Focus on MCH

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Focus on MCH

• KALHD Mid-Year Meeting
• June 19 and 20, 2007

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Agenda

• Background
• Outcome Data
• Survey Summary
• Proposal
• Discussion
• Consensus/Next steps

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Background

• 2006 MCH Block Grant Reductions
• KDHE/KALHD Prioritization
• No time
• 2007 More Reductions
• Try again
• New formula - Children in poverty
• Essentially population based
• Major dislocation of funding

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Conclusion
Budget Reductions New Formula Problems
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Try Something Else

• Added more members to the workgroup
• Develop KALHD proposal
• Start with the assumption that increased funding
  would be necessary -- create a proposal and new
  formula
• Data
• Survey
• Prioritize
• Accountability
• Just in caseAccreditation? Regions?

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MCH Team Members (20)
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Staff

• Edie Snethen
• Sara Spinks
• Dennis Kriesel (KAC)
• Sarah Carkhuff-Fizell (KHI)
• Laura Harrington (KHI)
• Gianfranco Pezzino (KHI)
• Vanessa Lamoreaux (KDHE)

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Prenatal Care
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Preterm and low birth weight
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(No Transcript)
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Staff presentations

• Laura Harrington
• Dennis Kriesel

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Laura HarringtonKansas Health Institute

• KALHDs Survey of Maternal and Child Health
  Programs in Local Health Departments

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Why did we conduct a survey?

• What is happening in communities at present?
• Which areas need additional focus and/or funding?
• Need to know
• Services and activities that are/ are not
  currently provided in the community
• Who provides the activities and services?

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Survey Goals

• Develop an understanding of
• current MCH activities/services provided by LHDs
• partnerships between LHDs and other community
  organizations
• location of MCH services/activities in the
  community
• gaps in MCH services/activities
• priorities of MCH programs in LHDs

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Survey Structure

• Organized around the Federal MCH Bureaus
  Essential Services
• Infrastructure Services
• Infrastructure Building Services
• Population-Based Services
• Enabling Services
• Direct Health Services

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Survey Structure, continued

• List of activities/services
• Respondents mark where in the community each
  service/activity is offered, including these
  options
• LHD (using MCH grant funds)
• LHD (not using MCH grant funds)
• Private Physician(s)
• Hospital(s)
• Safety Network Clinics
• Community partnership/collaborative
• Activity not provided in the community currently
• Other, please specify
• Respondents could choose as many answers as were
  applicable

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Overview of Respondents

• 61/100 total respondents (61 response rate)
• 14 Frontier Counties
• 22 Rural Counties
• 13 Densely Settled Rural Counties
• 7 Semi-Urban Counties
• 5 Urban Counties

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Top 10 Results in LHDs, using MCH Block grant
funds

• 1. Breastfeeding support (91 of communities)
• 2. Provide SIDS prevention education (84)
• 3. Provide home visits by a lay person to some
  homes (84)
• 4. Provide referral and linkage to medical
  prenatal care (79)
• 5. Post-partum education (77)
• 6. Provide universal home visits by lay visitor
  to all new parents (76)
• 7. Referral to a medical home (75)
• 8. Provide home visits by a registered nurse to
  some homes (74)
• 9. Prenatal education (73)
• 10. Referral to a dental care provider (72)

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Top 10 Results in LHDs,not using MCH Block Grant
Funds

• 1. Administer childhood immunizations (80 of
  communities)
• 2. Provide nutritional educational services (79)
• 3. Provide immunization outreach (78)
• 4. Assist in establishing eligibility for public
  programs such as HealthWave or Medicaid (71)
• 5. Educate and refer to other health and
  prescription plans (71)
• 6. Pregnancy detection (68)
• 7. Referral to a dental care provider (65)
• 8. Assess and refer on nutritional issues (64)
• 9. Referral to a medical home (62)
• 10. Educate the community about importance of
  childhood immunizations (61)

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Services Commonly Covered in LHDs with and
without MCH Grant Funds

• In Top 10
• Referral to a dental care provider
• Referral to a medical home
• In Top 15 (in addition to above)
• Assist in establishing eligibility for public
  programs such as HealthWave or Medicaid
• Provide referral and linkage to medical prenatal
  care

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Interpretation of Services Offered in LHDs

• With MCH Block Grant Funds
• 4/10 services are Population-Based Services
• 6/10 services are Enabling Services
• Without MCH Block Grant Funds
• 2/10 services are Population-Based Services
• 5/10 services are Enabling Services
• 3/10 services are Direct Health Services

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Private Physician(s)

• 3/10 of the top ranked activities under the
  direction of private physicians begin with
  assess and refer for(e.g.)
• Mental health issues
• Substance abuse issues
• Nutritional issues
• Activities and services ranged from 64-0
  covered by Private Physicians
• Possibility for greater partnerships and
  collaboratives with private physicians?

