State Health Resources for Women & Children

1. State Health Resources for Women & Children Denise Higgins, Chief Family & Community Health Bureau MT Department of Public Health & Human Services dehiggins@mt.gov April 26, 2013

2. Conference Objective Identify at least 5 currently available resources for Women and Children in the State of Montana

3. Essential Public Health Services • Monitor health status to identify and solve community health problems. • Diagnose and investigate health problems and health hazards in the community. • Inform, educate, and empower people about health issues. • Mobilize community partnerships and action to identify and solve health problems. • Develop policies and plans that support individual and community health efforts. • Enforce laws and regulations that protect health and ensure safety. • Link people to needed personal health services and assure the provision of health care when otherwise unavailable. • Assure competent public and personal health care workforce. • Evaluate effectiveness, accessibility, and quality of personal and population-based health services. • Research for new insights and innovative solutions to health problems.

4. Maternal & Child Health • MCH is the professional and academic field that focuses on the determinants, mechanisms and systems that promote and maintain the health, safety, well-being, and appropriate development of children and their families in communities and societies, in order to enhance the future health and welfare of society and subsequent generations.

5. What does MCH include? • Determinants of health • Disparities • Pregnancy health • Pre-conception health • Reproductive health • Child health • Children with special health care needs • School health • Adolescent health • Oral health • Nutrition • Health policies • International health • Health care and insurance • Advocacy

6. Pyramid of Services • Infrastructure Building Services form the foundation of the program. These services create the capacity on which all other MCH services rely, such as maintaining data systems, ensuring a well-trained workforce, and establishing integrated, coordinated systems of care. • Population-Based Services reach the entire MCH population, providing disease prevention and health promotion services such as universal screening programs and public information campaigns. • Enabling Services help vulnerable populations—children and families who are poor, have special health care needs, or are at risk of poor health outcomes—access needed services and optimize health benefits. • Direct Health Care Services provide gap-filling primary and preventive health care services that would not otherwise be available through other funding sources or providers.

7. Risk Factors *difference is statistically significant

8. Risk Factors Mother’s smoking status by age, Montana residents Montana Office of Vital Statistics, 2008-2010.

9. Five-Year Infant Mortality Rates and Fetal Mortality Ratios, Montana Residents, 1962-2011

10. Access and Outcomes Prenatal care initiation, low birth weight, and preterm birth in Montana, by age of mother, Montana Office of Vital Statistics, 2009

11. Teen Pregnancy Teen (15-19) birth rates by race, 2 year averages, Montana Montana Office of Vital Statistics, 2002-2011

12. Teen Pregnancy Teen (15-19) birth rates by race, MT and US Montana Office of Vital Statistics, 2010 85.7

13. Promote the Health of Mother, Infants and Children: By 2017, increase the number of women aged 15-44 years who receive reproductive health care services at Title X clinics from 26,480 to 28,000. (HP 2020 Target: 78.8%) By 2017, increase the percentage of women who reported entering prenatal care in the first trimester from 72% to 80%. (HP 2020 Target: 78% ) By 2017, increase the percentage of women who report abstaining from smoking during pregnancy from 83% to 90%. (HP 2020 Target: 98%) By 2017, decrease the rate of live births per 1000 that are preterm from .88 per 1000 live births to .5 per 1000 live births. (HP 2020 Target: 1 per 1000 live births)

14. Evidence-based Interventions • Decreasing teen pregnancy and teen births can be achieved in two ways • Contraceptive use among sexually active teens • Delay/decrease initiation of sexual activity • Draw the Line/Respect the Line (6th, 7th and 8th grade youth) • Focuses on postponing sexual activity • Addresses social pressures, communication and negotiation skills

15. Evidence-based Interventions Delaying initiation of sexual activity and pregnancy prevention • Reducing the Risk(High school youth) • Decrease sexual initiation • Decrease sexual risk taking • Increase contraception use for sexually active teens • Teen Outreach Program (High school youth) • After-school service program that focuses on positive self-image, life management skills and goal setting

