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MCAH Title-V Local Capacity Assessment. Sandra Copley MCAH Director Field Nursing Program Manager. Overview. Goals of the Assessment Essential Services Santa Barbara County Population Focus Areas Worse than CA Worse than HP2010 Worsening local indicators

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Mcah title v local capacity assessment

MCAH Title-V Local Capacity Assessment

Sandra Copley

MCAH Director

Field Nursing Program Manager


Overview
Overview

  • Goals of the Assessment

  • Essential Services

  • Santa Barbara County Population

  • Focus Areas

    • Worse than CA

    • Worse than HP2010

    • Worsening local indicators

  • 27 Health Indicators


Focus
Focus

  • Primary Focus – assessing the capacity of the local MCAH System to carry out the 10 Essential Public Health Services to Promote Maternal & Child Health in America

  • Includes assessment of local capacity and all organizations that serve the MCAH population in our jurisdiction

  • Increase knowledge of MCAH Program Community-wide


Goals of local mcah program
Goals of Local MCAH Program

  • MCAH Goals:

    • All children will be born healthy to healthy mothers

    • No health status disparities among racial/ethnic, gender, economic and regional groups

    • A safe and healthy environment for women, children and their families

    • Equal access for all women, children and their families to appropriate and needed care within an integrated and seamless system


Ten essential service areas
TenEssential Service Areas

1. Monitor health status to identify and solve community health problems

2. Diagnose and investigate health problems and health hazards in the community

3. Inform, educate, and empower people about health issues

4. Mobilize community partnerships and action to identify and solve health problems

5. Develop policies and plans that support individual and community health efforts


Ten essential service areas continued
Ten Essential Service Areas - Continued

6. Enforce laws and regulations that protect health insurance and safety

7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable

8. Assure a competent public and personal health care workforce

9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services

10. Research for new insights and innovative solutions to health problems


Population by city sbc 2008 estimates n 428 665
Population by City SBC 2008 Estimates N = 428,665

21%

21%

10%

7%

3%

2%

1%

1%

34%


Population by adult education level sbc 2006 estimates
Population by Adult Education Level SBC 2006 Estimates


Population by age group sbc 2008 estimates
Population by Age Group SBC 2008 estimates


Population by race ethnicity sbc 2008 estimates
Population by Race/EthnicitySBC 2008 Estimates

54.3%

36.7%

4.4%

2.5%

0.6%

1.5%



Focus areas worse than ca
Focus Areas Worse than CA

  • Local indicators worse than CA

    • Teen Births

    • Early Prenatal Care

    • Overweight Children


Worse than ca 2b births to teens age 15 17 sbc and ca 2002 2006
Worse than CA: (2B)Births to Teens (age 15-17), SBC and CA 2002-2006

HP2010= 43 per 1,000


Births to teens age 15 17 by race ethnicity addendum 2b sbc and ca 2002 2006
Births to Teens (age 15-17)By Race/Ethnicity (addendum 2B)SBC and CA 2002-2006

HP2010= 43 per 1,000


Prenatal care begun 1 st trimester santa barbara county and california 2002 2006
Prenatal Care Begun 1st TrimesterSanta Barbara County and California2002-2006

Percent

HP2010 > 90%


Prenatal care begun 1 st trimester by race ethnicity santa barbara county 2002 2006
Prenatal Care Begun 1st Trimester by Race/Ethnicity Santa Barbara County 2002-2006

Percent

HP2010 > 90%


Worse than ca overweight children age 5 19 19b sbc and ca 3 yr averages
Worse than CA:Overweight Children (age 5-19) (#19B)SBC and CA , 3 Yr. Averages

HP2010 = 5.0

PedNSS – local income children in federally funded MCAH programs – not to

general population


Focus areas worse than hp2010
Focus Areas Worse than HP2010

  • Select local indicatorsworse than HP2010

    • Low birth weight births (<2500g) *

    • Very low birth weight births (<1500g)

    • Preterm births

    • Post-Neonatal death rate

    • Early Prenatal care

    • Overweight children


Worse than hp2010 percent of low birth weight 3 2 500 g sbc and ca 1997 2006
Worse than HP2010:Percent of Low Birth Weight (#3)(< 2,500 g) SBC and CA 1997-2006

