September 6, 2019 Title V Child Health Needs Assessment and Action Planning Statewide Screening Collaborative Meeting Eileen Yamada, MD, MPH California Department of Public Health, MCAH Division
Objectives for Today • Share key priorities for Child Health documented by our local MCAH programs in their needs assessments • Share data related to child and family health • Obtain specific feedback on opportunities for alignment and partnership with other Departments and programs to improve child and family health and well-being
First… what is Title V? The Maternal and Child Health Services Block Grant • Mission: Improve the health and well-being of the nation’s mothers, infants, children and youth, including children and youth with special health care needs, and their families. • Target populations: Mothers, infants, children, & children and youth with special health care needs, adolescents • State agencies submit an application for Title V funding and a report to federal Health Resources and Services Administration (HRSA) annually • Statewide, comprehensive needs assessment is required every 5 years Photo credit: Getty Images
Moving towards Population-Based Services • HRSA, our federal funder, Direct Services is encouraging States to assess how to move down Enabling the pyramid toward Services population-based services Public Health Services and Systems (Population-Based) Maternal & Child Health Pyramid Source: Appendix H of the MCH Block Grant; MCAH Working Framework: MCH Pyramid of Services
Photo credit: Getty Images Early Local MCAH Feedback Child Health
Feedback from Local MCAH Programs’ Priority Needs • Prevention of childhood adversity and toxic stress • Supporting child mental, social, and emotional health • Access to needed health and social services • Building family resilience/child abuse prevention • Trauma-informed care • Developmental screening • Addressing social determinants of health (poverty; affordable housing; food security; and quality, affordable child care) • Addressing health inequities • Other child health areas: Oral health; overweight/obesity prevention; physical activity • Other domains: Maternal mental health, perinatal substance use, breastfeeding MCAH Directors meeting, May 2019 Form B local needs assessment
Barriers Previously Noted by Statewide Screening Collaborative and MCAH • Workforce issues for referrals • High Regional Center caseloads, families with needs but not eligible for early intervention • Provider workforce inadequate to meet needs • Primary care pediatric providers do not have capacity to manage mental health problems • System issues • Difficulty navigating the referral process • Insurance coverage for specific providers • Transportation issues • Provider reimbursements inadequate • Need for family-centered, coordinated care, including cultural aspects • Feedback loop after referral is made to Regional Center often missing • Families with competing social stressors Dooley D. Behavioral Health Services for Children and Adolescents. Webinar, May 15, 2019. Statewide Screening Collaborative meetings, 2017-2019.
Photo credit: Getty Images Reports/Literature-Recommendations for Healthy, Vibrant Children
Vib ibrant and Healt lthy Kid ids: Alig ligning Scie ience Practice, and Polic licy to ity ( National Academy of Scie Advance Healt lth Equit iences) • Intervene early • Support caregivers • Reform health care system services to promote healthy development • Create supportive and stable early living conditions • Maximize the potential of early care and education to promote health outcomes • Implement initiatives across systems to support children, families, other caregivers, and communities • Integrate and coordinate resources across the education, social services, and healthcare systems, and make them available to translate science to action https://www.nap.edu/catalog/25466/vibrant-and-healthy-kids-aligning-science-practice-and-policy-to
Variable Health Trajectories: Life Course Approach
Health Care- Related Measures: Child Health • Adequate insurance Photo credit: Getty Images • Developmental Screening
HRSA National Performance Measure 15: Adequate and Continuous Insurance by Age Group, California, 2016-2017 90.0 80.0 70.0 79.6 60.0 Percent 50.0 40.0 72.3 68.9 30.0 20.0 10.0 0.0 0-5 year olds 6-11 year olds 12-17 year olds Child and Adolescent Health Measurement Initiative. National Survey of Children’s Health, 2016 -17. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved 08/12/19 from www.childhealthdata.org.
HRSA National Performance Measure 6: Percent of children who received a developmental screening in the past year, health care setting, ages 9-35 months, California & Nation, 2016-17 50.0 40.0 Percent 30.0 20.0 31.1 10.0 22.2 0.0 California Nation Child and Adolescent Health Measurement Initiative. National Survey of Children’s Health, 2016 -17. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved 08/12/19 from www.childhealthdata.org.
Child and Family- related Measures Photo credit: Getty Images • Child flourishing measure (0-5 years) • Family resilience • Reading to child (0-5 years) • Child with 2 or more ACEs
Chil ildhood Flo lourishing in in U.S .S. School-Age Chil ildren • ~40% of U.S. school-age children met the criteria for flourishing (National Survey of Children’s Health (NSCH), 2016 -17)* • Flourishing index was based on a 3-item index for 6- 17 year olds (Children’s interest and curiosity in learning new things, persistence in completing tasks, capacity to regulate emotions) by parent/guardian report • The prevalence of flourishing increased in a grade fashion with increasing levels of family resilience and connection Ɨ at each level of ACEs, household income, and special health care needs. *NSCH funded by HRSA MCHB. Address-based sampling with parent or guardian self-administered survey (paper/online) of randomly selected child. Ɨ Family Resilience and Connection Index, 4-item family resilience measure (When family faces problems, how often do they talk together about what to do, work together to solve problems, know they have strengths to draw on, stay hopeful even in difficult times ), parent-child connection measure, and parent coping measure. Bethell CD et al. Family Resilience and Connection Promote Flourishing among US Children, even amid Adversity. Health Affairs 2019. 38(5): 729-737.
Percent of children by number of flourishing items* met, 6 months-5 years, California, 2016-17 80.0 60.0 Percent 40.0 59.3 20.0 31.2 9.5 0.0 ≤2 3 4 Four questions to capture curiosity and discovery about learning, resilience, attachment with parent, and contentment with life. The survey asked, "How true are each of the following statements about this child: 1) child is affectionate and tender, 2) child bounces back quickly when things don’t go his/her way, 3) child shows interest and curiosity in learning new thing, 4) child smiles and laughs a lot. Child and Adolescent Health Measurement Initiative. National Survey of Children’s Health, 2016 -17. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved 08/12/19 from www.childhealthdata.org.
Family resilience by age group, California, National Survey of Children’s Health, 2016 -17 100.0 90.0 80.0 70.0 60.0 Percent 50.0 84.6 40.0 79.4 74.7 30.0 20.0 10.0 0.0 0-5 year olds 6-11 year olds 12-17 year olds Child and Adolescent Health Measurement Initiative. National Survey of Children’s Health, 2016 -17. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved 08/12/19 from www.childhealthdata.org.
Percent of children who had books read everyday, by ethnicity, 0-5 years, California Health Interview Survey, 2017 100.0 90.0 80.0 70.0 60.0 Percent 50.0 83 40.0 70.6 65.1 30.0 58.9 20.0 10.0 0.0 Latino White, non-latino Black, non-latino Asian non-latino UCLA Center for Health Policy Research. AskCHIS 2017. Children who had books read everyday (by race/ethnicity). Available at http://ask.chis.ucla.edu. Exported on August 23, 2019.
Percent of children who experienced 2+ ACES by age group California, 2016-17 30.0 25.0 20.0 Percent 15.0 10.0 18.4 18 5.0 8.3 0.0 0-5 year olds 6-11 year olds 12-17 year olds Child and Adolescent Health Measurement Initiative. National Survey of Children’s Health, 2016 -17. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved 08/12/19 from www.childhealthdata.org.
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