16. MCH in Montana • Funding to 54 local County Health Departments • Immunizations • Women’s and Men’s Health • WIC • Home Visiting • Children with Special Health Care Needs • Newborn Hearing and Metabolic Screening • Clinical Genetics • Recruitment, Retention, Loan Repayment

17. Montana WIC WIC contracts with 27 Regional Programs to offer the WIC program benefits to women, infants, and children throughout MT Nutrition education, breastfeeding support, food packages Serve an average of 20,000 participants each month

18. Who we serve Pregnant, breastfeeding and postpartum women Infants & children up to 5 years old <185% poverty level Adjunctively eligible: Medicaid, TANF, SNAP, free/reduced school lunch Live in Montana At nutritional risk Refer all pregnant women

19. Nutritional Services At certification Screen income, check residence and ID, physical presence Collect anthropometric & biochemical data (ht, wt, hgb) Collect dietary, socioeconomic and medical data = Assess/Risk Code Provide client centered education based on risk Create care plan including referrals, follow up schedule and ed. topics Follow up Refer to care plan, f/u on education, referrals, goals, current education Mid-year assessment Anthropometrics, brief assessment & education

21. Montana WIC Program1400 Broadway, Cogswell Bldg. C305PO Box 202951Helena, MT 59620-2951Telephone: 800-433-4298 or (406) 444-5533 www.wic.mt.gov

22. Women’s & Men’s Health • 14 Title X clinics around the state • Resources on: • Family Planning • Teen pregnancy prevention • Health education & outreach • Information on breast & cervical health • Men’s health • STI/HIV prevention

23. Who is a Title X patient? • Anyone can receive services from a Title X Family Planning Clinic. However, for those services to be subsidized by Title X funds, the patient must be: • Females or males who want to avoid unintended pregnancies or achieve intended pregnancies. • Post-menopausal women are not eligible for Title X services since they are unable to become pregnant and would not need contraceptive counseling. There is no such limit for men as they do not have a definite end to their reproductive years. • Adolescents may be served confidentially* as long as they receive counseling on the following: • Importance of family involvement • Abstinence • Sexual coercion • Confidentiality • STI/HIV prevention *MCA 41-1-402: Validity of consent of minor for health services

24. Patient Services • Education and counseling that includes • Birth control methods • Adolescent counseling (parental involvement, sexual coercion, abstinence, confidentiality and STI/HIV and pregnancy prevention) • Tobacco cessation • Nutrition and physical activity • Immunization • Reproductive Life Plans • Reproductive Health exams for men and women • Testing • STI • HIV • Pregnancy • Contraception • Cancer Screening • Breast • Cervical • Colo-rectal • Referral that includes • Pregnancy • Weight management • Primary care • Abnormal breast and pap follow-up • Mental health

26. Women’s and Men’s Health Section Montana Department of Public Health and Human Services 1400 E Broadway A116 Helena MT 59620 Phone: 406-444-0983Fax: 406-444-2606www.dphhs.mt.gov/publichealth/wmh/womensreproductive.shtml

27. Maternal and Early Childhood Home Visiting Evidence-based models • Nurse-Family Partnership • Missoula & RiverStone Health • Parents As Teachers • Lake, Flathead, Lincoln and Mineral Referral networks with local health departments

28. Nurse-Family Partnership • Focus: Healthy pregnancy, knowledgeable and responsible parenthood, and personal growth and development • Clients: First time, low income pregnant women, to the child’s second birthday • Enrollment timing: By the end of the 28th week of pregnancy • Visits: weekly (1st 4 weeks and 1st 6 weeks postpartum), otherwise every other week, then monthly when child is 21-24 months • Nurse home visitor

29. Parents as Teachers • Focus: parenting education, family support, school readiness, building protective factors within the family • Clients: identified by community, recommend enrolling prenatally or in infancy; served until the child turns 3 or 5 • Visits: Every week to every other week • Personal visits and group connections • Parent educator

30. Domains • Child health • Maternal health • Child development and school readiness • Family economic self-sufficiency • Linkages and referrals • Parenting practices • Child maltreatment • Juvenile delinquency, family violence, and crime

