2020-2025 Title V Community Assessment Kelley Barragan, MCAH Program - - PowerPoint PPT Presentation

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Santa Barbara County Maternal Child and Adolescent Health 2020-2025 Title V Community Assessment

Kelley Barragan, MCAH Program Coordinator Mitchell Hee, Epidemiology Intern Michelle Wehmer, Epidemiologist

PHD Mission: To improve the health of our communities by preventing disease, promoting wellness, ensuring access to needed health care, and maintaining a safe and healthy environment.

Objectives

 Define Title V requirements  Examine local worsening and improving indicators  Identify priority problems  Discuss current solutions and how we, as a community, can create change

Title V Maternal & Child Health Block Grant

Reporting requirements mandate completion of a State annual report that specify:

 Needs of the State MCAH population  Programs and policies implemented to meet those needs  Monitor progress toward achieving federal and state performance outcome measures  Management/expenditure of funding  Every 5 years a comprehensive statewide needs assessment must be conducted of the MCH population

Title V Maternal & Child Health Block Grant

In California - Decentralized statewide needs assessment process - each local health jurisdiction (LHJ) conducts a needs assessment Key Objectives  Identify local needs and capacity  Obtain stakeholder input at the local level  Focus local MCAH efforts by having each LHJ identify priority areas they will focus on during the next 5 years  Develop a local five-year action plan

Methodology for 2020-2025 SBC Title V Needs Assessment

 Analyzed FHOP (Family Health Outcomes Project) Databooks and

• ther local epi data reports on various MCAH health indicators

 Incorporated data from various community needs assessments  Santa Barbara County Public Health Department Community Needs Assessment 2016  Cottage Health Community Needs Assessment 2016  Dignity Health Community Needs Assessment 2016  Santa Barbara County Children’s Scorecard 2017  Santa Barbara County First 5 Strategic Plan 2017-2021  Santa Barbara County Oral Health Needs Assessment 2019  Administered web-based survey to stakeholders on priority issues, causes, intervention/strategies, and partners  Obtained feedback from community at Stakeholder Meeting via roundtable discussions

2015-2020 Community Assessment MCAH priorities

 Increase health care and insurance access to low-income women and children in Santa Barbara County  Increase community-wide knowledge, access and linkage of children to a dental home where possible to ensure preventive care and increase access to fluoride varnish.  Increase number of health care providers who routinely screen pregnant women and mothers of children under 2 years of age for Perinatal Mood and Anxiety Disorder (PMAD) and refer as needed.  Increased number of health care providers who routinely screen pregnant women and mothers of children under 2 years of age for Substance Use and refer as needed.  To reduce the number of SIDS/SUID events by promoting optimal sleep environments.

Highlights of success from 2015-2020 Needs Assessment Action Plans

• MCAH Field Nursing Unit updated policies and implemented CQI

activities to ensure all eligible children, pregnant ,and postpartum women are enrolled in Medi-Cal, had access to timely care, and received dental resources and information.

• Local Oral Health Collaborative developed an oral health campaign

focusing on children 0-5.

• Perinatal Wellness Coalition worked to update resource guide of local

Substance Abuse treatment services.

• MCAH Program surveyed local CPSP providers on PMAD and SA

screening practices and provided current recommendations and resources.

• Partnership with Marian Regional Medical Center and other local

partners to address PMADs through creation of a web-based resource directory with 211, community/provider trainings, and development

• f a tool-kit.
• Collaboration with SBHCC and Sansum Diabetes Research Institute to

develop a pilot project with a “Centering-Like” model for GDM clients.

• MCAH Program provided SIDS/Safe Sleep presentations to numerous

local organizations that interact with pregnant women/0-1 y/o.

