Mono County
Maternal Child & Adolescent Health
2016-2020 Title V Needs Assessment
Public Health Planning Team Meeting
Presented by: Sandra Pearce, RN, PHN, MS, CNS
MCAH Director
January 23, 2014
Outline
•
Purpose of Meeting and Needs Assessment Participation
•
Title V Maternal, Child, and Adolescent Health (MCAH) Block Grant
•
10 Essential Public Health and MCAH Services
•
The Title V Needs Assessment and Timeline
•
California’s MCAH Priorities
•
Local Data
•
Priority Setting for Mono County
Why Are We Here?
•
MCAH cannot do this without you!
o
o
•
Public Health Planning Team
o
o
o
•
Collaborative effort to prioritize and determine the most effective use of
the County’s MCAH funds over the next 5 years.
What is the County’s capacity to achieve local goals, and ability to
leverage funds, avoid duplication of services, and use resources wisely.
Review the indicator data and prioritize local health problems
Develop problem statements
Identify partners and interventions to address selected priorities
Community Partners and Stakeholders
o
o
o
Consult on factors that contribute to local priorities
Develop mutually beneficial goals and interventions between agencies
Network and build working relationships to maximize resources
Title V MCAH Block Grant
Mission:
• To improve the health of all of America’s mothers and children.
Vision:
• An America where all children and families are healthy and thriving.
Partnership:
• Collaboration on the federal, state, and local level.
Flexibility:
• Allows states and local jurisdictions to address the unique needs of
their MCAH populations.
The 10
Essential
Public
Health
Services
10 MCAH Essential Services
www.jhsph.edu/WCHPC/publications/pubmchfx.pdf
Title V Needs Assessment
•
At the beginning of every five year grant cycle, a comprehensive
statewide needs assessment must be conducted of the MCAH
population.
•
The state decentralizes this process by having each local jurisdiction
conduct their own needs assessment.
•
The goals of the local needs assessment process include:
1.
Obtaining stakeholder /community partner input
2.
Building local jurisdiction needs assessment capacity
3.
Identifying public health issues that would be missed by only using
state level information
4.
Developing an action plan to address identified issues
Timeline
•
Public Health Planning Team Meetings
January 23, 2014:
o Review needs assessment process and identify and prioritize problems.
February 27, 2014:
o Analyze problems and develop problem statements.
March 27, 2014:
o Identify strategies, partners and activities to address selected priority
problems.
•
Community Partner and Stakeholder Participation
April – May 2014
• Local Needs Assessment Due to State MCAH: June 16, 2014
• 5 Year Action Plan Due to State MCAH: May 15, 2015
• State Needs Assessment due to Federal MCAH: July 2015
California’s MCAH Priorities
Goal 1: Improve Outreach and Access to Quality Health and
Human Services
Access to health care
• Access to dental care
• Access to mental health care
•
Goal 2: Improve Maternal Health
• Late initiation of prenatal care and/or inadequate prenatal care
Perinatal mood and anxiety disorders
• Partner/family violence
•
Goal 3: Improve Infant Health
SIDS/SUID
• Prematurity/Low birth weight
• Perinatal substance use
•
California’s MCAH Priorities
Goal 4: Improve Nutrition and Physical Activity
Exclusive breastfeeding initiation and duration
• Overweight/obesity – children, adolescents, or women
•
Goal 5: Improve Child Health
•
•
•
Childhood Injury
Child abuse
Oral health
Goal 6: Improve Adolescent Health
•
•
•
•
•
Adolescent sexual health
Adolescent pregnancy
Adolescent injuries
Adolescent violence
Adolescent mental health
The Data
There are many data limitations in a small county with few residents.
• The difference of one case can make local rates seem very high or very low.
• Confidence intervals, which tell us if differences in rates are significant, are
wide. Therefore, Mono County’s rates are often statistically equivalent to the
State’s rates, even if they seem much better or worse.
• Data can be insufficient for data analysis when there are too few cases.
• Data is often grouped by years or by multiple counties so there is enough
data to analyze. Grouping counties can lead to an incorrect picture of local
health indicators.
Mono County strives to have significantly better rates than the State, and to
surpass the Healthy People 2020 objectives.
Healthy People provides
science-based, 10-year national
objectives for improving the
health of all Americans.
Local rates have surpassed the
HP2020 objectives
Local rates are statistically equivalent
to HP2020 objectives
Local rates are significantly better
than the State
Local rates are statistically equivalent
to the State
Local rates are higher or lower than
the State, but significance cannot be
determined.