HP2010 = 5.0


Worse than hp2010 percent of very low birth weight 4 1 500 g sbc and ca 1997 2006
Worse than HP2010:Percent of Very Low Birth Weight (#4) (< 1,500 g) SBC and CA 1997-2006

HP2010 = 0.90


Worse than hp2010 preterm births 37 weeks 5 sbc and ca 2002 2006
Worse than HP2010:Preterm Births (< 37 weeks)(#5)SBC and CA 2002-2006

HP2010=7.6


Worse than hp2010 post neonatal death rate per 1 000 births sbc 2002 2006 10
Worse than HP2010:Post-Neonatal Death Rate per 1,000 births, SBC 2002-2006(#10)

HP2010=1.2

Post-neonatal deaths: are deaths occurring between > 28 to 365 days


Focus areas worsening local indicators
Focus Areas Worsening local indicators

  • Local indicators worsening over time

    • Injury hospitalizations (non-fatal, ages 15-24)

    • Injury hospitalizations for motor vehicle accidents (non-fatal, age 15-24)

    • Children living in foster care

    • Chlamydia rate (females 15-19)

    • Overweight children

    • Low Birth Weight live births


Worsening local indicators injury hospitalizations age 15 24 non fatal sbc and ca 3 yr avg 23a
Worsening local indicators:Injury Hospitalizations (age 15-24) Non-fatal, SBC and CA 3 Yr. Avg. (#23A)


Worsening local indicators mva hospitalizations age 15 24 non fatal sbc and ca 3 yr avg 24 b
Worsening local indicators:MVA Hospitalizations (age 15-24) Non-fatal, SBC and CA 3 Yr. Avg. (#24 B)


Worsening local indicators children living in foster care 25 sbc and ca july 2007
Worsening local indicators:Children Living in Foster Care (#25)SBC and CA, July 2007

Source: CWS/FHOP


Worsening local indicators chlamydia rate per 1 000 females age 15 19 sbc 3 yr averages 21
Worsening local indicators:Chlamydia Rate per 1,000 Females (age 15-19), SBC 3 YR. Averages (#21)


Focus areas additional
Focus Areas Additional

  • Additional local indicators

    • Uninsured children (age 0-18)

    • Child (age 2-11) dental visits

    • Child (age 2-11) dental insurance

    • Exclusive breastfeeding at hospital discharge

PENDING 2007 DATA from CHIS


Additional uninsured children age 0 18 sbc and ca 2001 2003 2005 16
Additional:Uninsured Children (age 0-18) SBC and CA 2001,2003,2005 (#16)


Additional frequency of child dental visits age 2 11 sbc and ca 2005 18
Additional: Frequency of Child Dental Visits,(age 2 – 11) SBC and CA 2005 (#18)


Additional children without dental insurance age 2 to 11 sbc and ca 2005 17
Additional:Children without Dental Insurance, (age 2 to 11) SBC and CA, 2005 (#17)


Additional exclusive breastfeeding rates by hospital sbc 2007 15
Additional:Exclusive Breastfeeding Rates By Hospital, SBC 2007(#15)

HP2010=75.0

SBC AVG = 56.7


Notable data highlights
Notable Data Highlights

  • Local percent of childhood overweight (ages 5-19) was the only Title V indicator higher than CA, HP2010, and over time

  • Low Birth Weight worse than HP 2010 and moving away from the goal


Data highlights continued
Data Highlights - continued

  • Local percentage of early prenatal carewas worse than for CA and HP2010, but getting better locally from 1995-2006

  • Injury/MVA hospitalization rates (age 15-24) haveincreased locally over time, but are lower than CA


Community strategic responses collaboratives
Community Strategic Responses/Collaboratives

  • MCAH Scope of Work

  • Kids Network Health Goals and Indicators

  • United Way

  • First 5


Mcah scope of work
MCAH Scope of Work

  • Provide information on community resources, services and referrals to the MCAH population

  • Promotes community-wide collaboration in the development and implementation of outreach programs and non-duplication of services

  • Provides a Perinatal Service Coordinator


Mcah scope of work field nursing
MCAH Scope of Work – Field Nursing

  • SIDS program

  • Promotes Health Insurance Coverage for Children

  • Promotes a decreasing incidence of overweight children

  • Promote early access/entry into prenatal care

  • Promote a decreasing incidence of births to teens 17 & under

  • Promote dental care for children and you 0-18 y/o

  • Promote a decreased incidence of substance use for pregnant and parenting women