• MCAH Field Nursing Unit incorporated the NEAR@Home Framework

to address ACEs with distribution of training materials to other local partners

Conceptual Framework Public Health System 10 Essential Functions

Source: CDC Website

Conceptual Framework Life Course Model

Conceptual Framework PHD Focus Area: Social Determinants of Health (SDOH)

Conceptual Framework PHD Focus Area: Health Equity

Source: Robert Wood Johnson Foundation https://www.rwjf.org/en/library/infographics/visualizing-health-equity.html#/download

Conceptual Framework PHD Focus Area: Adverse Childhood Experiences (ACEs)

Overview of SBC Demographics

Add picture of SBC

Source: visitcalifornia.com

SBC Population by City, 2016 (N = 447,073)

Santa Maria 23.9% Guadalupe 1.6% Lompoc 9.8% Solvang 1.2% Buellton 1.1% Santa Barbara 21.1% Goleta 7.0% Carpinteria 3.1% Balance Of County 31.2%

Source: California Department of Finance, Population Estimates, 2016

SBC Population by Race and Ethnicity, 2016

Hispanic 44.4%, 44.4 White 45.9%, 45.9 Black 1.7%, 1.7 American Indian 0.3%, 0.3 Asian 5.1%, 5.1 API 0.1%, 0.1 Multi-Race 2.4%, 2.4

Source: Census Data 2016

SBC Population Race and Ethnicity by City, 2016

Lompoc

Hispanic 52.8% White 34.1% Black 5.3% American Indian 0.5% Asian 3% API 0.4% Multi-Race 3.8% Other 0.1%

Source: Census Data 2016

Santa Maria

Hispanic 73.4% White 19.5% Black 0.8% American Indian 0.1% Asian 5.1% API 0.1% Multi-Race 0.9% Other 0.1%

Santa Barbara

Hispanic 38.2% White 54.5% Black 1.4% American Indian 0.3% Asian 3.5% API 0% Multi-Race 2% Other 0.1%

SBC Population by Age Group, 2016

<5 6.5% 5-24 32.0% 25-44 24.6% 45-64 22.9% 65+ 14.0%

Source: Census Data 2016

SBC Population Age Groups by City, 2016

8.7% 29.0% 27.6% 24.3% 10.5%

Lompoc

<5 5-24 25-44 45-64 65+

Source: Census Data 2016

9.5% 33.7% 28.3% 18.7% 9.8%

Santa Maria

5.5% 26.0% 27.2% 24.2% 17.1%

Santa Barbara

SBC Birth Rate, 2007- 2016

52.0 54.0 56.0 58.0 60.0 62.0 64.0 66.0 68.0 70.0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Birth Rate (per 1,000 population)

Source: SBC PHD Vital Records; State of California, Department of Finance, State and County Population Projections by Race/Ethnicity, Detailed Age, and Gender, 2010-2060. Sacramento, California, January 2018.

Race and Ethnicity of Mothers who gave Birth in 2016, N=5501

Hispanic 65% White 28% Asian 5% Unknown 1% Black 1% American Indian 0%

Source: CA Birth Statistical Master File, 2016

Santa Barbara County Medi-Cal Clients

Source: 2017 Santa Barbara County Children’s Scorecard, p.33

Medi-Cal Delivery Rates by Local vs. State and Ethnicity Highlights:

Hispanics have a higher rate of Medi-Cal deliveries than Whites Locally and in CA.

Source: CA Birth Statistical Master File, 43.4 58.4

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Rate of Delivery with MediCal

Local Versus State

CA SBC

23.1 20.1 63.0 78.0

0.0 20.0 40.0 60.0 80.0 100.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Rate of Delivery with MediCal

By Ethnicity

CA White SBC White CA Hispanic SBC Hispanic

Education Level and Public Assistance, 2016

Education level:  The percentage of births to mothers with an education level below GED (does not include 17 births where an address was withheld and removes births where mother education was not answered):  North County 50.3% (1224/2431)  Middle County 20.4% (187/915)  South County 14.0% (213/1521) Public Assistance:  Medi-Cal Births by SBC Geographic Area (5,501 births in 2016) show that 61.1% of births are to women on Medi-Cal county-wide.  79.4% of births in North County were to Medi-Cal recipients.

Source: Vital Records Birth Stat Master File, 2016.

Highlights:

North County mothers have less formal education than Mid or South County mothers. North County has a higher percentage of births to Medi-Cal recipients than Mid or South County

Poverty

44.7 47.0

36.0 38.0 40.0 42.0 44.0 46.0 48.0 50.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Rate of Individuals in Poverty

SBC Population by Age 0-18

CA SBC

Highlights:

The rate of Children and Females living in poverty is higher in SBC than CA.