31. Maternal and Infant Home Visiting Montana Department of Public Health and Human Services 1400 E Broadway B102Helena MT 59620 Phone: 406-444-6940Fax: 406-444-2606www.dphhs.mt.gov/publichealth/homevisiting/miechv.shtml

32. Children’s Special Health Services • Partner with regional sites to assure access to pediatric specialty care. • Community Medical Center, Missoula • St. Vincent’s, Billings • Great Falls Clinic, Great Falls

33. Cystic Fibrosis Team Clinic Cerebral Palsy/Spasticity Cleft/Craniofacial Team Clinic Endocrine Clinic Epilepsy Clinic Genetic Evaluation & Outreach Services – Shodair Hospital Hemophilia Clinic High Risk Infant Follow-up Clinic Juvenile Rheumatoid Arthritis Metabolic Clinic (PKU) Muscular Dystrophy Nephrology Clinic Neurology Clinic Neural Tube Defects/Spina Bifida Clinic Neurology Outreach Clinic Orthopedic Clinic Pulmonary Clinic Rehabilitation Clinic Rheumatology Clinic Urology Ensuring a broad range of Pediatric Specialty Clinics

34. Travel Distance for CF Patients who Attend CF Team Clinics

35. 1. Age- birth through 18 years of age. Is diagnosed with special health care needs. OR 3. At risk for chronic physical, developmental, behavioral, or emotional conditions. AND 4. Requires health and related services of a type or amount beyond that required by children of the same age. ELIGIBILITY

36. Financial Assistance • CSHS • $2,000 cap • Financial and clinical criteria • Can be renewed annually • Genetic Testing • Clinical criteria • For genetic laboratory testing • All ages qualify

37. Children’sSpecial HealthServices Montana Department of Public Health and Human Services PO Box 202951Helena MT 59620-2951 (406) 444-3622 (local)(800) 762-9891 (toll free in state)Fax: (406) 444-2750 Email: cshs@mt.gov www.cshs.mt.gov

39. Early Hearing Detection and Intervention (EHDI) National Goals • Goal 1: All newborns will be screened for hearing loss before one month of age, preferably before hospital discharge. • Goal 2: All infants who screen positive will have a diagnostic audiologic evaluation before 3 months of age. • Goal 3: All infants identified with a hearing loss will receive appropriate early intervention services before 6 months of age.

40. NBHSI Program Partners • Montana School for the Deaf and the Blind • Parents • NBHS Stakeholders Group • 28 Birth Hospitals • Midwives • Pediatric Audiologists • Hearing Conservation Program Audiologists (Montana Office of Public Instruction) • Montana Part C Program • Montana Physicians • County Health Departments/Home Visiting Programs

41. Sharlene Schmidt Jeff Griffin Tina Berg Carl Clark Hearing Conservation Program Audiologists, 2013, Montana Sharon Nash Susan Kalarchik Sue Bressler Sue Roller Shey Mayland Tina Hoagland

42. Counties Providing Hearing Screenings, 2013, Montana NBHS Pilot Sites Home Visiting Sites Providing Hearing Screening Home Visiting Sites Who Plan To Implement Hearing Screening

43. Greg Freeman**, M.S. CC-A Leah Jacobsen, Au.D. Ashley Anderson**, Au.D. Pediatric Audiologists, 2013, Montana Ruth Fugleberg, M.C.S.D. Hillary Carter**, Au.D. Kristy Foss, M.C.S.D. Janice Johnson, Au.D. Kelsey Mann**, Au.D. Tracy Hayden, Au.D. Crystal Dvorak**, Au.D. ** New Pediatric Audiologists since 2011

44. Primary Care Office • Primary Care Office main focus is to use available data, i.e. Medicaid/Medicare visits to determine areas of the state that are in need of primary care doctors, dentists, nurses, and other health care professionals. These areas may be eligible to apply for Federal Funding by working with the Primary Care Association. • Information source for loan repayment options for primary care and mid-level health care professionals to work in health shortage areas.

46. Questions?