Block Grant Highlights and Updates Mitch DeValliere, DC Department - - PowerPoint PPT Presentation

Mitch DeValliere, DC Title V MCH Program Manager Ingrid Mburia, PhD, MPH MCH Epidemiologist August 24, 2018

Nevada Title V Maternal and Child Health(MCH) Block Grant Highlights and Updates

Department of Health and Human Services Division of Public and Behavioral Health Maternal and Child Health Program

Brian Sandoval Governor Richard Whitley, MS Administrator

Julie Kotchevar, PhD Administrator Ihsan Azzam, MD, PhD Chief Medical Officer

Department of Health and Human Services 2

Table of Contents

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Organization Priorities Activity Highlights Data Highlights Fiscal Updates Contacts

Department of Health and Human Services 3

Nevada Maternal, Child and Adolescent Health Section Includes:

Title V Maternal Child Health (MCH) Program Pregnancy Risk Assessment Monitoring System (PRAMS) Teen Pregnancy Prevention

• Personal Responsibility

Education Program (PREP)

• Abstinence Education Grant

Program (AEGP)

Early Hearing Detection and Intervention (EHDI) Nevada Maternal Infant and Early Childhood Home Visiting (MIECHV) Program

Department of Health and Human Services 4

Nevada Title V MCH Program Includes:

Maternal Infant Program (MIP) Children and Youth with Special Health Care Needs (CYSHCN) Adolescent Health and Wellness Program (AHWP) Rape Prevention and Education (RPE) Program MCH Epidemiology Fiscal Staff

Department of Health and Human Services 5

Beth Handler, MPH Title V MCH Director Vickie Ives, MA CYSHCN Director Mitch DeValliere, DC Title V Program Manager

Christina Turner MIP Coordinator Deborah Duchesne RPE Coordinator Eileen Hough, MPH AHWP Coordinator Justin Bennett, MA CYSHCN Coordinator Ingrid Mburia, PhD MCH Epidemiology Jennifer Quihuis Management Analyst

Title V MCH Organizational Chart

Department of Health and Human Services 6

Priority Areas

Improve preconception and interconception health among women of childbearing age, National Performance Measure (NPM) 1 Breastfeeding promotion (NPM 4) Increase developmental screening (NPM 6) Promote healthy weight (NPM 8)

Department of Health and Human Services 7

Priority Areas

Reduce teen pregnancy, State Performance Measure (SPM) 2 Improve care coordination (NPM 10) Reduce substance use during pregnancy (NPM 14) Increase adequate insurance coverage among children (NPM 15)

Department of Health and Human Services 8

Improve Preconception and Interconception Health among Women of Childbearing Age Increase the percent of women ages 15-44 receiving routine check-ups in the previous year to 70% by 2020 Increase to 77.9% the percent of women receiving prenatal care in the first trimester by 2020 Increase the percent of adolescents aged 12-17 with a preventive medical visit in the past year to 78% by 2020

Department of Health and Human Services 9

Breastfeeding Promotion

Increase the percent of children who are ever breastfed to 90% by 2020 Increase the percent of children who are exclusively breastfed at 6 months to 28% by 2020 Increase the percent of baby-friendly hospitals in Nevada to 33% by 2020

Increase Developmental Screening

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Increase the percent of children (10- 71 months) who receive a developmental screening using a parent-completed screening tool to 31.9% by 2020

Promote Healthy Weight

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Increase the percent of middle and high school students who are physically active at least 60 minutes a day to 48.8% Increase the percent of children ages 6-11 who are physically active at least 60 minutes a day to 48.8%

Reduce Teen Pregnancy

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Reduce pregnancies among adolescent females aged 15 to 17 years old to 36.2 pregnancies per 1,000 by 2020 Reduce pregnancies among adolescent females aged 18 to 19 years old to 105.9 pregnancies per 1,000 by 2020 Reduce repeat pregnancies among adolescent females aged 15 to 19 years to 15% by 2020

Improve Care Coordination

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Increase the percent of children with special health care needs with a medical home in the past year to 53.3% by 2020 Increase the percent of children without special health care needs with a medical home in the past year to 58.4% by 2020 Increase the number of WIC, Home Visiting, Healthy Start, and other program participants that received information on the benefits of a medical home Increase the number of referrals to Nevada Children’s Medical Home Portal

Reduce Substance Use During Pregnancy

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Reduce the percent of women who smoke during pregnancy Reduce the percent of children who are exposed to secondhand smoke Increase the percent of women who call the Quitline for assistance Reduce the percent of women using substances during pregnancy

Increase Adequate Insurance Coverage Among Children

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Increase the percent of adequately insured children Increase the percent of callers to Nevada 2-1-1 inquiring/requesting health insurance benefits information Increase the percent of adolescents aged 12-17 with a preventive medical visit in the past year to 78% by 2020