33.7 36.4

0.0 10.0 20.0 30.0 40.0 50.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Rate of Individuals in Poverty

SBC Females by Age 18-64

CA SBC

Source: Small Area Health Insurance Estimates

Unemployment per 100 People in the Employment Market

6.2 5.3

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Unemployment Rate

CA SBC

Highlight:

Unemployment rates have been decreasing the past several years and SB is doing better than CA.

Source: Office of Attorney General ; CA Department of Finance

MCAH Health Indicators

79% of pregnant women received prenatal care beginning the first trimester in Santa Barbara County in 2016.

Source: https://scorecard.childrennow.org/?ind=earlyPrenatalCare&yr=1

CA Avg: 84%

78.1 73.9 70.9 73.3 75.2 76.8 76.8 77.7 79.6 79.3

65 70 75 80 85 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Percent per 100 Live Births

Prenatal Care Received During the First Trimester Santa Barbara County, 2007-2016

SBC HP 2020 Target 77.9%

Source: PHD Birth Statistical Master Files, 2007-2016

• unknown responses removed from data.

Prenatal Care in the first trimester by ethnicity, SBC, 2007-2016

85.6% 83.4% 84.8% 86.4% 85.0% 87.5% 85.4% 86.9% 87.5% 87.0% 70.1% 65.1% 62.1% 67.2% 70.2% 71.0% 72.1% 73.2% 73.0% 74.1% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Percentage of Pregnant Women Whites Latinas

Source: PHD Birth Statistical Master Files, 2007-2016.

Highlight:

Consistently lower rate

• f prenatal care among

Latinas than Whites

Tdap Vaccination

Tdap Immunizations during pregnancy per 100 females delivering a live birth (2015-2016). SBC Rate: 57.5 CA Rate: 50.4

Highlight:

Local Tdap immunization rates during pregnancy are greater than CA rates, but room for improvement when compared to other 20 counties with highest number of births.

Source: FHOP Community Health Status Report, 2017

Gestational Diabetes Rates by Local vs. State and Ethnicity

0.0 2.0 4.0 6.0 8.0 10.0 12.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Rate of Gestational Diabetes

Local Versus State

CA SBC

Highlight:

Hispanic women have higher rates of GDM than Whites both locally and in CA.

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Rate of Gestational Diabetes

By Ethnicity

CA White SBC White CA Hispanic SBC Hispanic

Source: Office of Statewide Health Planning and Development. Hospital Discharge Data.

Diabetes in Pregnancy

 In the United States, about 1% to 2% of pregnant women have type 1 or type 2 diabetes and about 6% to 9% of pregnant women develop gestational diabetes (Source: CDC).  In 2018, 8.9% of postpartum women in the WIC program (211/2376) reported having GDM in the past.

Perinatal Mental Health

 One in five California women who recently gave birth experienced symptoms of depression during or after pregnancy, according to the MIHA survey. That translates to about 100,000 women a year.  All women are at risk for symptoms of perinatal depression; however, Black or Latina women, teens, women who have low incomes or those who have experienced hardships in their childhood or during pregnancy are at heightened risk of having symptoms of depression.

Highlights:

20% of California women experience symptoms of depression during or after pregnancy Women of certain racial/ethnic groups, in lower social economic levels, that are younger, and /or who experience hardships in childhood are at greater risk

Source: “Symptoms of Depression During and After Pregnancy” MIHA Issue Brief https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/Communications/Data-Brief-MIHA-2018-01.pdf

Perinatal Depression

Highlight:

Local rates are not statistically significant when compared to CA Rates Prenatal depressive symptoms per 100 females delivering a live birth (2013-2015). SBC Rate: 17.3 CA Rate: 14.1 Postpartum depressive symptoms per 100 females delivering a live birth (2013-2015). SBC Rate: 15.2 CA Rate: 13.5

Source: FHOP Community Health Status Report, 2017

Substance Abuse Hospitalizations

• f Pregnant

Women

21.0 17.3

0.0 5.0 10.0 15.0 20.0 25.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Rate of Pregnant Women Admits

All 15-44 year olds CA SBC

Highlight:

Substance Abuse Hospitalizations of Pregnant Women has been trending up locally.

