TITLE V MATERNAL AND CHILD HEALTH

NEEDS ASSESSMENT, 2016-2020

Mindy Laughlin, RN

Title V Director

Missouri Department of Health and Senior Services

Venkata PS Garikapaty, MSc, MS, PhD, MPH

Chief, Office of Epidemiology

Missouri Department of Health and Senior Services

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03/22/2017 Public Health Conference, Jefferson City, MO

Transformation of the MCH Block

Grant 2

Triple Aims of Transformation

1. Reduce Burden

2. Maintain Flexibility

3. Improve Accountability

Triple Aims #1 3

1. Reduce Burden

Fewer data reporting forms

Less repetition in narrative reporting

Provision of Federally Available Data (FAD) for

National Performance Measures (NPMs) and National

Outcome Measures (NOMs) for States, when possible

Triple Aims #2 4

Retain Flexibility -- Missouri:

Develops a 5-year plan to address unique Priority

Needs and National MCH Priorities (Year One)

Selects 8 of 15 NPMs based on Priority Needs (Year

One)

Develops one or more Evidence-based or –informed

Strategy Measures (ESMs) for each NPM (Year Two)

Establishes State performance measures (SPMs) to

address Priority Needs not addressed by NPMs

(Year Two)

Triple Aims #3 5

Improve Accountability

Documentation of Title V program impact

Development of State Action Plan that links Priority

Needs with National/State outcome and performance

measures and with evidence-based or –informed

strategies

Development of measurable Title V activities that

directly address the 8 selected NPMs and reflect areas

where State Title V programs can have demonstrated

impact

Three Tier Performance Measure

Framework 6

National Outcome Measures

National Performance Measures

Evidence-Based or Evidence-Informed Strategy Measures

Performance Measure Framework 7

National Outcome Measures (NOMs) are for

population health assessment

15 National Performance Measures (NPMs)

identified across 6 population domains

As available, NPMs and NOMs are drawn from

national data sources and prepopulated for States

to analyze

If data are not available, States will provide their

own data.

State Title V MCH Program Needs Assessment,

Planning, Implementation and Monitoring Process 8

National Performance Priority Areas and

MCH Population Domains 9

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MCH Needs Assessment: Core Activities

Part 1: Qualitative–Stakeholder Input (Focus

Groups: Consumers, Providers and Agencies)

Part 2: Quantitative–Epidemiological Analysis of

MCH Indicators

Part 3: Identification of State MCH Priorities

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Stakeholder Input - Process 12

Family Partnership Summit for CYSHCN families,

Family Partnership Survey - April 11-12, 2014

Consumer and Provider focus groups across the

state:

60-90 minute sessions, study guide with issues

followed by a survey

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Reasons that Prevented Families from

Getting Health Care Services for Child

15.2%

4.6%

4.6%

0.0%

4.6%

4.5%

6.1%

4.6%

13.6%

It was too expensive

Inconvenient office hours

Transportation problems

Don't have a regular health care provider

Provider or service not available in mycommunity

Could not find a provider who would seemy child

Could not miss school or work

No insurance

Insurance did not cover

22% of families reported having been prevented or delayed from

getting health care for their child

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FOCUS GROUPS SUMMER 2015 – IN YOUR COMMUNITY

We Want to Know What

You Think

Sponsored by the Missouri Department of Health

and Senior Services 15

Focus Groups: When, Where and Who?

Town/City Location

Type of Focus

Group Date

Participant

Counts

(n=186)

Sedalia Pettis County Health Center Consumer August 21 11

Jefferson City Central Missouri Community Action Agency Consumer August 29 20

Columbia Columbia/Boone County Health Dept. Consumer September 9 2

Columbia Columbia/Boone County Health Dept. Consumer September 9 18

Springfield Jordan Valley Community Health Center Consumer September 15 10

Branson Taney County Health Dept. Consumer September 16 8

Joplin South Joplin Early Head Start Consumer September 17 9

Kansas City Kansas City Health Dept. Consumer September 24 9

Hayti DAEOC Pemiscot County Office Consumer September 29 10

Kennett DAEOC Kennett Head Start Center Consumer September 29 13

Poplar Bluff Butler Co. Community Action Center Consumer September 30 15

Doniphan Ripley County Health Dept. Consumer September 30 14

Cape

Girardeau Cape Girardeau Public Health Center Provider October 1 16

St. Louis City of St. Louis Health Dept. Consumer November 7 15

Columbia

Centro Latino (Hispanic)

Consumer November 18 16

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Demographics of Survey Participants

Participant’s Age

Less than 20 years 5%

20 to 30 years 32%

31 to 40 years 31%

41 to 50 years 17%

51 to 60 years 11%

61 years or older 4%

Participant’s Race

White/Caucasian 58%

African-American 34% (11.6%)

Asian –

Other 8%

Participant’s Ethnicity

non-Hispanic 88%

Hispanic 12% (3%)

Primary language in household

English 98%

Spanish 4%

Other 1%

Do you have a child with special

health care needs?

