Nations MCH
population. Bureau efforts are driven by a
commitment to the following values
12MCHB Values Statement
- Affordable and accessible high quality care for
all - Accountable, regularly monitored and evaluated
evidence-based quality care - Preventive, protective health care that address
individuals physical, psychological, and social
needs
13MCHB Values Statement
- Comprehensive, coordinated care in medical homes
that includes direct and enabling services - Consumer-oriented, family-centered and
culturally-competent care linked to community
services - Continually improving health care based on
research, evaluation, training/education,
technical assistance, and the dissemination of
up-to-date information
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15MCHB Strategic Plan Goals
- Provide National Leadership for Maternal and
Child Health by creating a shared vision and
goals for MCH, informing the public about MCH
needs and issues, modeling new approaches to
strengthen MCH, forging strong collaborative
partnerships, and fostering a respectful
environment that supports creativity, action, and
accountability for MCH issues.
16MCHB Strategic Plan Goals
- Eliminate health disparities in health status
outcomes, through the removal of economic, social
and cultural barriers to receiving comprehensive
timely and appropriate health care
17MCHB Strategic Plan Goals
- To assure the highest quality of care through the
development of practice guidance, data
monitoring, and evaluation tools the utilization
of evidence-based research and the availability
of a well-trained, culturally diverse workforce
18MCHB Strategic Plan Goals
- To facilitate access to care through the
development and improvement of the MCH health
infrastructure and systems of care to enhance the
provision of the necessary coordinated, quality
health care
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20MCH BUREAU
PERFORMANCE
21CORE PUBLIC HEALTH SERVICES DELIVERED BY
MCH AGENCIES
DIRECT HEALTH CARE SERVICES (GAP
FILLING) Examples Basic Health Services and
Health Services for CSHCN
MCH
EPSDT
CHC
SCHIP
ENABLING SERVICES Examples Transportation,
Translation, Outreach, Respite Care, Health
Education, Family Support Services, Purchase
of Health Insurance, Case Management,
Coordination with Medicaid, WIC and Education
POPULATION--BASED SERVICES Examples Newborn
Screening, Lead Screening, Immunization, Sudden
Infant Death Counseling, Oral Health, Injury
Prevention, Nutrition and Outreach/Public
Education
INFRASTRUCTURE BUILDING SERVICES Examples Needs
Assessment, Evaluation, Planning, Policy
Development, Coordination, Quality Assurance,
Standards Development, Monitoring, Training,
Applied Research, Systems of Care and
Information Systems
22MCH BUREAU
ACCOUNTABILITY
23MCHB Program Strengths
- Genuine partnership between Federal government,
states, and communities - Statement of priorities consistent with the
Healthy People 2000 and 2010 goals - Commitment to both Federal and State financing
evidenced by match of 4 Federal to 3 State
dollars
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25MCHB Program Strengths
- 5 year needs assessment planning
- Framework that targets states expenditures to
the entire MCH population--infants, children,
adolescents, women, pregnant women, CSHCN - Flexibility for States to tailor programs
- Commitment for coordination with all other major
childrens programs--idea, WIC, Medicaid, SCHIP,
nutrition, Headstart, early intervention
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27MCHB Program Strengths
- Special Federal project grant authorities
- SPRANS--enhance major purposes of State formula
grants
(15 set aside of the total Title V
appropriation) - CISS--enhance State and local communities ability
to increase the comprehensiveness of local
service delivery systems
(12 3/4 set aside of the total Title V
appropriation over 600 million)
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29MCH Bureau Performance Measurement System
MCHB PROGRAM AND RESOURCE ALLOCATION
MCHB PERFORMANCE MEASURES
MCHB OUTCOME MEASURES
MCHB PRIORITIES AND GOALS
MCHB NEEDS ASSESSMENT HEALTH STATUS INDICATORS
PERINATAL MORTALITY
STATE BLOCK GRANT
STATE/ NATIONAL INDICATORS
I. DECREASE DISPARITIES
INFANT MORTALITY
DIRECT HEALTH
SPRANS
HEALTHY PEOPLE 2010
NEONATAL MORTALITY
ENABLING SERVICES
II. INCREASE QUALITY
HEALTHY START
POSTNEONATAL MORTALITY
LEGISLATIVE PRIORITIES
POPULATION BASED
EMERGENCY SERVICES FOR CHILDREN
CHILD MORTALITY
III. IMPROVE INFRASTRUCTURE
PARTNERSHIPS INPUT
TRAUMATIC BRAIN INJURY
INFRASTRUCTURE SERVICES
INFANT DEATH DISPARITY
30Discretionary Grants--Levels of Performance Data
- Standardized family of 30-35 national performance
measures - Set of standardized forms similar to those in the
block grant - Minimal data set for each Division beyond that in
performance measures - Selected grantee performance measures from large
grantee programs - Otheradministrative or leadership data
- Standardized application and guidance
31Title V SPRANS Performance Measurement System
SPRANS PROGRAM AND RESOURCE ALLOCATION
SPRANS PERFORMANCE MEASURES
SPRANS OUTCOME MEASURES
SPRANS PRIORITIES AND GOALS
SPRANS NEEDS ASSESSMENT HEALTH STATUS INDICATORS
PERINATAL MORTALITY
DSCSHCN
STATE/ NATIONAL INDICATORS
I. DECREASE DISPARITIES
INFANT MORTALITY
DIRECT HEALTH
DCAFH
HEALTHY PEOPLE 2010
NEONATAL MORTALITY
ENABLING SERVICES
DRTE
II. INCREASE QUALITY
POSTNEONATAL MORTALITY
DPSWH
LEGISLATIVE PRIORITIES
POPULATION BASED
CHILD MORTALITY
DSCH