Improve Pre- and Interconception Health National Performance Measure (NPM) 1

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Improve Pre- and Interconception Health Federal Fiscal Year (FFY) 2018 Highlights:

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Postpartum depression screens and support of the Perinatal Mood and Anxiety Disorders (PMAD) program Developed and distributed Medicaid coding sheets: Screening, Brief Intervention, and Referral to Treatment (SBIRT); Long Acting Reversible Contraceptives (LARC); post- partum depression screen Go Before You Show media campaign Collaborative Improvement and Innovation Network (CoIIN) on Infant Mortality

Improve Pre- and Interconception Health Highlights:

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SoberMomsHealthyBabies.org website and media campaign Perinatal quality activities to reduce neonatal abstinence syndrome (NAS) through Nevada National Governors Association (NGA) Learning Network for Improving Birth Outcomes and CoIIN efforts Pregnancy Risk Assessment Monitoring System (PRAMS) media campaign

Breastfeeding Promotion NPM 4

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Baby Steps to Breastfeeding Success training given at eleven Nevada hospitals 86 Nevada businesses pledged to provide welcoming environments to breastfeeding mothers through the Breastfeeding Welcomed Here campaign by Nevada WIC and supported with Title V MCH funds Seven (7) hospitals in Clark County implemented the parent education portion of the Baby Safe Sleep program

Increase Developmental Screening NPM 6

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Increase Developmental Screening

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• Promote Early Periodic Screening Diagnosis and Treatment (EPSDT)
• Milestone Moments distribution
• Support University Center for Autism and Neurodevelopment

(UCAN) and Nevada Leadership Education in Neurodevelopment and Related Disabilities (NvLEND) to increase screening, and training to identify developmental delays

• Increase capacity to deliver ASQ-SE and other screenings
• Training for tribal public health nurses in Owyhee and Elko
• NV Home Visiting partnership

Collaborate with public and private partners to improve the percent of children receiving developmental screening, and increase the number of partners trained on developmental screenings.

Promote Healthy Weight NPM 8

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Trauma informed yoga for high risk youth: Cutting Edge Practice Innovation Station Adolescent physical activity social media campaign aimed at adolescents Kindergarten Health Survey Partnered with Chronic Disease Prevention and Health Promotion (CDPHP)

• n elementary-aged youth

social media campaign

Reduce Teen Pregnancy

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Support rural public health nurses to provide pregnancy risk screening and education Promote access to health insurance and well visits for adolescents Promote “One Key Question” Provide support to Local Health Authority (LHA) efforts to reduce teen pregnancy, especially increasing access to Long Acting Reversible Contraception (LARC)

Reduce Teen Pregnancy State Performance Measure (SPM) 2

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Support rural public health nurses to provide pregnancy risk screening and education Promote access to health insurance and well visits for adolescents Promote “One Key Question” Provide support to Local Health Authority (LHA) efforts to reduce teen pregnancy

Improve Care Coordination NPM 11

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• Community-based programs
• MCH coalitions
• Nevada’s Family-to-Family/Family Voices entity Family TIES
• Nevada 2-1-1 and
• Public and private stakeholders.

Statewide Partners:

• Improve access to healthcare and transition

supports, social service resources, and information for children, families, and providers.

Established Nevada Children’s Medical Home Portal

https://nv.medicalhomeportal.org/

Reduce Substance Use During Pregnancy NPM 14

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• SoberMomsHealthyBabies.org
• Comprehensive Addiction and Recovery Act

(CARA) Partnership

• Substance Use Tool Kit
• Marijuana Informational Resources

Resources for Prevention

• PRAMS
• Tobacco Quitline promotion
• SoberMomsHealtyBabies.org
• Tobacco Social Media campaign with Chronic

Disease Prevention and Health Promotion Support systems to collect information regarding the percent of women who smoke or use/misuse substances during pregnancy

Increase Adequate Insurance Coverage Among Children NPM 15

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Senate Bill (SB) 325 (2017 Nevada Legislative Session) authorizes children less than 19 years of age lawfully residing in the US to enroll in Nevada Medicaid Adolescent Health and Wellness Program partners disseminate informational brochures regarding insurance enrollment and the importance of adolescent wellness visits Title V MCH funded partners offer assistance with completing insurance applications

Data and Trends Highlights Green = positive Red = needs attention

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Green indicates a positive trend

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National Performance Measure (NPM) 1 Percent of women with a past year preventive medical visit

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Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

0.0 100.0 2010 2011 2012 2013 2014 2015 2016

Percent of women with a past year preventive medical visit: Nevada vs. United States, 2010-2016

