Transcript Systems Development and Public Health Core Functions

Early Intervention: Federal
Requirements and Model Programs
Using Title V to Improve Outcomes for
Young Children and Their Families
Deborah Klein Walker, EdD
Principal Associate
Health Services Research and Evaluation
Abt Associates
ABCD II Consortium Network
August 2004
Outline of Presentation
• Review Public Health Model Guiding
Principles and System of Care
• Outline Components of Title V (Maternal
and Child Health Block Grant)
• Examples of Early Childhood Services
and Links to Title V
GOAL
Develop and enhance systems of care in
neighborhoods and communities which
promote:
 Healthy Children in
 Healthy Families in
 Healthy Communities
MCH PUBLIC HEALTH FOCUS
• Communicable Diseases
• “New Morbidity”
• “New Social Problems”
• Healthy Communities
HEALTHY PEOPLE 2010 GOALS:
• Promoting Healthy Behaviors
• Promote Health and Safe Communities
• Improve Systems for Personal and
Public Health
• Prevent and Reduce Diseases and
Disorders
OUTCOMES
• Infant Mortality
• Immunization
• Child Fatalities
• Teen Births
OUTCOMES
• Children in Poverty
• Low Birth weight
• Child Abuse
• Single Parents
The Public Health (and MCH)
Focus on Improved Health
Outcomes Assumes a System
of Care Must Be in Place
Early Childhood System Sectors
• Health
• Education
• Social Services
• Child Care
PUBLIC HEALTH (MCH) GOALS
FOR A SYSTEM OF CARE
• Community-Based
• Family Centered
• Consumers Engaged as Partners With
Professionals
• Coordinated
• Comprehensive
• Prevention-Oriented
• Early and Continuous Availability
PUBLIC HEALTH (MCH) GOALS
FOR A SYSTEM OF CARE
• Cultural, Language and Socioeconomic
Sensitivity
• Non-Categorical Approach
• Quality of Care Standards
• Flexible and Adaptable
• Integration with Criminal Justice,
Employment, Housing, etc.
HEALTH FINANCING IS
NECESSARY BUT NOT
SUFFICIENT
KEY PUBLIC HEALTH (MCH) ROLE
SYSTEMS DEVELOPMENT AT ALL
GOVERNMENT LEVELS
PUBLIC HEALTH CORE
FUNCTIONS
• ASSESSMENT
• POLICY DEVELOPMENT
• ASSURANCE
Future of Public Health, Institute of Medicine, 1988
ASSESSMENT STRATEGIES
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Monitor Health Status
Needs Assessment
Surveillance
Diagnosis and Investigation
Program Monitoring and Evaluation
Quality Improvement Systems
POLICY DEVELOPMENT
STRATEGIES
• Leadership and Advocacy
• Planning
• Collaborative Partnerships
• Ensure Financing
• Ensure Public/community Participation
• Legislation
• Innovations
ASSURANCE STRATEGIES
• Education and Training
• Direct Services
• Public Information, Education, Referrals
• Community Mobilization
• Licensing, Regulation, Certification
• Standards Setting and Guidelines
• Program Monitoring and Evaluation
TITLE V BLOCK GRANT
• Social Security Act - 1935
• Amended in 1960’s, 1981, 1989, 1996
• Federal/State/Local Partnership
• Point of Accountability for ALL “MCH
Population”
• Available in All States
• Core Public Health Functions Used for
Systems Development
MATERNAL AND CHILD HEALTH TITLE V
SOCIAL SECURITY ACT
1935
Enacted
1960’s - 70’s
Expansion
1981
Block Grant
1989
OBRA
1996
Welfare Reform
TITLE V PURPOSE
• To improve the health of ALL mothers and children
 Provide and assure access to quality maternal and
child health services…
 Reduce infant mortality, preventable
diseases…promote health of low income
children...
 Provide rehabilitation services to those <16 who
receive SSI (Title XVI) benefits to the extent such
services are not provided under Title XIX…
 Promote family-centered, community-based ,
coordinated care for children with special health
care needs
MAJOR STATE / FEDERAL
MCH/Title V ROLES
• Promote MCH through public health core
functions
• Support development of community-based child
and family systems
• Coordinate child health care and administer
supplemental health services
• Enable access for MCH underserved
populations
What Title V Agencies are Called
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Maternal and Child Health
Maternal, Child and Family Health
Child and Family Health
Youth and Family Health
Family Health
Family and Community Health
Title V Conditions
• 85% to state block grant; 15% for
SPRANS (Special Projects of Regional
and National Significance)
• States must provide a $3 match for
every $4 federal dollars
• Must conduct a statewide needs
assessment every 5 years
Title V Conditions
• Maintenance of effort required to be
level at least equal to the level provided
in FY1989
• States must use:
At least 30% of MCH Block Grant
funds for preventive and primary care
services for children
At least 30% for services for children
with special health care needs
MCH PYRAMID OF
HEALTH SERVICES
Direct Health
Care Services
Enabling Services
Population-Based Services
Infrastructure Building Services:
MCH REPORTING SYSTEMS
• National MCH Outcome Measures
• National MCH Performance Measures
• State-determined MCH Performance
Measures
• National Health Status Indicators
MCH TITLE V
PERFORMANCE MEASURES SYSTEM
• Implemented for FY99 Application to the
MCH Block Grant (July 1998)
• Determined by State / Federal Process
• 18 Core Performance Measures in 4 Areas:
Direct Health Care Services (Gap Filling)
Enabling Services
Population-Based Services
Infrastructure Building Services
• 6 Core Outcome Measures
• Up to 10 State Negotiated Measures
MCH OUTCOME MEASURES
• Infant Mortality Rate (IMR) per 1,000 live births.
