Assessment and Action Planning Statewide Screening Collaborative - - PowerPoint PPT Presentation

Title V Child Health Needs Assessment and Action Planning

Statewide Screening Collaborative Meeting

September 6, 2019 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

Direct Services Enabling Services Public Health Services and Systems (Population-Based)

• HRSA, our federal funder,

is encouraging States to assess how to move down the pyramid toward population-based services

Source: Appendix H of the MCH Block Grant; MCAH Working Framework: MCH Pyramid of Services

Maternal & Child Health Pyramid

Early Local MCAH Feedback

Child Health

Photo credit: Getty Images

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.

Reports/Literature-Recommendations for Healthy, Vibrant Children

Photo credit: Getty Images

Vib ibrant and Healt lthy Kid ids: Alig ligning Scie ience Practice, and Polic licy to Advance Healt lth Equit ity (National Academy of Scie 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
• Developmental Screening

Photo credit: Getty Images

79.6 68.9 72.3 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 0-5 year olds 6-11 year olds 12-17 year olds Percent

HRSA National Performance Measure 15: Adequate and Continuous Insurance by Age Group, California, 2016-2017

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.

22.2 31.1 0.0 10.0 20.0 30.0 40.0 50.0 California Nation Percent

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

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

• Child flourishing measure (0-5 years)
• Family resilience
• Reading to child (0-5 years)
• Child with 2 or more ACEs

Photo credit: Getty Images

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 connectionƗ 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.

ƗFamily 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.

9.5 31.2 59.3 0.0 20.0 40.0 60.0 80.0 ≤2 3 4 Percent Percent of children by number of flourishing items* met, 6 months-5 years, California, 2016-17

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. 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.

84.6 79.4 74.7 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 0-5 year olds 6-11 year olds 12-17 year olds Percent

Family resilience by age group, California, National Survey of Children’s Health, 2016-17

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.

58.9 83 70.6 65.1 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Latino White, non-latino Black, non-latino Asian non-latino Percent

Percent of children who had books read everyday, by ethnicity, 0-5 years, California Health Interview Survey, 2017

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.

8.3 18 18.4 0.0 5.0 10.0 15.0 20.0 25.0 30.0 0-5 year olds 6-11 year olds 12-17 year olds Percent

Percent of children who experienced 2+ ACES by age group California, 2016-17

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.

24.4 18.4 11.6 8.2 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 0-99% FPL 100-199% FPL 200-399% FPL 400% FPL or greater Percent

Children who experienced 2+ ACEs by federal poverty level (FPL), California, National Survey of Children’s Health, 2016-17

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.

Other Family Measures

• Family sings and tells stories to children (0 – 5 years)
• Family shares ideas (6-17 years)
• Family eats meals together
• Screen time
• Parental aggravation
• Emotional help with parenthood
• Coping with daily demands of raising children
• Parent participation in child’s event/activities (6 – 17 years)

Neighborhood Measures

• Supportive neighborhood
• Safe neighborhood
• Neighborhood amenities

Photo credit: Getty Images

47.0 49.8 57.2 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 0-5 year olds 6-11 year olds 12-17 year olds Percent

Percent of children living in a supportive neighborhood by age group, California, 2016-17

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.

55 57 69 10 20 30 40 50 60 70 80 Household income 100- 199% FPL Household income 200- 399% FPL Household income 400% FPL or greater Percentage

Children who definitely live in a safe neighborhood, by income level, 0-17 years, California 2016-2017

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.

55.4 39.2 10 20 30 40 50 60 70 California Nationwide Percent

Children who live in a neighborhood with all 4 amenities*, 0-17 years, California & Nation, 2016-2017

*The four neighborhood amenities were: park or playground, recreation center/community center/boys’ and girls’ club, sidewalks or walking paths, and library or bookmobile. 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.

Social Determinants of Health

• Child poverty (impact of safety net social services)

https://www.ppic.org/publication/child-poverty-in-california/

Childhood Poverty: California, 2017

California Poverty Measure, PPIC/Stanford Center on Poverty and Inequality

• 19.3% of children (1.7 million) lived in poverty
• 23.6% of children lived above, but close to (1.5x) the poverty line
• ~43% of California’s children were poor or near poor
• Child poverty rate (using CPM) varies by county:
• Los Angeles County – 26.1% Orange County – 24.2%
• Santa Barbara – 24.2%
• Santa Cruz – 23.8%
• El Dorado County – 8.2%

Child Poverty in in California, 2017 Public Policy In Institute of f California

• Based on the California Poverty Measure, the poverty rate in CA in 2017

varied by race/ethnicity:

• Latino children (25.8%)
• African American children (18.6%)
• Asian American/Pacific Islander children (14.4%)
• White children (10.4%)
• Without safety net resources, child poverty would have been much

higher in 2017: 31.9% (~2.9 million vs. 1.7 million)

https://www.ppic.org/publication/child-poverty-in-california/

https://www.ppic.org/publication/child-poverty-in-california/

Discussion

Discussion (P (Population-based Perspective):

• What are the key upstream population-based strategies (e.g., policies or

population-level interventions) to improve the child-parent/caregiver relationship and family resilience?

• What are the evidence-based strategies/policies/environmental changes needed

to make a difference?

• What is already being done?
• How can Title V (state and local) partner with other Departments and

programs to align efforts to improve child health and well-being?

• What measure is your organization monitoring for child health and well-

being? Where do you get this data?

Discussion (P (Population-based Perspective):

• Identify potential questions to propose for Maternal Infant Health

Assessment regarding maternal resilience, social support and cohesion, and maternal knowledge of child development and parenting

• Is there a need for longitudinal data over time to better understand the

effect of maternal factors on child health?

• What are the key issues to improve developmental screening?
• What are the key issues to improve linkages to services?
• In what sector(s) are the biggest gaps? What opportunities are there to address

these gaps?

MCAH-Identified Needs and Potential Next xt Steps

• More robust data to understand subpopulation differences
• Identify upstream prevention measures and partner with others to decrease

ACEs and improve child and family resilience (public health and population- based approaches)

• Improve the parent-child relationship; address social determinants of health
• Partner with others to improve developmental screening and linkage to

services

• Improve access to needed services (health, mental health, dental, and social

services) to meet the needs of our culturally and linguistically diverse populations

• California Home Visiting Program: Identify funds to strengthen programs

through mental health consultation and training

Acknowledgements

• Local California MCAH Programs
• G. Vanine Guenzburger – Research Scientist, CDPH MCAH
• Nichole Watmore, MPH – Research Scientist, CDPH
• Jennifer Gregson, MPH, PhD – Research Scientist, CDPH MCAH
• Thea Perrino, MPH, MBA – Chief, CHVP, CDPH MCAH
• Anina Sanchez – Program Consultant, CDPH MCAH CHVP
• Stefanie Lee – Web and Media Analyst, CDPH, MCAH
• Shawn Savolainen – Health Program Specialist, CDPH MCAH
• Sarah Leff, MPH – CYSCHN Project Director, CDPH MCAH

Thank you!

Eileen Yamada, MD, MPH Eileen.Yamada@cdph.ca.gov