III. IMPROVE INFRASTRUCTURE
PARTNERSHIPS INPUT
INFRASTRUCTURE SERVICES
ODIM
INFANT DEATH DISPARITY
32Numbers Served In MCH Block Grant Program, 1997
And 2003
SOURCE TITLE V INFORMATION SYSTEM
33Accountability
- Face-to-face reviews with Federal staff, outside
experts, and State staff - An extensive narrative description of State MCH
services with special attention to each
performance and outcome measure - Completion of a set of program and financial data
tables
34Accountability
- Budget and expenditures for the four levels of
the pyramid - Progress towards successful achievement of
performance measures - Positive impact on the outcome measures
35Accountability
- Implementation of the electronic reporting
package (ERP) with which all States must report - Sharing of data with States and other
constituencies - Preparation of special data reports
- Timely data on the internet
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37MCHB
BUDGET 2006
38The MCH Bureau Authorizing Legislation
- MCH Services Block Grant (Title V, Social
Security Act) - Traumatic Brain Injury (Section 1252, Public
Health Service Act) - Healthy Start (Title III, Public Health Service
Act, Section 330H)
39The MCH Bureau Authorizing Legislation
- Emergency Medical Services Children (Section
1910, Public Health Service Act) - Newborn Hearing Screening (Title III, Public
Health Service Act, Section 399M)
40MCH Formula and Allocation
- Whenever the total appropriation exceeds 600
million - 12.75 of the amount is used to fund the
Community Integrated Service System (CISS)
set-aside program - Remainder is allocated as 85 to States and 15
retained by the Secretary for SPRANS projects
41MCH Formula and Allocation
- The amounts appropriated for States are allocated
as follows - Funds appropriated up to 422,050,000 are
distributed on the basis of the amount awarded in
FY 1983 - Above 422,050,000 are distributed on the basis
of the number of low-income children (under 18)
in each State in relation to the total number of
such children nationally
42MCH Budget for 2005, and 2006(millions)
FY2005
2006(PB)
2006(S)
2006(H)
- MCHBG723.9...723.9...710.0.700.0
- State.591.1....601.9..579.1573.0
- SPRANS..102.7....106.2.....102.2101.2
- CISS...14.6...15.8.. 11.7....... 10.8
- Earmark...15.5.....0.0.. 17.0....... 15.0
1-numbers may not add due to rounding
43MCH Budget for 2005, and 2006(millions)
FY2005
2006(PB)
2006(S)
2006(H)
- Healthy Start102.5..97.7104.097.9
- Hearing.... 9.8 .. 0.0... 9.810.0
- EMSC..19.8.0.0 20.019.0
- TBI 9.3..0.0 9.3 9.0
- Sickle Cell .. 0.2.....0.0 0.5 0.0
1-numbers may not add due to rounding
44MCH Budget for 2005, and 2006(millions)
2005
2006(PB)
2006(S)
2006(H)
- SPRANS Earmarks
- Oral Health..4.96 ..0.0..5.0.5.0
- Sickle Cell.3.97...0.0..4.0.4.0
- Epilepsy....2.98...0.0..3.0.3.0
- Genetics.1.98......0.0..2.0.3.0
- Mental Health.1.59...0.0...1.0...0.0
- Fetal Alcohol..-----.-----1.00.0
1-numbers may not add due to rounding
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46 MCH BUREAU
HISTORY
47The MCH Block Grant (Title V) history
- 1912--Creation of the Childrens Bureau
- to investigate and report on the status of
children and on their common as well as special
needs - 1913Prenatal Care published
- 1914Infant Care published
- 1921--Sheppard-Towner Act
- First federal grant-in-aid program to States for
health, to promote the welfare and hygiene of
maternity and infancy - 1930American Academy of Pediatrics
48The MCH Block Grant (Title V) history
- 1935--Title V of the Social Security Act
- Grants-in-aid to States for MCH programs,
services for crippled children, and child welfare
services - 1943Autism is officially described by Dr. Leo
Kanner - 1950disposable diapers are invented by Marion
Donovan
49The MCH Block Grant (Title V) history
- 1957Mental retardation programs
- Congress earmarked 1M for demonstration clinical
programs for children with mental retardation - 1962St. Judes founded by Danny Thomas
- 1963-5MIC and C Y programs
- Three new grants NICU, family planning, dental
care - 1968electronic fetal monitoring first used
- 1969--Administration transferred to the Public
Health Service
50The MCH Block Grant (Title V) history
- 1981 (OBRA 81)--Converted Title V to a block
grant by combining seven categorical programs - MCH/CSHCN
- SSI
- Lead screening
- Genetic diseases
- SIDS counseling programs OBRA 81
- Hemophilia treatment centers
- Adolescent program grant
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52The MCH Block Grant (Title V) history
- 1982Prenatal test for sickle cell disease
- 1984Emergency medical services for children
enacted - 1989 (OBRA 89)--Introduced major changes
- Application with needs assessment and priorities
- Measurable objectives
- Budget accountability
- Documentation of match
- Maintenance of effort
53The MCH Block Grant (Title V) history
- 1991Healthy start enacted
- 1996Abstinence education program begun
- 2000Performance measures, CSHCN survey,
www.mchdata.net, newborn screening, abstinence,
poison control, bioterrorism
54The MCH Block Grant (Title V) history
- 2004Performance measures, CSHCN survey, child
health survey, anti-bullying campaign, early
childhood, newborn screening, womens health,
discretionary grants reporting system, data and
evaluation, training strategic plan
55 MCH BUREAU
LAW
56The MCH Block Grant (Title V) States Program
501(a)(1)(a-d)
- Title V authorizes appropriations to states to
improve the health of all mothers and children - To provide and assure mothers and children...