29.5 22.5 15.8 15.3

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Rate of Pregnant Women Admits

By race and ethnicity CA White SBC White CA Hispanic SBC Hispanic

Source: Office of Statewide Health Planning and Development. Hospital Discharge Data

Substance Use In SBC

According to 2013-15 MIHA data:  13.5% of SBC women had any binge drinking during the 3 months before they knew they were pregnant  8.8% of SBC women had any alcohol use in the 3rd Trimester

• No data for <High School
• 5.9% High School Graduate/GED
• 8.3% Any College
• 20.5% College Graduate

In FY 17/18, 13% (193/1455) of families served by MCAH Field Nursing Unit were identified with current or past substance use.

Highlight:

A higher percentage of college-educated mothers used alcohol in the 3rd trimester than those with less formal education.

Percentage of Mothers Breastfeeding In- Hospital, 2010- 2017

2010 2011 2012 2013 2014 2015 2016 2017 SBC - Any 95.2 95.5 95.0 95.2 95.7 95.4 95.9 96.2 CA - Any 90.8 91.7 92.3 93.0 93.6 93.9 94.0 94.0 SBC - Exclusive 60.9 56.3 54.8 56.5 59.0 57.8 59.3 61.6 CA - Exclusive 56.8 60.6 62.6 64.8 66.8 68.6 69.6 69.8 HP 2020 - Target 81.9 81.9 81.9 81.9 81.9 81.9 81.9 81.9 81.9

96.2 94.0 61.6 69.8

HP 2020 'Any BF', 81.9%

40.0 50.0 60.0 70.0 80.0 90.0 100.0

Breastfeeding Percentage

Highlight:

Local percentage of any breastfeeding is greater than CA and HP 2020 Target Local percentage of exclusive breastfeeding is lower than CA

Source: California In-Hospital Breastfeeding as Indicated on the Newborn Screening Test Form Statewide and Maternal County of Residence, 2010-2017.

59% of newborns were exclusively breastfed while in the hospital in Santa Barbara County in 2016.

Source: https://childrennow-scorecard.netlify.com/?ind=breastFeeding&yr=1

CA Avg: 70%

69.6% 69.80% 59.3% 61.60% 54.0% 56.0% 58.0% 60.0% 62.0% 64.0% 66.0% 68.0% 70.0% 72.0% 2016 2017

Percentage of Exclusive Breastfeeding Exclusive In-Hospital Breastfeeding per 100 Females Delivering a Live Birth CA SBC

Source: California In-Hospital Breastfeeding as Indicated on the Newborn Screening Test Form Statewide and Maternal County of Residence, 2016-2017.

Exclusive In-Hospital Breastfeeding by Hospital, SBC, 2016

42.8% 49.6% 60.3% 47.3% 46.8% 76.2% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% Lompoc Valley Medical Center Marian Medical Center Santa Barbara Cottage Hospital

Percentage of Exclusive Breastfeeding Santa Barbara County, 2012 (Left Bar), 2016 (Right Bar)

Source: California In-Hospital Breastfeeding as Indicated on the Newborn Screening Test Form Statewide, County and Hospital of Occurrence: 2016.

Highlight:

Cottage and Lompoc have increased exclusive in- hospital breastfeeding rates, while Marian has decreased. Cottage received Baby Friendly designation in 2018 and Marian is working toward their designation.

Breastfeeding Ethnic Disparities Exclusive Breastfeeding 3 Months After Delivery

79.9% Women of Caucasian ethnicity exclusively breastfed in- hospital, while 50% of Hispanic women exclusively breastfed in hospital (SBC 2016). SBC’s average breastfeeding rate 3 months after delivery 33.5%; the state’s average is 29.1%

 Comparison is not significant

Source: California In-Hospital Breastfeeding as Indicated on the Newborn Screening Test Form Statewide, County and Hospital of Occurrence: 2016. FHOP Community Health Status Report, 2017

Teen Birth Rate, SBC, 2007-2016

10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

Birth Rate (per 1,000 population)

Santa Barbara County** California

* Teenage mothers are defined as 15-19 years of age at time of childbirth. Source: Vital Statistics Query System - cdph.ca.gov Population: Department of Finance Demographic Unit, 2017 http://www.dof.ca.gov/research/demographic/projections/ ** Statewide data: Report 2-2: Birth Rates by Age of Mother 2007-2016, https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/Data/Adolescent/Adolescent-Birth- Rates-2016.pdf

Highlight:

Teen birth rates have been decreasing both in CA and SBC.