Local rates are significantly worse
than the State or HP2020 objectives
Data
Legend
Goal 1 Indicator Data
Improve Outreach and Access to Quality Health and Human Services
Health Indicator
Local
Rate
State
Rate
HP2020
Rate
% uninsured children (age 0-18)
12.0
(11.3-12.7)
9.3
(9.3-9.4)
0
% uninsured women (age 18-64)
23.0
(22.2-23.7)
22.1
(22.1-22.2)
0
% Medi-Cal insured deliveries
46.9
(42.3-51.5)
47.2
(47.1-47.3)
n/a
% prenatal care in the first
trimester (for live births)
74.6
(70.3-78.5)
83.3
(83.2-83.4)
77.9
% children who had a doctor
visit in the last year (age 0-17)
89.3
(86.6-92.0)
89.4
(88.2-90.6)
n/a
n/a
% women who had a doctor visit
in the last year (age 18+)
85.6
(77.5-93.8)
85.9
(85.1-86.7)
n/a
n/a
% children who had a dental visit
83.2
in the last year (age 3-11)
(78.1-88.3)
85.8
(84.1-87.5)
n/a
n/a
* Data is preliminary and undergoing a final review
State
Comp
HP2020
Comp
n/a
Goal 2 Indicator Data
Improve Maternal Health
Local
Rate
State
Rate
HP2020
Rate
% females (age 15-44) with birth within 24
months of previous live birth
19.0
(14.6-24.3)
21.0
20.9-21.1
n/a
% low-risk females delivering a live birth by
c-section
24.2
(20.3-28.7)
27.6
(27.5-27.7)
n/a
Gestational diabetes per 1,000 females (age
15-44) at delivery
2.5
(0.4-13.8)
1.0
(1.0-1.1)
n/a
Substance use dx per 1,000 hospitalizations
of pregnant females (age 15-44)
4.6
(1.3-16.6)
14
(13.8-14.2)
n/a
Mood disorder hospitalizations per 100,000
females (age 15-44)
(329.8-625.6)
(1026.5-1034.7)
1030.6
n/a
Assault hospitalizations per 100,000 females
(age 15-44)
0
10.6
(10.2-11.1)
n/a
Domestic violence calls per 100,000 people
471.6
439.5
n/a
Health Indicator
454.4
(410.9-541.3)
* Data is preliminary and undergoing a final review
(438.2-440.7)
State
Comp
Goal 2 Indicator Data (continued)
Improve Maternal Health
Local
Rate
State
Rate
HP2020
Rate
% females (age 15-44) who smoked during
the 1st or 3rd trimester of pregnancy
28.3
(19.6-36.9)
8.1
(7.1-9.1)
n/a
% females (age 18+) who currently smoke
11.3
(6.1-16.6)
11.0
10.3-11.7
n/a
% females (age 18+) who in the last year
participated in binge drinking
11.3
(6.1-16.6)
11.0
10.3-11.7
n/a
Health Indicator
* Data is preliminary and undergoing a final review
State
Comp
Goal 3 Indicator Data
Improve Infant Health
Health Indicator
Fetal and infant deaths per
1,000 during the perinatal
period
Local
Rate
n/a
State
Rate
HP2020
Rate
State
Comp
HP2020
Comp
n/a
5.9
n/a
n/a
n/a
n/a
Infant (less than 1 year) deaths
per 1,000 live births
n/a
n/a
6.0
% live births less than 37 weeks
gestation
4.9
(3.3-7.4)
8.6
(8.6-8.7)
11.4
% live births less than 2,500
grams (low birth weight)
5.8
(4.0-8.4)
6.8
(6.8-6.8)
7.8
% live births less than 1,500
grams (very low birth weight)
0.7
(0.2-2.0)
1.2
(1.1-1.2)
1.4
* Data is preliminary and undergoing a final review
Goal 4 Indicator Data
Improve Nutrition and Physical Activity
Local Rate
State Rate
HP2020
Rate
% overweight children (age 2-5)
enrolled in CHDP
20.2
42.1
n/a
% overweight and obese children in
public schools grades 5,7,9 & 11
32.4
38
n/a
% overweight females (age 15-44)
38.9
(21.2-56.6)
43.1
(41.4-44.8)
n/a
% daily folic acid use in the month
before pregnancy
26.7
(19.4-34.0)
34.4
(32.3-36.4)
n/a
% exclusive in-hospital
breastfeeding
77.4
(68.5-84.3)
62.6
(62.5-62.8)
n/a
Health Indicator
* Data is preliminary and undergoing a final review
State
Comp
Goal 5 Indicator Data
Improve Child Health
Local
Rate
State
Rate
HP2020
Rate
Child (age 1-4) deaths per
100,000
0
22.7
(21.6-24.0)
25.7
insufficient
data
Child (age 5-14) deaths per
100,000
0
(10.4-138.4)
11.2
(10.7-11.8)
n/a
n/a
0
7.2-96.1
18.1
17.6-18.7
n/a
n/a
Health Indicator
Child (age 0-14) motor vehicle
injury hospitalizations per
100,000
* Data is preliminary and undergoing a final review
State
Comp
HP2020
Comp
Goal 6 Indicator Data
Improve Adolescent Health
Health Indicator
Local
Rate
State
Rate
HP2020
Rate
Births to teenage females (age 15-17)
per 1,000
11.8
(6.0-23.0)
16.8
(16.7-17.0)
25.7
Births to teenage females (age 15-19)
per 1,000
20.6
(13.8-30.8)
31.6
(31.4-31.8)
n/a
n/a
% teenage females (age < 20) with
birth within 24 months of previous live
birth
100
(15.0-85.0)
56.7
(56.0-57.4)
n/a
n/a
0
41.7
(40.4-43.1)
55.7
93.3
70.3
(68.6-72.2)
88.5
Adolescent (age 15-19) deaths per
100,000
Adolescent (age 20-24) deaths per
100,000
Adolescent (age 15-14) mental health
hospitalizations per 100,000
Adolescent (age 15-14) substance use
hospitalizations per 100,000
Adolescent female (age 15-24)
reported cases of Chlamydia per
100,000
(59.2-390.6)
(31.7-273.9)
380.3
State
Comp
HP2020
Comp
(248.9-580.8)
(1,276.5-1,287.3)
1,281.9
n/a
n/a
289.8
(178.5-470.2)
638.7
(634.9-642.5)
n/a
n/a
1,075.9
2,905.4
n/a
n/a
* Data is preliminary and undergoing a final review
Priorities