TITLE V MCH BLOCK GRANT
Application for 2013
Report for 2011
Presented to the MCH Advisory Task Force
September 7, 2012
Overview
• Politics
• 201 legislators up for reelection in November 2012 due to
redistricting, at least 30 not seeking re-election
• Will the GOP win the house and senate again?
• Governor - Democrat
Overview
• Population
• 5.3 million – ½ in 7 county metro area
• Children under 5 year old - 6.8% (U.S. 6.7%)
• Over age 18 - 75.8% (U.S. 75.5%)
• Over age 65 -12.3% (U.S. 12.6%)
• Over 179,000 CYSHN (14.3% of children)
Overview
• Population
(cont.)
• Birth rates dropped to the lowest in 20 years
• 2010 - 68,407
• Less diverse than US – 17% minorities (36% US)
• 30% of > 5 year olds
• Some parts of the state greater than others
• 71% Mahnomen, 60% Nobles, 54% Ramsey, 58% Hennepin
• International immigrants – 14% of children
Overview
• Economics
• 1 in 10 Minnesotans live in poverty
• 140,000 children below the federal poverty guidelines
• WIC participation declined – 127,985
Overview
• Disparities
• Teen Pregnancy – down overall
(U.S 34.3/1,000)
• 14.9/1,000 White
• 48.5/1,000 African-American
• 67.1/1,000 American Indian
• 31.4/1,000 Asian
• 63.2/1,000 Hispanic
• Deaths
• American Indian - 2 times higher than White
• African American - 1.5 times higher
Overview
• Insurance
• 3rd best in U.S for residents insured
• 9.1% lack health insurance
• 5.4% children are without insurance coverage
• 480,000 uninsured
• 85,000 < 18
• 56% group coverage
• 30% public programs (Medicaid, Minnesota Care, Medicare)
• 41.3% of births on Medicaid
State Initiatives
• Highlights
• Race to the Top: Early Learning Challenge
• $45 million to improve results for young children and build capacity and
accountability into the learning system
• Health Care Homes (medical home)
• 170 certified clinics
• 1,764 clinicians
Department Initiatives
• Public Health Accreditation - 2013
• Maternal and Child Health Advisory Task Force
• Sunset in 2011 and reestablished in 2012
• 15 new members
• 2 work groups CYSHN and Family Home Visiting
Agency Capacity
• American Indian Health Director
• Strategic planning to maximize use of resources and expertise and to
support collaboration around American Indian health initiatives
• Maternal and Child Health/Children with Special Health Needs
Section
• Separate sections due to size and breadth of programs
Agency Capacity
• Maternal and Child Health Programs
• Family Home Visiting
• $7 million TANF funding
• $10.2 million Maternal, Infant and Early Childhood Home Visiting
• March 2012 received MIECHV Expansion grant
• Infant Mortality Reduction
• New IM Coordinator
• Region V Collaborative
• Child Care – Race to the Top
• Child Care Health Consultant
• Child Care Contracts – 4 transformation zones
Agency Capacity
• Children and Youth with Special Health Care Needs
Program
• Health Care Home (Medical Home)
• 170 certified clinics
• 1,764 clinicians
• Autism
• Legislative Autism Spectrum Disorder Task Force – develop state plan
• Qualitative Study on Autism related to accessing resources and culture
• Birth Defects
• New preconception care grants
• Statewide Expansion
State Priorities
• Goal 1: Increase health equity and reduce health
disparities for pregnant women, mothers and infants,
children and adolescents, and children and youth with
special health care needs.
• Goal 2: Focus efforts on activities that result in positive
outcomes across the lifespan.
Priorities
1. Improve Birth Outcomes
2. Improve the Health of Children and Adolescents
3. Promote Optimal Mental Health
4. Reduce Child Injury and Death
5. Assure Quality Screening, Identification, and
Intervention
6. Improve Access to Quality Health Care and Needed
Services
7. Assure Healthy Youth Development
NPM 1: The percent of screen positive newborns who received
timely follow up to definitive diagnosis and clinical management
for condition(s) mandated by their State-sponsored newborn
screening programs.
• 173 infants confirmed through newborn screening
• Legal issues related to genetic privacy act and blood spot
storage
• Court decision made that limits the number of days blood
spot cards can be stored
NPM 2:The percent of children with special health care needs
age 0 to 18 years whose families partner in decision making at all
levels and are satisfied with the services they receive.