Teenage Births by City, SBC, 2009- 2016

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0%

Percentage of Teenage Births

SBC Carpinteria SB City Lompoc Guadalupe Santa Maria

* Teenage mothers are defined as 15-19 years of age at time of childbirth. * Location is determined by mother's residency Source: Birth data: Vital Records office of Santa Barbara County and Vital Statistics Query System - cdph.ca.gov

Highlight:

The percentage of teenage births has decreased in all cities between 2009 and 2016. Santa Maria and Guadalupe have the highest percentages of teen births in the county.

2005 2011 2016 Santa Barbara County 651/6192 551/5803 321/5501 Carpinteria 30/225 14/192 7/199 Santa Barbara City 118/1915 77/1071 29/1235 Lompoc 96/928 85/876 47/838 Guadalupe 19/170 23/141 8/136 Santa Maria 371/2670 303/2619 204/2527 Numerator: Number of Teen Births by Location Denominator: Total Number of Births by Location

* Teenage mothers are defined as 15-19 years of age at time of childbirth. * Location is determined by mother's residency Source: Birth data: Vital Records office of Santa Barbara County and Vital Statistics Query System - cdph.ca.gov

Highlight:

The percentage of teenage births has decreased in all cities between 2009 and 2016. Santa Maria and Guadalupe have the highest percentages of teen births in the county.

Teenage Births by City, SBC, 2009- 2016

Teenage Birth by Region, SBC, 2016

North County, 213, 66.6% Central County, 52, 16.3% South County, 55, 17.2%

Source: Vital Records Birth Statistical Master File, 2016; 1 birth did not have a zip code identified

Highlight:

There are a higher number of births to teens in North County than South or Mid County.

Cesarean Births per 100 Low Risk Females

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rate of Cesarean Births CA SBC

Source: CA Birth Statistical Master File,

HP 2020 goal = 23.9%

Highlight:

SBC is statistically doing worse than CA in cesarean births of low risk females.

Percentage of Underweight Births, SBC, 2007- 2016

5000 5200 5400 5600 5800 6000 6200 6400 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0% Number of Births

Percentage of Total Births

Total Births LBW HP 2020 LBW 7.8% VLBW HP 2020 VLBW 1.4%

* Low Birth Weight (LBW) is defined as 1500-2499 g * Very Low Birth Weight (VLBW) is defined as under 1500g Source: Birth data: Vital Records office of Santa Barbara County and Vital Statistics Query System - cdph.ca.gov

Highlight:

There has been a decrease in births in SBC

• ver time. VLBW appears

stable, but LBW has slightly increased in the last two yeas. SBC met the HP 2020 target for both LWB and VLBW from 2007-2016.

Percentage of Premature Births, SBC, 2007-2016 Highlight:

Between 2010-2016, SBC met or exceeded the HP 2020 target. In recent years, the percentage of premature births has trended up locally.

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Percentage of Premature Births

Percentage of Premature births HP 2020 Target 9.4%

Source: State Birth Statistical Master files, 2007-2016

Unintended Pregnancies Highlight:

While the SBC rate is not statistically different than CA, 30% of pregnancies are miss- timed or unwanted. Mis-timed or unwanted pregnancy per 100 females delivering a live birth (2013-2015). SBC Rate: 30.8 CA Rate: 30.5

Source: FHOP Community Health Status Report, 2017

Births Occurring Within 18 Months

• f a Previous Live

Birth

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 2007 2008 2009 2010 2011 2012 2013 2014 2015

Birth Rate CA SBC

Highlight:

While the SBC rate is not statistically different than CA, 25% of women are conceiving before the recommended time.

Source: CA Birth Statistical Master File,

Sexually Transmitted Diseases (STDs)

Highlight:

Chlamydia (CT) remains the most common reportable disease in CA and is at its highest recorded level since 1990. Gonorrhea (GC) cases continued to increase sharply across all regions. Early syphilis (ES) cases continued to increase across all regions.

