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
1
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
10
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
11
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
13
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
14
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
16
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%
17
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)
18
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
19
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
32
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
34
2016 Health Outcomes - Missouri 2016 Health Factors - Missouri
Different Years, Same Counties..
Source: County Health Rankings, http://www.countyhealthrankings.org
35
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)
36
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:
573-751-6435
573-526-0452