Nevada United States Objective

NPM 1

Percent of women with a past year preventive medical visit

Year

2010 2011 2012 2013

2014 2015 2016 Nevada

54.2 55.7 59.0 60.1

61.1 64.0 65.4 United States

65.4 64 65.7 65.2

66 66.1 67.4 Objective

70 70 70 70

70 70 70 Nevada Percent Change: 2009- 2016

20.7

National Outcome Measure (NOM) 1 Percent of pregnant women who receive prenatal care beginning in the first trimester

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Data Source: National Vital Statistics System (NVSS)

50.0 60.0 70.0 80.0

2010 2011 2012 2013 2014 2015 2016

Percent of women who receive prenatal care beginning in the first trimester: Nevada vs. United States, 2010-2016

Nevada United states Objective

NOM 1

Percent of women who receive prenatal care beginning in the first trimester

Year 2010 2011 2012 2013 2014 2015 2016 Nevada 65.9 66.8 68.1 68.4 70.7 72.6 73.1 United States 73.1 73.7 74.1 74.2 76.7 77 77.1 Objective 77.9 77.9 77.9 77.9 77.9 77.9 77.9 Nevada Percent Change: 2010- 2016 10.9

Red Indicates attention needed

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NOM 2 Rate of severe maternal morbidity per 10,000 delivery hospitalizations

33 Data Source: HCUP State Inpatient Databases (SID) Note: Data for 2015 represents only three quarters of the year (January through September) due to the transition to ICD-10-CM in the last quarter of 2015; thus the rate should be interpreted with caution as it does not represent a full year of change relative to 2014.

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2008 2009 2010 2011 2012 2013 2014 2015 Q1-Q3

Rate of severe maternal morbidity per 10,000 delivery hospitalizations: Nevada vs. United States, 2008-2015 (Q1-Q3)

Nevada United States

NOM 2

Rate of Severe maternal morbidity per 10,000 delivery hospitalizations

Year 2008 2009 2010 2011 2012 2013 2014 2015 Nevada 87.1 89.0 94.3 91.2 107.5 98.2 132.1 130.4 United States 112.6 123.7 128.6 133.1 137.7 138.7 143.9 144.1 Objective NA NA NA NA NA NA NA NA Percent Change: 2009-2015 49.7

NOM 11 The rate of infants born with neonatal abstinence syndrome per 1,000 delivery hospitalizations

34 Data Source: HCUP State Inpatient Databases (SID) Notes: Data for 2015 represents only three quarters of the year (January through September) due to the transition to ICD-10-CM in the last quarter of 2015; thus the rate should be interpreted with caution as it does not represent a full year of change relative to 2014.

10 2008 2009 2010 2011 2012 2013 2014 2015 Q1-Q3

The rate of infants born with neonatal abstinence syndrome per 1,000 delivery hospitalizations: Nevada vs. US, 2008-2015 (Q1-Q3)

Nevada United States

NOM 11

The rate of infants born with neonatal abstinence syndrome per 1,000 delivery hospitalizations

Year 2008 2009 2010 2011 2012 2013 2014 2015 Nevada 1.64 1.9 2.9 3.5 5.0 5.3 5.6 7.8 United States 2.23 2.8 3.4 4.0 4.7 5.5 6.1 6.4 Objective N/A N/A N/A N/A N/A N/A N/A Nevada percent Change: 2008- 2015 (Q1-Q3) 372.6

State Performance Measures

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State Performance Measure 2016 Data 2017 Data 2020 Objective

SPM 1: Percent of mothers reporting late or no prenatal care 7.9 4.6 4.0 SPM 2: Percent Repeat teen birth 16.6 22.9 15 SPM 3: Percent of women who use substances during pregnancy 5.5 5.5 3.5 SPM 4: Teenage pregnancy rate (per 1,000 teenage females) 29 Data not yet available 26 Source: Nevada Vital Records

Fiscal Update

Department of Health and Human Services 36

• Title V HRSA Federal Funds

$2,090,604

• State MCH General Funds

$1,574,296

• Total

$3,664,900

State MCH General Funds $1,574,296 Title V HRSA Federal Funds $2,090,604

FY 2017 Expenditures

State MCH General Funds Title V HRSA Federal Funds

30-30-10 rule

Department of Health and Human Services 37

10% Title V Administrative Costs 30% Children and Youth with Special Health Care Needs 30% Preventive and Primary Care for Children

How Funds are Allocated

Department of Health and Human Services 38

Funds are distributed on a 2 year allocation Notices of Grant Award (NOGAs) are sent throughout the year, but the amounts vary Funds are budgeted and spent based on the NOGAs

Thank you!

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Questions? Contact: Mitch DeValliere, DC - Title V MCH Program Manager bdevalliere@health.nv.gov Ingrid Mburia, PhD, MPH – MCH Epidemiologist and PRAMS Lead Coordinator imburia@health.nv.gov