Maternal and Child Health Assessment 2015
In 2015, the Minnesota Department of Health conducted a Maternal and Child Health Needs Assessment for the state of
Minnesota. Under the direction of a community leadership team, this assessment identified nine priorities for improving
the health of mothers, children, adolescents, pregnant women, infants, and children and youth with special health needs.
Working with stakeholders from across Minnesota, the leadership team identified specific areas of focus for each priority,
along with possible measurements, strategies, practices, and action recommendations. We understand that there are some
overlap among the nine priority areas; to avoid duplication, most areas of focus are only identified once, even though they
could be under multiple priorities. (For example, prenatal care is important for both Preventive Health Care and Healthy
Babies, but it is only listed under Healthy and Planned Pregnancy.)
These priority sheets were created to provide data and ideas for community members, policy makers, public health
professionals, and others working towards improving maternal and child health in Minnesota.
Priority: Promote Positive Mental Health
Create Minnesota communities where every person can realize his or her own potential, cope with the normal stresses
of life, work productively and fruitfully, and make a contribution to her or his community. Building communities
where people are connected and have the power to achieve community-specific, culturally-focused, actions to build
resilience and change the social and economic conditions that enable trauma and health inequity.
Focus areas:
•
•
•
•
•
•
•
Available, culturally, and linguistically appropriate, and quality mental health services
Build local community capacity to address mental health and well-being
Address historical, generational trauma and promote resilience
Integrate behavioral health with primary care – both mental health and substance use treatment
Postpartum depression prevention and treatment
Suicide prevention
Bullying prevention
The Maternal Child and Health Assessment Leadership Team identified these specific action recommendations to
promote positive mental health in Minnesota:
1. Create more opportunities for community dialogue, capacity building, and engagement in decision making
regarding mental health.
2. Develop measures for "culturally appropriate care" to increase understanding of accessibility and address problems.
3. Increase access to mental health education, preventive care and treatment for youth, including building the capacity
of specific approaches for youth of color and for youth who identify as Lesbian, Gay, Bisexual, Trans, or Queer
(LGBTQ).
4. Increase social-emotional/mental/behavioral health screening and referrals to appropriate treatment and support.
5. Build capacity to provide mental health services (prevention, assessment, and treatment) throughout the state
through integrative behavioral health and professionals maximizing their licensure capability.
Page 1
6/7/2016
Available, culturally appropriate and quality mental health services
Objectives:
• Improve access to culturally welcoming and appropriate mental health services.
• Increase the percent of children and families with mental health concerns who receive early treatment.
• Increase social-emotional, and mental health screening by primary care providers.
• Increase and build diverse communities’ capacity to develop more clinicians and mental health workers from
those communities.
• Increase access to community based mental health services in greater Minnesota.
• Improve data collection, dissemination, and coordination.
• Address premature mortality of people with serious and persistent mental illness.
In Minnesota, only the metro area and the southeast region are considered to have adequate mental health coverage. The
rest of the state are designated shortage areas (Office of Rural Health, Minnesota Department of Health).
According to the 2013 report from the Mental Health Workgroup of Minnesota’s Statewide Community Health Services
Advisory Committee, Minnesotans with serious and persistent mental illness die 24 years earlier than the general
population. In Minnesota, American Indian adults and those reporting “other” as their race report “poor mental health” at
greater rates than the overall public.
Chart 1: Percent of Minnesota Adults Reporting Poor Mental Health, 2014
Source: The Henry J. Kaiser Family Foundation as found on www.kff.org, 2/22/2016.
Measurements/outcomes to understand availability of appropriate and quality mental health services:
•
•
•
•
•
Percent of adults reporting “poor mental health.”
Percent of patients with major depression achieving and maintaining remission.
Percent of children and adolescents enrolled in Medicaid who have a Child and Teen Checkup, who have received
a social-emotional screening.
Time from a child receiving a positive screen for a social-emotional concern to completing an evaluation or
assessment and, if needed, starting to receive treatment and support.
Percent of children and youth with special health needs who have a mental health or social-emotional concern
who are receiving treatment.
Page 2
6/7/2016
Examples of strategies and practices to support appropriate and quality mental health services:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Promote social-emotional development in young children within primary care and early childhood care/education.
Include mental health in community health assessments.
Include mental health in health impact assessments.
Develop measures to understand and track capacity of providers to deliver culturally competent and welcoming
care.
Increase the number of providers of infant (0-3) mental health; include education of infant mental health in
schools’ curriculum.
Develop patient navigation systems.
Improve the timeliness of receiving mental health services after onset of symptoms.
Map the mental health resources and processes available to community members.