Syphilis and Congenital Syphilis Highlight:

Over the last several years, CA has experienced a steep increase in syphilis among women and congenital syphilis

Santa Barbara County

Source: MIHA, 2013-2014

Infant Sleep Practices

Highlight:

The percentage of women always or often sharing a bed with an infant is higher in SBC than CA. Mothers with less formal education share a bed more

• ften than those with higher

levels of education. Mothers enrolled in Medi-Cal share a bed more often than those with private insurance.

44.8% 34.1% 65.1% 30.3% 52.9% 31.3% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% SBC CA Without High School Diploma Graduated from College With Medi- Cal With Private Insurance

Percentage of Women Always or Often Sharing a Bed with an Infant

Uninsured per 100 Females Aged 18- 64 Years Old Highlight:

In 2011, “1 in 4” women were uninsured, whereas in 2015, “1 in 10” women were uninsured in SBC. In recent years, SBC has statistically been doing worse than CA

0.0 5.0 10.0 15.0 20.0 25.0 30.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rate of Uninsured Females

CA SBC HP 2020 Target

Source: Small Area Health Insurance Estimates

Uninsured per 100 Individuals Aged 0- 18 Highlight:

The Affordable Care Act (2014) and SB75 (2016) have significantly impacted the number of SBC children with medical insurance. However, between 2013- 2015, SBC was statistically doing worse than CA.

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rate of Uninsured Individuals

CA SBC HP 2020 Target

Source: Small Area Health Insurance Estimates

Children’s Oral Health (CA vs. SBC)

74.0% 13.0% 4.1% 8.9% 76.3% 22.1% 1.5% 0.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% < 6 months ago 6-12 months ago > 12 months ago Never

Estimated Percentage of Children Ages 2-11, by Length of Time Since Their Last Dental Visit

CA SBC

Highlight:

Of the parents surveyed locally, the majority reported their children saw a dentist less than 6 months ago.

Source: SB Oral Health Needs Assessment (2018) p.16-17

Children’s Oral Health

646 737 582 477 463 345 100 200 300 400 500 600 700 800 2012 2013 2014 2015 2016 2017

Figure 9. Untreated Tooth Decay in Kindergarteners, Santa Barbara County. 2012-2017

Source: SBC Oral Health Needs Assessment (2018) p. 18

Highlight:

In SBC, the number of untreated tooth decay in kindergarteners has generally decreased from 2012 to 2017.

Dental Access in SBC

Santa Barbara County Residents who qualify and are enrolled in the Medi-Cal program receive dental insurance through the Medi-Cal Dental program. Santa Barbara County is home to 352 dentists. Out of those dentists, only 20 are accepting new patients.

Highlight:

Medi-cal clients in SBC who need to establish care have limited access.

Source: SBC Oral Health Needs Assessment p. 23

SBC School Immunization Rates Highlight:

Vaccination rates have been increasing for children in Childcare Centers and Kindergartens in SBC.

88.17% 87.16% 87.61% 88.02% 89.79% 89.10% 94.60% 95.90% 93.23% 93.63% 92.10% 92.10% 94.40% 94.90% 96.40% 96.50% 80.0% 85.0% 90.0% 95.0% 100.0%

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19

Percent Fully Vaccinated

Childcare Centers Kindergartens 5.24% 6.04% 5.57% 5.92% 4.76% 4.40% 2.60% 1.20% 3.21% 2.89% 4.27% 4.72% 2.94% 3.60% 0.70% 0.00% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0%

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19

Percent PBE Students

Childcare Centers Kindergartens

Source: CDPH Immunization Branch

Childhood Obesity

mid north south 2010 11.32% 14.25% 8.86% 2018 14.3% 15.98% 10.08%

Highlight: There are higher rates

• f obesity in North and

Mid County than South amongst 2-5 year olds enrolled in WIC.

Source: SBC WIC

Childhood Obesity

Highlight: Although local percentages for 7th and 9th graders is similar to CA, a greater proportion of SBC 5th graders are

• verweight/obese

compared to their CA peers.