Access to quality maternal and child health
services - To reduce infant mortalitypreventable diseases
and handicapping conditions among
childrenincrease number of...Immunized
children
57The MCH Block Grant (Title V) States Program
501(a)(1)(a-d)
- To increase low income children receiving health
assessments anddiagnosis and treatment services - Promote healthby providing prenatal, delivery,
and postpartum care - Promote health of children by providing
preventive and primary care services
58The MCH Block Grant (Title V) States Program
501(a)(1)(a-d)
- To provide rehabilitation services for blind and
disabled individuals under 16 receiving benefits
under Title XVI, to the extentit is not provided
under Title XIX - To provide and promote family-centered,
community-based, coordinated carefor children
with special health care needsand facilitate
community based systems of services for such
children and their families
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60The MCH Block Grant (Title V) SPRANS
501(a)(2)
- To provide for SPRANS, research, and training
for MCH and CSHCN, for genetic disease testing,
counseling, and information development and
dissemination programs, for grants (including
funding for comprehensive hemophilia diagnostic
treatment centers) relating to hemophilia without
regard to age, and for the screening of newborns
for sickle cell anemia, and other genetic
disorders and follow-up services
61The MCH Block Grant (Title V) CISS
501(a)(3)
- To provide for maternal and infant health home
visiting programs - Increase participation of obstetricians and
pediatricians under Title V and Title XIX
62The MCH Block Grant (Title V) CISS
501(a)(3)
- Develop integrated MCH delivery systems and use
the model application form - Develop MCH centers which provide prenatal,
delivery, and postpartum care for pregnant women
and preventive and primary care services for
infants up to age one
63The MCH Block Grant (Title V) CISS
501(a)(3)
- Develop MCH projects to serve rural populations
- Develop outpatient and community based services
programs (including day care centers) for CSHCN
whose medical services are provided primarily
through inpatient institutional care
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65The MCH Block Grant (Title V) Restrictions
504(b)(1-5)
- cannot pay for inpatient services, other than
for services to CSHCN or to high-risk pregnant
women and infants - cannot make cash payments to intended recipients
of health services
66The MCH Block Grant (Title V) Restrictions
504(b)(1-5)
- cannot purchase or improve land, buildings, or
other major medical equipment - cannot use for satisfying the requirement for
expenditure of non-federal funds - cannot pay for research or training other than
to a public or nonprofit private entity
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68The MCH Block Grant The State Shall
505(a)(5)(A,D,E)
- establish a fair method for allocating funds
among such individuals, areas, and localities who
need MCH services - apply guidelines for content of health care
assessments and services and for assuring their
quality
69The MCH Block Grant The State Shall
505(a)(5)(A,D,E)
- assure charges, if imposed, will be public, are
not for low income mothers and children, and will
be adjusted to reflect income, resources, and
family size - provide for a toll-free hotline for use of
parents to access information about providers for
Title V and XIX and about other relevant health
care providers
70The MCH Block Grant The State Shall
505(a)(5)(F)(i-iv)
- coordinate activities with EPSDT including
periodicity and content standards and ensure no
duplication - arrange and carry out coordination agreements for
care and services with Title XIX
71The MCH Block Grant The State Shall
505(a)(5)(F)(i-iv)
- coordinate activities with other related
Federal programs--WIC, education, other health,
developmental disability, and family planning - provide for services to identify pregnant women
and infants eligible for Medicaid and assist them
in applying for assistance
72The MCH Block Grant The State Shall
505(a)(5)(F)
- make the application public within the State to
facilitate comment from any person (including any
Federal or other public agency) during its
development and after its development
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74The MCH Block Grant Administration 509(b)
- The State health agency shall be responsible for
the administration (or supervision of the
administration) of programs carried out under
this Title, except that for a State which on July
1, 1967, administered CSHCN by another Sate
agency, it still complies
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76Contact
Peter C. van Dyck, M.D., M.P.H. HRSA/MCHB http/
/mchb.hrsa.gov/