Support local/statewide efforts to reduce the stigma associated with mental illness, such as the Make It OK
campaign.
Incorporate mental health topics into existing health education strategies.
Promote tele-health communication for rural MN where transportation and child care is an issue.
Provide cultural trainings for providers, educators and law enforcement and other professionals working with
culturally diverse communities.
Define and codify culturally specific services, to support enhanced payment or support for providers.
Increase universal screening for social-emotional concerns for children and caregivers.
Increase access and acceptability of mental health services through the use of community health workers.
Promote effective social-emotional/mental health screening and referral practices within primary care.
Building Community Capacity
Objectives:
•
•
Increase understanding about the role of community capacity in addressing mental health and well-being.
Increase the number of communities that have a collective vision for creating positive mental well-being.
Measurements/outcomes related to building community capacity:
No specific measurements for community capacity building have yet been formally established. Community capacity
may be best measured by qualitative responses. However, the following are possible initial quantitative elements:
•
•
•
Number of different sectors involved and cross-sector efforts being implemented.
Number of results/reports tied to identified community values/goals.
Number of resident/community leaders involved in meaningful ways.
Examples of strategies or practices to build community capacity:
•
•
•
•
•
•
•
Host community dialogues to identify issues of common concern and share stories about the barriers and
opportunities for individual, family and community resilience.
Develop community level vision for addressing trauma and building resilience, as well as the social and economic
conditions that support trauma and resilience.
Intentionally conduct key informant interviews if members of the community are not coming to the table.
Select a community priority project related to the identified shared concerns.
Expand leadership opportunities to include parents, youth, persons with mental health concerns, other members of
the community in identifying activities and practices to build community support for positive mental health.
Identify and share local level data regarding issues important to the community, especially the social and
economic factors related to trauma, resilience and mental well-being.
Host training opportunities for community leaders about mental well-being and resilience, and adverse childhood
experiences.
Page 3
6/7/2016
•
•
•
•
•
Identify other partners who are not at the table and why they might be of interest.
Use of SAMHSA Strategic Prevention Framework, designed to help states, jurisdictions, tribes, and communities
build the infrastructure necessary for effective and sustainable prevention. Each step contains key milestones and
products that are essential to the validity of the process.
Support community and cultural organizations in implementing curriculums to engage youth in understanding the
impact of historical trauma, healing from the effects, and the promotion of healthy lifestyles.
Use strength-based curriculum to address real-world issues that youth face while building upon the communityidentified strengths, resiliency, and hope for future generations.
Provide training for Community Health Workers to promote mental health and well-being.
Address historical and intergenerational trauma, and build resilience
Objectives:
•
•
Improve health outcomes by addressing historical and intergenerational trauma in communities of color.
Decrease disparities in mental health outcomes.
Chart 2: Adverse Childhood Experience Data by Race
Source: Minnesota Department of Human Services, Adverse Childhood Experiences in Minnesota Report, 2013.
Possible measurements/outcomes related to addressing trauma:
•
•
Percent of local public health agencies with community health plans that address historical or community-level
trauma.
Number of community leaders receiving training regarding supporting communities in addressing trauma.
Page 4
6/7/2016
Examples of strategies and practices to address trauma:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Partner with tribes and local public health who are working to build resilience, mental health promotion and social
determinants of health.
Create opportunities for people to connect and practice cultural or spiritual traditions.
Create opportunities for people to build meaningful relationships (e.g. mentoring).
Work with local mentoring programs to improve program quality and prioritize children and youth with trauma.
Create opportunities, in schools and other community settings, for children and adults to build developmentally
appropriate and meaningful skills, such as: social and emotional, communication, and problem solving.
Create universal public health home visiting to support parenting skills.
Parenting education and skills programs.
Implement trauma assessments and protocols in clinics, schools, child-care.
Include members from the communities affected by plans and programs in the planning efforts.
Educate local public health, schools, health care, and community-based organizations on the impact of historical
and intergenerational trauma and the strategies for reducing trauma and building resilience.
Prepare providers to more effectively serve children and families exposed to and experiencing trauma.
Provide education and resources on trauma informed organizations and care for community organizations and
care providers.
Support intergenerational mental health strategies.
Mentoring programs.
Develop a community-level intervention to mobilize stakeholders to collaborate on selecting and implementing
evidence-based prevention programs designed to prevent youth problem behaviors, such as substance abuse and
delinquency.
Emphasizes adolescent interventions that focus on skill development, pro-social activities, and caregiver/youth
communication, which are addressed in this proposal.