No 70%

Yes 30%

(21%)

Relationship to Child

Mother 75%

Father 7%

Biological parent 1%

Adoptive parent 1%

Foster parent 3%

Legal guardian 1%

Other 12%

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Provider Focus Group Summary

Information/access: health care system too complex

Continuity of care (especially if mom’s care does not continue past pregnancy)

Transportation issues

Integrating public health into the schools would improve child health in rural areas

Further improve health education services

Disincentives to increase earnings: loss of Medicaid benefits not offset by wages gained (and loss of insurance)

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Consumer Focus Groups Summary

Slow approval of Medicaid applications affects PNC

Too few rural and Medicaid providers

Lack of dental care and mental health services

Transportation barriers–especially in rural areas

Case management–especially for SHCN children

Language barriers (need more/better interpreters)

Disincentive to increase earnings

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MCH Profile – Missouri

• Missouri Population – 6 million (83.3% white, 11.8% AA)

• Women population – 51% (84% white, 10% AA)

• 34% of women in childbearing age (18-44 years) (82% white, 14% AA)

% of Medicaid births = 40% (2015) – 34% whites, 72% AA

Percentage (%) of Medicaid Births, by Race,

Missouri 1990-2015

Source: MO DHSS. Vital Statistics – Births.

Percentage (%) of Medicaid Births, by County,

Missouri 2011-2015

State Rate (2011-2015) = 42.6%

Rate per 100 Live Births with Known Medicaid Status

Source: MO DHSS. Vital Statistics-Births

Barriers for Prenatal Care, 2009-2014 23

Source: Missouri Risk Assessment Monitoring System (PRAMS)

Barriers for Prenatal Care, 2007-2014 24

Source: Missouri Risk Assessment Monitoring System (PRAMS)

Inadequate Prenatal Care Rates by

Insurance Status, MO, 2010-2014 25

Health Insurance Status at various stages of

pregnancy, PRAMS 2012-2014

Infant Mortality Rate, MO and U.S.,

2000-2015

HP 2020: 6.0 per 1,000

Source: MO DHSS. Vital Statistics Mortality files, U.S.: CDC, NCHS. National Vital Statistics System,

Mortality. https://www.cdc.gov/nchs/data/databriefs/db267.pdf

IMR by Race, MO and U.S., 2000-2015

Source: MO data: DHSS. Vital Statistics Mortality files, U.S. data: CDC, NCHS. Compressed Mortality File on

CDC WONDER. https://wonder.cdc.gov/cmf-icd10.html

Infant Mortality Rate, MO, 1996-2015

State Rate (1996-2015) = 7.2

/1,000 live births

Rate per 1,000 Live Births

Source: MODHSS Vital Statistics-Deaths

Low Birth Weight rates (%) by County, Missouri, 2011-2015

State Rate (2011-2015)= 8.1%

Rate per 100 Live Births with Known Birth Weight

Source: MO DHSS. Vital Statistics-Births

Preterm Birth Rate (%) by County, Missouri,

2011-2015

State Rate (2011-2015) = 9.8%

Rate per 100 Live Births with Known Gestational Age

Source: MO DHSS. Vital Statistics-Births

Source: MO DHSS Vital Statistics, US: CDC, NCHS. National Vital Statistics.

http://wonder.cdc.gov/natality-current.html

Smoking During Pregnancy, US and MO,

1990-2015

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Domain = Cross Cutting/Life Course

Priority Area = Smoking

Smoking During Pregnancy, by County, Missouri,

2011-2015

State Rate (2011-2015) = 17.3%

Rate per 100 Live Births with Known Smoking Status

Source: MO DHSS. Vital Statistics-Births

Health Outcomes & Factors Map – County

Health Rankings, 2016

Source: 2016 County Health Rankings, http://www.countyhealthrankings.org

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2016 Health Outcomes - Missouri 2016 Health Factors - Missouri

Different Years, Same Counties..

Source: County Health Rankings, http://www.countyhealthrankings.org

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Final Stretch – Stakeholders Meeting

March 31, 2015, Jefferson City, MO

Review of qualitative and quantitative data

Title V Programs – Gap Analysis

Identification of state priorities

Nominal ranking of priorities – stakeholders

Review of priorities in relation to quantitative and

qualitative data (focus groups)

Identification of Missouri’s MCH priorities for the

next five years (eight out of fifteen NPMs)

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Ranking of MCH Priorities 37

Eight National Priority Areas for Missouri 38

Domain – Cross Cutting/Life Course

Ensure adequate health insurance coverage and improve health

care access for MCH populations – Adequate Insurance Coverage

Prevent and reduce smoking among women of childbearing age,

pregnant women and reduce childhood exposure to second hand

smoke – Household Smoking

Domain – Women/Maternal Health

Improve pre-conception, prenatal and postpartum health care

services for women of child bearing age – Well Woman Care

Improve maternal/newborn health by reducing cesarean deliveries

among low-risk first births – Low Risk Cesarean Deliveries

National Priority Areas for Missouri (contd..) 39

Domain – Perinatal/Infant Health

Ensure risk appropriate care for high risk infants to reduce infant

deaths – Perinatal Regionalization

Domain – Child Health and/or Adolescent Health

Reduce intentional and unintentional injuries among children and

adolescents – Child Safety/Injury

Domain – Child Health

Support adequate early childhood development and education –

Developmental Screening

Domain – Children with Special Health Care Needs

Ensure coordinated, comprehensive and ongoing health care services

for children with/without special health care needs – Medical Home

State Priority Areas Chosen by Missouri 40

Enhance breastfeeding initiation and duration rates among Missouri mothers – Breastfeeding

Promote safe sleep practices among newborns to reduce sleep-related infant deaths – Safe Sleep

Enhance access to oral health care services for MCH populations – Oral Health

Reduce obesity among women of childbearing age, children and adolescents – Physical Activity

Improve access to mental health care services for MCH populations – Mental Health

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THANK YOU!!

Contact Information:

Mindy.Laughlin@health.mo.gov

573-751-6435

Venkata.Garikapaty@health.mo.gov

573-526-0452