  • Promote access to care for women with PPD

  • Continue to promote the decreasing incidence of maltreatment of children younger than 18

  • Continue to collaborate with Children’s System of Care

  • Maintain collaborative partnership with First 5 Welcome Every Baby


Top mcah priority areas for fy 05 10
Top MCAH Priority Areas for FY 05-10

  • Children without Insurance

  • Overweight Children

  • Births to Teens 17 yrs and under

  • Early Entry into prenatal care

  • Perinatal Substance Abuse and Teen Drug Use

  • Dental Care 0-18 yrs


Community strategies
Community Strategies

  • Kids Network

  • United Way

  • First 5


Essential service 5
Essential Service # 5

  • Provide leadership for priority setting, planning, and policy development to support community efforts to assure the health of women, children, youth and their families.

  • What are our capacity needs?


Essential service 5 continued
Essential Service # 5 - Continued

Strengths

  • Kids Scorecard and Collaborative process

  • Community Health Status Report includes key MCAH factors and is used county-wide

  • Collaborative efforts with coalitions and collaboratives have been maintained


Essential service 5 continued1
Essential Service # 5 - Continued

Weaknesses:

  • MCAH Data from Field Nursing not readily available to the public

  • Lack of annual communication mechanism about MCAH with stakeholders

  • MCAH Epi 10% - may need more at critical times

  • MCAH needs more involvement in the implementation of joint local and State initiatives/policies that directly effect the MCAH population


Essential service 5 continued2
Essential Service # 5 - Continued

Opportunities:

  • Is an MCAH Advisory Committee warranted?

  • Annual communication about MCAH with stakeholders?

    Threats:

  • Fragile economy and limited spending/changes for all government-related services

  • Further PHD cuts for fiscal solvency


Capacity needs
Capacity Needs

  • How can the capacity of Essential Service # 5 be improved?

  • What are the potential challenges on improving this capacity (e.g., impact on local MCAH services, stakeholder concerns, availability of resources).

  • How can other local organizations, local jurisdictions or the State MCAH Program help improve this capacity?


Essential service 7
Essential Service # 7

  • Link women, children, and youth to health and other community and family services, and assure access to comprehensive, quality systems of care.

  • What are our Capacity Needs?


Essential service 7 continued
Essential Service # 7 - Continued

Strengths

  • Local networks and public/private partnerships in the community

  • Diverse staff with strong community ties

  • Cross-divisional and inter-agency collaboration


Essential service 7 continued1
Essential Service # 7 - Continued

Weaknesses:

  • Staffing shortages and cuts in the PHD Field Nursing Unit

  • The MCAH Director has had responsibilities away from community needs secondary to organizational changes in the PHD and lack of PHD Executive knowledge of MCAH State and Federal Guidelines

  • Lack of financial resources to have competitive nursing salaries

  • Agencies have various best practices that may be linked to funding resources/grants/federal funding.

  • Limited bilingual Public Health Nurses in MCAH Field Nursing

  • Limited Mixteco translators and limited funding to hire


Essential Service # 7 - Continued

Opportunities:

  • Increase efficiencies and accountability in MCAH Field Nursing Program

  • New leadership and innovative approaches to field nursing

  • Executive branch of PHD more informed and responsive to needs of women and children in our community

    Threats:

  • Fragile economy and limited spending/changes for all government-related services

  • Further PHD cuts for fiscal solvency


Capacity needs1
CAPACITY NEEDS

  • How can capacity of Essential Service # 7 be improved?

  • What are the potential challenges on improving this capacity (e.g., impact on local MCAH services, stakeholder concerns, availability of resources).

  • How can other local organizations, local jurisdictions or the State MCAH Program help improve this capacity?


What s next
What’s Next……..

Next Meeting Date

Suggestions for further SWOT Analysis of Essential Services

Stakeholder Needs


Acknowledgments
Acknowledgments

  • Epidemiology Unit- Laura MacColl, EPI

  • Epidemiology Unit- Amy Bellomy, Senior EPI

  • Susan Klein-Rothschild, Assistant Deputy Director

  • Dr. Frank Alvarez, Deputy Health Officer


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