Students Who Are Overweight or Obese, by Grade Level, 2017

Source: Kids Data

Children and Youth with Special Health Care Needs (CYSHN)

Intimate Partner Violence

0.0 100.0 200.0 300.0 400.0 500.0 600.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rate of Domestic Violence Calls CA SBC

Highlight:

In recent years (2013- 2015), SBC’s rate of calls to police for violent or aggressive behavior within the home is statistically better than CA. However, we are not fully sure what this data may be telling us.

Source: Office of the Attorney General. CA Department of Finance.

Local Domestic Violence Solutions data on clients receiving shelter services Highlight:

While it is difficult to assess the incidence of domestic violence in SBC, domestic violence solutions has numbers of those receiving emergency services through the shelter system.

Source: 2017 Santa Barbara County Children’s Scorecard

Intimate Partner Violence

2013-14 MIHA data shows that 10.6% of women in SBC compared to 7.1% of women in CA had some form of physical or psychological intimate partner violence (IPV) during pregnancy. In FY 17/18, 11% (152/1455) of participants in the MCAH Field Nursing Unit, self-identified with current or history of Intimate Partner Violence.

Highlight:

The percentage of women experiencing some form of physical or psychological intimate partner violence during pregnancy is higher in SBC than CA.

Source: MIHA; 2013-2014 and SBC MCAH Health Indicator Data

0.0 50.0 100.0 150.0 200.0 250.0 300.0 350.0 400.0 450.0 500.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rate of ED Visits

CA SBC HP 2020 Target 461.2

Assault Hospitalizations of Females aged 15- 44 years old

Highlight:

In recent years (2013- 2015), SBC’s rate of assault hospitalizations for women is statistically better than CA. However, we are not fully sure what this data may be telling us.

Source: Office of Statewide Health Planning and Development. Hospital Discharge Data.

Substance Abuse Diagnosis of 15-24 year olds

0.0 200.0 400.0 600.0 800.0 1,000.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Substance Abuse Diagnosis Rate

All 15-24 Year Olds CA SBC

Highlight:

The rate of substance abuse diagnosis for 15-24 year olds may be better in SBC than CA, but it is increasing locally. Whites in both SBC and CA have higher rates of substance use diagnosis than Hispanics.

Source: Office of Statewide Health Planning and Development. Hospital Discharge Data.

0.0 200.0 400.0 600.0 800.0 1,000.0 1,200.0 1,400.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Substance Abuse Diagnosis Rate

15-24 Year Olds by Race and Ethnicity CA White SBC White CA Hispanic SBC Hispanic

0.0 500.0 1,000.0 1,500.0 2,000.0 2,500.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Mental Health Diagnosis Rate

15-24 Year Olds by Race and Ethnicity

CA White SBC White CA Hispanic SBC Hispanic

Mental Health Diagnosis of 15-24 Year Olds

0.0 500.0 1,000.0 1,500.0 2,000.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Mental Health Diagnosis Rate

All 15-24 Year Olds CA SBC

Highlight:

While the rate of mental health diagnosis for 15- 24 year olds in SBC is better than CA, we are not certain about the meaning of this data.

Source: Office of Statewide Health Planning and Development. Hospital Discharge Data.

Youth Served by Behavioral Wellness Highlight:

Each year, the SBC Department of Behavioral Wellness serves over 3,000 children and youth diagnosed with severe mental illness and/or substance use disorders. Numbers have remained steady for mental health programs, while there has been a decrease in youth receiving treatment for severe drug and alcohol disorders.

Source: 2017 Santa Barbara County Children’s Scorecard

Alcohol and Drug Use amongst children/ adolescents

Highlight: Youth educated in NT settings have a higher reported usage of alcohol and drugs compared to their traditionally educated peers.

Source: 2017 Santa Barbara County Children’s Scorecard

SBC CWS Referrals Highlight:

Since 2008, the number of referrals to SBC Child Welfare Services (CWS) has increased, but the percentage of substantiated allegations has decreased. Children < 1 year old have the highest rate of abuse and neglect. General Neglect is consistently the number one cause of substantiated cases.

Source: 2017 Santa Barbara County Children’s Scorecard

Children in Foster Care per 1000 Children Age 0-17

0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rate of Children in Foster Care CA SBC

Highlight:

The rate of children in foster care is significantly less in recent years than CA.