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Hospitals

• 3/10 services began with assess and refer
• 4/10 services are related to patient education
• Nutritional education services
• Post-partum education
• Prenatal education
• Parental childbirth education

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Safety Network Clinics

• The highest reported percentage for any one
  activity supported by Safety Network Clinics is
  17.
• In most communities, Safety Network Clinics are
  not providing many MCH Essential Services
  (range17-0).
• 3/10 services began with Educate the community
  about(e.g.)
• Childhood immunizations
• Importance of other MCH issues
• Importance of prenatal care

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Community Partnerships/ Collaboratives

• 2/10 services are providing services
• Substance abuse services
• Mental health services
• 5/10 services related to community collaboration
• Participating in collaborations, partnerships,
  coalitions, and workgroups on related topics

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Top 10 Services which LHDs Reported as Not
Currently Provided in the Community

• 1. Direct health services for juvenile detention
  centers (71)
• 2. Link to MCH-related services through community
  hotline (63)
• 3. Monitor health disparities among racial
  ethnic groups (51)
• 4. Provide universal risk screenings for all new
  parents (48)
• 5. Direct health services for incarcerated women
  (45)
• 6. Target services to racial and ethnic groups to
  reduce health status disparities (42)
• 7. Provide lead screening for pregnant women
  (41)
• 8. Develop reports on MCH status in the community
  for policymakers and stakeholders (other than
  KDHE) (40)
• 9. Provide maternal depression screening (40)
• 10. Participate in policy development on MCH
  issues (35)

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Dennis KrieselKansas Association of Counties

• Data Analysis

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The Data What We Used

• Four measures were selected that closely linked
  to MCH activities and could serve as potential
  topics for legislative discussions
• Inadequate Prenatal Care
• No Prenatal Care
• Low Birth Weight
• Premature births

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Challenges in Data Acquisition

• Original source was Kansas Information for
  Communities (KIC)
• KIC blocked information in all categories where
  fewer than six cases existed
• Information for selected categories was requested
  and provided by KDHE
• Missing information filled via 2005 Annual
  Summary of Vital Statistics

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KS MCH Measures (2000-2005)

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MCH Measures by Density Class
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Low Birth Weight
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No Prenatal Care
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Premature Births
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Inadequate Prenatal Care
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LPA AuditLow Birth weight and Premature Babies
Reviewing Programs Aimed At Reducing Their
Incidence and Associated Costs (June 2003)
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Draft Proposal
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Draft Proposal

• Based on MCH 2010 and Needs Assessment
• Prioritize adequate prenatal care
• 90
• No care
• Prioritize improvement in birth weight
• Population risk reduction

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State Contribution Ranking
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Local Contribution Ranking
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The math

• 2005 Births -- 39,701
• 2005 Inadequate Prenatal Care -- 4,907
• 2005 No Prenatal Care -- 397

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More math

• 40,000 births x 90 36,000
• Currently, 35,000 adequate prenatal care
• 1,000 to reach 90 goal
• Assumptions
• Nursing caseworker - 45,000
• Caseload - 50 per caseworker
• 1,000/50 20 caseworkers
• 20 x 45,000 900,000

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And more math

• 400 no prenatal care
• Assumptions
• No coverage
• 1,000 to provide prenatal coverage
• 400 x 1,000 400,000

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And even more math

• 40,000 births
• Assumptions
• Population wide risk reduction education and
  strategies
• 5 per birth
• 40,000 x 5 200,000

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Summary

• 900,000 increase prenatal care
• 400,000 increase coverage
• 200,000 other risk reduction strategies
• 1,500,000 total proposal

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Next steps

• OK?
• Begin discussions
• KDHE
• KAC
• Other partners, stakeholders or supporters
• Refine data and survey analysis
• Develop new formula to apply if increased funding
  is received
• Develop an ongoing KALHD MCH workgroup?