Trauma-Focused Cognitive Behavioral Therapy is a model of psychotherapy that effectively combines traumasensitive interventions with cognitive behavioral therapy. It is designed to address the needs of children with Post
Traumatic Stress Disorder (PTSD) or other significant behavioral problems related to traumatic life experiences.
Focus on policies pertaining to children needing residential mental health treatment or therapeutic foster care, to
help families overcome the confusion that could cause parents to relinquish custody in order to qualify for
services and funding for their children. Training increases understanding and improves practice among county
social services, county attorneys, providers, advocates, and parents.
Page 5
6/7/2016
Integrating behavioral (mental and substance use) health with primary care
Objective: Develop and promote effective collaborative care models that integrate behavioral and physical health to
improve the experience, quality and cost of services for individuals with complex mental health needs.
Chart 3: Outcome Measures from DIAMOND, one model for integrating behavioral health with primary care:
Source: Institute for Clinical Systems Improvement White Paper, MN, June 2014*PHQ-9: Patient Health Questionnaire Depression
Module. Patients include all with major depression or dysthymia diagnoses with PHQ-9 > 9 who enrolled into DIAMOND and did not
decrease or transfer care to another health care system. Re-measured denominator includes all patients enrolled into DIAMOND who
had PHQ-9 follow-up at 6 months, +/- 30 days.
Measurements/outcomes regarding integrating behavioral health with primary care:
•
•
Increase the number of clinics actively integrating behavioral health into primary care.
Increase the number of individuals with serious mental illness who are receiving behavioral health and physical
health care through a collaborative care model.
Examples of strategies and practices to support integrating behavioral health with primary care:
•
•
•
•
•
•
•
Integrate behavioral health into Health Care Homes, using existing care coordination, navigation and assessments.
Outreach to educate clinic managers and providers on basics of behavioral health integration and the technical
support available.
Increase primary care competence and confidence in screening and offering basic mental health services through
quality improvement projects.
Establish and promote behavioral health homes.
Use quality improvement practices to support increased referrals and improved communication between primary
care and the early intervention system.
Screen adolescents for depression in well child visits.
Implement universal depression screening for primary caregivers in well child checks, along with proper referrals
and follow up.
Page 6
6/7/2016
Postpartum depression prevention and treatment
Objectives: Increase depression/postpartum depression screening by primary care providers.
Chart 4: Percent of self-reported postpartum depression by race, MN 2009-2011
Source: Minnesota’s Pregnancy Risk Assessment Monitoring System, 2009-2011
Measurements/outcomes:
•
•
•
Percent of pregnant women screened for depression during routine prenatal care.
Percent of mothers aged 18-44 having a live birth who reported that they felt down, depressed, or hopeless "often"
or "always" after the birth of their baby, by selected socio-demographic characteristics.
Percent of self-reported postpartum depression by race.
Examples of strategies and practices:
•
•
•
•
•
Increase number of providers for maternal mental health; change/require assessments during hospital stays after
giving birth.
Improve support for mothers (and their children) who live with mental illness.
Create a safe environment for moms to receive mental health care and appropriately address fears of having their
children taken away if they utilize care. If there are issues, provide appropriate support (versus child protection).
Promote awareness, prevention and treatment of mental health issues related to childbearing through internet
campaigns targeting families and communities, and provider education.
Implement universal depression screening for primary caregivers in well child checks, along with proper referrals
and follow up.
Page 7
6/7/2016
Suicide prevention
Objectives:
•
•
Reduce suicide attempts by adolescents
Reduce suicide rate in Minnesota by 10% in five years, 20% in ten years, ultimately working towards zero deaths.
Chart 5: Suicide rate by race, MN vs National, 2011
Source: National Vital Statistics System, 2011
Youth rates have been stable over the last decade; however, in Minnesota suicide remains the second leading cause of
death for youth ages 10-24. Students of color are more likely to report thinking about and attempting suicide.
From 1999 to 2011, Minnesota’s female suicide rate increased from 3.0 per 100,000 to 5.0 per 100,000, a 67% increase.
Suicide is the 2nd leading cause of death for 10-19 year olds in Minnesota. Of those reporting a suicide attempt, only 32%
received mental health treatment in the past year.
Chart 6: Percent of 9th and 11th grade students (combined) who “seriously considered attempting suicide during
the last year”, 2013
Source: Minnesota Student Survey, 2013
Page 8
6/7/2016
Percent of Minnesota youth who have ever tried to kill themselves by health status, grade and gender, 2010
Male
Health Status
Neither physical or
mental health condition
Physical health
condition only
Mental health condition
only
Both physical and
mental health condition
Female
6th grade
9th grade
12th grade
6th grade
9th grade
12th grade
2.6%
3%
3.6%
2.3%
4%
4%
4.6%
5%
6.2%
4.3%
6.3%
6.1%
12.1%
20.6%
25.5%
14.6%
29.6%
25.5%
17.1%
27.6%
35.3%
17.6%
39.4%
31.5%
Source: Minnesota Student Survey, 2010
Measurements/outcomes regarding suicide prevention:
•
•
•
Percent of youth who have ever tried to kill themselves.