Source: Office of the Attorney General. CA Department of Finance.

Adverse Childhood Experiences (ACEs)

Estimated percentage of children ages 0-17 who have experienced two or more adverse experiences as of their current age (2016). SBC: 16.3% percent of children CA: 16.4% percent of children

Highlight:

1 in 6 Children have experienced two or more

• ACEs. The rate is not

statistically different between CA and SBC.

Source: FHOP Community Health Status Report, 2017

In Summary

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Improving Locally

 Rate of Mothers Seeking Prenatal Care (overall)  Prevalence of Domestic Violence Calls  Teenage Births  School Immunization Rates

Better Than CA

 Substance Abuse Diagnoses of 15-24 year olds  Substance Abuse Hospitalizations of Pregnant Women  Births Within 18 Months of a Previous Live Birth  Assault Hospitalizations of Females Aged 15-44 Years Old  Prevalence of Domestic Violence Calls  Mental Health Diagnoses of 15-24 Year Olds  Unemployment Rate  Children in Foster Care  Maternal Mortality Rate

Meeting HP 2020

 Percentage of Underweight Births  Infant Mortality  Rate of Mothers Seeking Prenatal Care (Overall)  Assault Hospitalizations of Females Aged 15-44 Years Old

Worsening Locally

 Rate of Uninsured Females Aged 18-64 Years Old

Worse than CA

 Percentage of Women Receiving Prenatal Care in First Trimester (overall)  Teenage Birth Rate  Percentage of Mothers Exclusively Breastfeeding (In-Hospital)  Rate of Cesarean Births from Low Risk Females  Rate of Uninsured Individuals 0-18 Years Old  Rate of Uninsured Females Aged 18-64 Years Old  Poverty Rate of Children and Adolescents  Poverty Rate of Females Aged 18-64 Years Old  Safe Sleep Practices (Bed sharing)

Not meeting HP 2020

 Percentage of Premature Births  Rate of Uninsured Individuals 0-17 Years Old  Rate of Uninsured Females Aged 18-64 Years Old  Rate of Cesarean Births from Low Risk Females

Results from Stakeholder Survey

 25 individuals responded  Sectors represented:  State/Local Health Department (28%)  CBOs (20%)  Hospital (16%)  Community Clinic/FQHC (12%)  Family Support Organization (8%)  State of Nationally Affiliated Non-Profit (4%)  Head Start (4%),  Individual or Family (4%)  WIC (4%)

MCAH Goal 1: Improve maternal* health and increase access to health care. *Women of childbearing age, pregnant, and/or postpartum women

N=25 N=25

MCAH Goal 2: Improve infant health and increase access to health care.

N=22 N=23

MCAH Goal 3: Improve child health and increase access to health care.

N=22

MCAH Goal 4: Improve Children and Youth with Special Health Care Needs* (CYSHCN) health and increase access to health care.

N=20

MCAH Goal 5: Improve Adolescent health and increase access to health care.

N=20 N=21

Break (10 min)

What do we want to do?

Santa Barbara County

Required to address by Title V for 2020-2025

All LHJs must identify at least:  Two problems in the Maternal domain (reproductive age women and pregnant/postpartum women)  Two problems in the Infant domain (one being SIDS)  One problem in the Child domain  One problem in the CYSHCN domain  One problem in the Adolescent domain If resources allow, LJHJs may also identify additional problems.

Small Group Breakouts

 Break out into 6 groups to discuss key issues, root causes, best practices/interventions, and partner organizations in each domain.  Facilitators will assist each group  Please try to have 4-5 members in each group  Reproductive Age Women  Pregnant/Postpartum Women  Infant  Child  CYSHN (Children and Youth with Special Healthcare Needs)  Adolescent

Next Steps?

Report to State MCAH – Due June 14th, 2019  Stakeholders and Community Partners  Problem Statements, Strategies, and Partners  Capacity Needs Develop Action Plans – Due March 13th, 2020  Engage partners willing to be involved or collaborate on identified key issues

Special Thanks

Michelle Wehmer Mitchell Hee Ed Tran Paige Batson Linda Oh Judy Savage Carmen Lemus Colleen Jensen

“Alone we can do little, but together we can do much.”

• Helen Keller