• Ratio of black IMR to the white IMR
• Neonatal Mortality Rate per 1,000 live births
• Post-neonatal Mortality Rate per 1,000 live
births
• Perinatal Mortality Rate per 1,000 births
• Child Death Rate per 100,000 children aged 114
MCH eGOV VISION PRINCIPLES
• Maximize user-friendly access to all
MCH information systems
• Assure data subject confidentiality
within a public health context
• Coordinate or integrate information
systems where possible and
appropriate, while utilizing shared
national standards.
MCH POPULATION-BASED
POTENTIAL DATA SOURCES
• Surveys (YRBS, BRFS, SLAITS,
PRAMS, etc.)
• Vital Statistics
• Surveillance Systems / Disease
Registries (e.g., Birth Defects,
Immunization, Cancer, etc.)
• Program / Service Management
Information Systems
State and Local Area Integrated Telephone
Survey (SLAITS)
• Developed by National Center of Health
Statistics (CDC)
• Random-digit-dial telephone survey
conducted by Abt Associates
• CSHCN module sponsored by MCHB to
assess prevalence and monitor indicators of
care for CSHCN in all 50 states and DC
• Child health module sponsored by MCHB to
document child health access and outcomes
in all 50 states and DC
What Does It Mean To “Assure”?
• Guarantee
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Pledge
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Promise
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Vow
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Confirm
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Insure
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Comfort
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Console
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Reassure
Assurance Functions of MCH
“ public health agencies assure their
constituents that services necessary to
achieve agreed upon goals are
provided, either by encouraging actions
by other entities (public or private), by
requiring such action through regulation
or by providing services directly ”
(Institute of Medicine,
The Future of Public Health, 1988)
CHARACTERISTICS OF
MCH ASSURANCE ROLES
• Prevention focused
• Applies to the entire MCH population
• Depends on the success of assessment
efforts
• Relies on sound policy development
• Relates to MCH systems development
role
• Implies advocacy and leadership
• Implies accountability for the outcome
MCH ASSURANCE EXAMPLES
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Direct provision of the service
Payment or contracting for the service
Set voluntary standards
Legislative required standards
Provide education and training to
providers
• Evaluate effectiveness of services
MCH ASSURANCE EXAMPLES
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Active regulation of the services
Quality assurance mechanisms
Monitor system compliance
Monitor compliance with service
standards
• Education of the public about services
MCH ASSURANCE EXAMPLES
• Facilitate public accountability
• Population-based data gathering and
reporting
• Facilitate active public/private
partnerships towards shared
accountability for MCH outcomes
EXAMPLES OF MCH PARTNERS
OUTSIDE OF HEALTH AGENCY
• Consumers/Families
• Researchers
• Advocacy Groups
• Policymakers
• Business/Industry
• Public and Private Agencies
• Providers
• Professional Groups
EARLY CHILDHOOD
STATE INITIATIVES
• CHIP - Child Health Insurance Expansions
• Home Visiting Expansions
• Education Reform
• Child Care Expansions
• Social Services Changes
• Welfare Reform
• Planning/Integration Efforts
STARTING POINTS
• Promote Responsible Parenthood
• Guarantee Quality Child Care Choices
• Ensure Good Health and Protection
• Mobilize Communities to Support Young
Children and Their Families
CHALLENGES
Coordination and Linkage
Federal-state-local
Cross systems
Academia to practice
Capacity
Community
Provider
CHALLENGES
Financing
Health
Education
Child care
Jobs
Attitudes and Commitment
Public
Business
Parents
IMPLEMENTATION OF
PUBLIC POLICY NEEDS
• Knowledge Base
• Political Will
• Social Strategies
KEY FEDERAL LEGISLATION
• SSA Title V - MCH Block Grant
• SSA Title IV - Welfare, Child Support,
Foster Care
• SSA Title XVI - Supplemental Security
Income (SSI)
• SSA Title XIX - Medicaid
KEY FEDERAL LEGISLATION
• SSA Title XXI - SCHIP
• OBRA ‘93 Family Preservation
• Child Care Block Grant
• Individuals with Disabilities Education Act
(IDEA)
• Head Start
KEY FEDERAL LEGISLATION
• Supplemental Nutrition Program for
Women, Infants and Children (WIC)
• Public Health Service Act
Community and Migrant Health Centers
(Sections 329 & 330)
Family Planning (Title X)
CRITICAL PARTNERS FOR
IMPROVING MCH OUTCOMES
• Parents and Families
• Providers
• Purchasers and Insurers
FUTURE GOALS FOR TITLE V
• Funded to Meet All Goals
• Recognized as Point of Accountability at
State and Federal Levels
• Linked to All Child and Family Service
Sectors
• Supported by General Public
• Supported by Local, State and National
Organizations