Percent of youth who have received mental health treatment following a suicide attempt.
Percent of youth with an identified special health need who make a suicide attempt.
Examples of strategies and practices to prevent suicide:
•
•
•
•
•
•
•
•
•
•
•
Support healthy and empowered individuals, families and communities to increase protection from suicide risk.
Coordinate the implementation of effective programs by clinical and community prevention service providers to
promote wellness, build resilience and prevent suicidal behaviors.
Promote suicide prevention as a core component of health care services.
Increase the timeliness and usefulness of data systems relevant to suicide prevention and improve the ability to
collect, analyze and use this information for action.
Sustain current suicide prevention efforts.
Incorporate depression/suicide prevention into all health education classes for students in middle and high school.
Increase education and awareness for specific populations, including LGBTQ.
Coordinate suicide prevention training in schools using an evidence-based curriculum.
Provide means restriction education to mental health professionals, teaching them how to effectively present
lifesaving information on suicide prevention in three brief steps.
Educate mental health advocates and the general public in being alert to the symptoms of depression and the
warning signs of suicide.
Host a Youth Summit to raise awareness of suicide and promote help-seeking behaviors.
Page 9
6/7/2016
Bullying prevention
Objectives: Reduce and eliminate incidents of bullying, harassment, and intimidation in Minnesota schools.
Chart 7: Percent of 9th grade students bullied by specific reasons and race (single or in combination), 2013
Source: Minnesota Student Survey, 2013.
Measurements/outcomes:
•
•
Percent of adolescents, ages 12 through 17, who are bullied.
Percent of adolescents, ages 12 through 17, who bully others.
Examples of strategies:
•
•
•
•
•
•
•
•
Train teachers and other school personnel and volunteers to prevent, recognize, and respond to bullying.
Implementing and maintaining a comprehensive, whole-school bullying prevention or positive school climate
program using tiered levels of support.
Intensive interventions, designed to re-build relationships (restorative practices, circles)
Increase bystander and adult skills to intervene.
Provide opportunities in school and out of school to build social skills, find safe places to contribute to the school
or community, and connect with caring adults.
Refer identified victims and bullies to student assistance staff to explore other experiences of victimization in
their life.
Restorative practices are designed to restore relationships and provide participants with an experience and set of
skills that are critical for building social and emotional health. The use of restorative practices has been shown to
be an effective method in the classroom in helping to reduce violence and bullying, misbehavior, repair harm, and
improve the overall climate for learning.
Coordinate policy, curriculum and practice: Interconnect bullying data, research, prevention and intervention best
practices and that of other victimizations, risk behaviors or perpetration in curriculum, policy and practice.
Page 10
6/7/2016
•
Promote a whole-school approach to preventing bullying, which includes:
• Reaffirming relationships through developing social and emotional skills.
• Repairing relationships through facilitated and supported dialogue.
• Rebuilding relationships through intensive facilitated dialogue that includes a broad social network.
Positive Mental Health was or is an identified priority, focus, or goal of all of these reports, plans, and
organizations:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Maternal and Child Health Assessment Inquiry Feedback – MDH
2010 Title V National Performance Measure
2010 Title V State Performance Measure
2015 Title V National Performance Measure
Adolescent Health Action Plan – MN
Advancing Health Equity Report
Centers for Disease Control and Prevention Healthy People 2020
Children’s Defense Fund – MN
Community Health Boards
Healthy MN 2020: Statewide Health Improvement Framework
Hospital Community Health Needs Assessments
Injury & Violence Prevention – MDH
MN Children & Youth With Special Health Needs Strategic Plan 2013-2018
MN Council of Health Plans
MN Statewide Health Assessment 2012
Prenatal to Three Plan
Rainbow Health Initiative
Rural Health Advisory Committee
For more information about the 2015 Maternal and Child Health Assessment, or about the Title V Block Grant, please
visit the Minnesota Department of Health webpage at http://www.health.state.mn.us/divs/cfh/na/ .
On the data charts above, all races are non-Hispanic ethnicity, unless otherwise indicated.
PO Box 64882, St. Paul, MN 55164-0882
651-201-3760
[email protected]
http://www.health.state.mn.us/divs/cfh/na/MCHNeedsAssessment.html
Page 11
6/7/2016