• 76.3% families partner in decision making at all levels
and are satisfied with the services they received.
• Measurement changed significantly for 2009/10
NS‐CSHN, and therefore cannot be compared to 2001
and 2005/06.
• Varies by subgroups, children without insurance
experience less satisfaction, as do those without a
health care home.
NPM 3:The percent of children with special health care needs
age 0 to 18 who receive coordinated, ongoing, comprehensive
care within a medical home.
• Title V-CYSHN staff integrated into Health Care Home Section
assigned to districts throughout the state:
• Develop local capacity in assuring access to quality services
• Promote interagency collaboration and coordination between other
state agencies to assure access to high quality care for children
• Certification of 171 clinics as health care homes includes pediatric
health care homes
NPM 4: The percent of children with special health care needs
age 0 to 18 whose families have adequate private and/or public
insurance to pay for the services they need.
• 93.3% of children under 17 have insurance
• Federal health reform being monitored
• Exploring Information & Assistance options for families
especially in regards to public programs
NPM 5: Percent of children with special health care needs age 0
to 18 whose families report the community-based service
systems are organized so they can use them easily.
• 69.5% are organized so families can access them
easily
• Limitations to data as must have NO difficulties or
delays in getting services, and be only sometimes or
never frustrated in efforts to get services .
• Access differs by type of special health need
• Less than ½ of CYSHN - functional limitations meet
measure compared to over ¾ of CYSHN whose
condition is managed by prescription medication.
NPM 6: The percentage of youth with special health care needs
who received the services necessary to make transitions to all
aspects of adult life, including adult health care, work, and
independence.
• MN State Council on Disabilities Transition Advisory
Group
• Health Care Home Pilot Projects around Transition in 3
communities
• Promote employment messaging from health care
providers
• Interagency collaboration – Part B, MnSIC, MDE
NPM 7: Percent of 19 to 35 month olds who have received full
schedule of age appropriate immunizations against Measles,
Mumps, Rubella, Polio, Diphtheria, Tetanus, Pertussis,
Haemophilus Influenza, and Hepatitis B.
• 2011 95% of 19 – 35 month old children receive a full
schedule of age appropriate immunizations.
NPM 8: The rate of birth (per 1,000) for teenagers aged 15
through 17 years.
• Overall teen birth rate decreased from 10.9 in 2010 to
9.98 in 2011. (13.9 in 2007)
• Family Planning Special Projects: $10.7 million
• Personal Responsibility in Education Program (PREP) :
$874,780/year for communities at greatest risk for teen
pregnancy and STIs.
NPM 9: Percent of third grade children who have received
protective sealants on at least one permanent molar tooth.
• Needs assessment – school based dental sealant
programs & infrastructure
• 2009-2010 19,328 children received sealants in school,
25% of schools
• 2011 29% of high-risk schools have a school-based
dental sealant program
NPM 10: The rate of deaths to children aged 14 years and
younger caused by motor vehicle crashes per 100,000 children.
• Holding at 1.82/100,000
• Primary seatbelt enforcement
• Strengthened booster seat law.
• 124 of 130 acute care hospitals designated as Level I, II,
III or IV trauma centers – reduce risk of MV related death
NPM 11: The percent of mothers who breastfeed their infants at 6
months of age.
• Exceeded goal for BF at 6 months - > 53%
• Initiation rates lower for refugee and low-income
populations
• Collaboration for a summit on Baby Friendly Hospitals
NPM 12: Percentage of newborns who have been screened for
hearing before hospital discharge.
• Increased to 98.3% of all newborns were screened.
• 570 infants who did not pass hearing screening and have
unknown diagnostic status
• 229 infants confirmed with a hearing loss up from 53 in
2006.
NPM 13: Percent of children without health insurance.
• 9.1% of Minnesotan’s uninsured in 2011 (7.2% in 2007)
• Health Care Reform activities
NPM 14: Percentage of children, ages 2 to 5 years, receiving
WIC services with a Body Mass Index (BMI) at or above the 85th
percentile.
• New standards for growth and weight status of 0-24
months
• Pilot test Patient Centered Services model into WIC
services in 5-8 local agencies
NPM 15: Percentage of women who smoke in the last three
months of pregnancy.
• Estimated 2010 – 13.1% (goal 10%)
• Smoking cessation programs
• Eliminating health disparities grants
• WIC
• RWJ cross-divisional tobacco message development
grant
NPM 16: The rate (per 100,000) of suicide deaths among
youths aged 15 through 19.
• 10/100,000 rate 2011 (estimated)
• $196,000 to 3 grantees for suicide prevention
• State & local prevention activities
NPM 17: Percent of very low birth weight infants delivered at
facilities for high-risk deliveries and neonates.
• 88% born in facilities appropriate for high-risk, very low
birth weight deliveries
• Provider education
• Prematurity Task Force – legislated 2011
NPM 18: Percent of infants born to pregnant women receiving
prenatal care beginning in the first trimester.
• 2010 86%
• Culturally appropriate prenatal care
• Reduce barriers to first trimester care including mental
health, violence, preconception care
• Twin Cities Healthy Start – improved perinatal care for
African-American and American Indian women
SPM 1: Percentage of women who did not consume
alcohol during the last three months of pregnancy.
• 84% (PRAMS data)
• Student Parent Support grant
• MOFAS “049” campaign: Zero alcohol for 9 months
SPM 2: Percentage of children enrolled in Medicaid who
receive at least one recommended Child and Teen Checkup
(C&TC) visit (EPSDT is known as C&TC in Minnesota).
• 72% estimated (delay in DHS data)
• Training and technical assistance to C&TC providers
• Convene a best practices work group to review hearing
screening for 0-21
SPM 3: Percentage of Minnesota children birth to 5 enrolled in
Medicaid who received a mental health screening using a
standardized instrument as part of their Child and Teen Checkup
(C&TC) visit (EPSDT is known as C&TC in Minnesota).
• 2.7% received screening using a standardized instrument
• Training and technical assistance to providers
• Develop a developmental and mental health screening
toolkit
SPM 4: Incidence rate of child maltreatment reports per 1,000
children birth through 17 years.
• Incidence rate decreased 12.1/1,000 in 2010 to
10.8/1,000 in 2011
• Increase in funding for Family Home Visiting (MIECHV)
• Increase capacity for evidence-based home visiting
programs
SPM 5: The number of children birth to three years of age
enrolled in the Follow-Along Program.
• 2010:
• 2011:
32,820
30,120
• Decrease in funding for FAP by IEICs
• Four programs discontinued their FAP
• One tribal program added
• Report of FAP program survey results on current
procedures and funding sources
• On-line ASQ and ASQ-SE in development
SPM 6: Percentage of children under the age of one year
participating in early intervention through Part C of the
Individuals with Disabilities Education Act.
• 2010:
• 2010:
• 2011:
.7% (543/73,019)
.9% (629/68,407)
.9% (597/68,407)
• IEIC restructured from 95 to 12 regional IEICs to assure
consistency and standardization of child find and public
awareness strategies regionally.
• Outreach to health care professionals
SPM 7: Percentage of participants in Minnesota’s family home
visiting program referred to community resources that received a
family home visitor follow-up on that referral.
• Increase in follow up from 79% to 82%
• Early identification and referral to community resources
• Cross-departmental and interagency systems planning to
facilitate effective referrals
SPM 8: Percentage of children and youth with special health care
needs that have received all needed health care services. (National
Survey of CSHCN)
• 87.1% (2005-06 data)
• 79.7% (2009-10 data)
• Policy support and discussion with state advisory
committees: MnSIC, ICC, DD Council, etc.
• Support for LPH to help facilitate service coordination
through WIC, FAP, FHV, and Early Hearing Detection &
Intervention Follow-up/Birth Defects LPH Follow-up
SPM 9: Percentage of families of children age 0-17 that report
costs not covered by insurance are usually or always
reasonable.
• 63% of families
• Provide insurance information to requested callers
• Continue to support parent to parent organizations in
providing information about public health programs
• Provide information and TA regarding access to
supplemental insurance programs that reduce costs and
help with out-of pocket expenses.
SPM 10: By 2013, collaborate with other state agencies
to identify a state performance measure and benchmark to
monitor positive youth development in Minnesota.
• Adolescent Health Report 2012
• Teen Outreach Program
Comments by Reviewers
• Strengths
• Written clearly, very readable
• Good overview – especially demographics
• HCH certifications impressive
• State priorities well selected
• Funding from sources other than HRSA (Race to the Top and ASTHO)
• Recommendations
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Increase or better explain input (state and local)
Life Course integration
Articulate role or contribution in listed collaborative activities
Update needs assessment section to include yearly activities on needs
assessment not just the five year assessment
Change performance objectives when met