Where policy happens Title V and MCH The Local Perspective

1. Where policy happensTitle V and MCHThe Local Perspective Carolyn B. Slack Director, MCH Division Columbus (OH) Health Department

2. What and Where is MCH? • Varies within local health departments • Who – women, children and families • What – Services – direct, enabling and population based and infrastructure • Where is MCH at Columbus HD

4. Where else is MCH? • Infectious Disease Division – Sexual Health clinics; Communicable Disease Program (Immunizations and Perinatal Hepatitis Program) • Community Health Division – Breast and Cervical Health; Alcohol and Other Drug Program – Women’s Program • Environmental Health Division – Lead Poisoning; Healthy Homes • Planning and Preparedness Division – Child Death Review • And, CSHCN are served through Franklin Co. HD!

5. Where are Title V $$? • Women’s Health Program • County grantee for Title V • CHD - $237,506 • Children’s Hospital - $543,632 • OSU High Risk - $125, 370 • Total - $906,508 • Over last 5 years – 27% decrease

6. What do we do with the Title V $$? • For CHD – direct, enabling and population services, some infrastructure • Subcontractors use $$ for direct, enabling and infrastructure services

7. MCH work and Title V • Focus on the work, not the dollars • “Pyramid” of services defines all the work we do for women, children and families • For example…….

8. Infrastructure Building • Data collection and reporting, coalition building, planning, policy development • Addressing prenatal care capacity in Columbus - an action agenda

9. Prenatal Care Capacity • PNC is key for improving outcomes of pregnancy and the health of women and infants • PNC is often the entry / re-entry into the health care system for women • PNC access, utilization and capacity is a challenge

10. What do the data tell us? 2002 Data for Ohio and Franklin County % Entering PNC in the First Trimester by Race/Ethnicity Race/Eth.Ohio Franklin Co. White 89.4% 90.9% Black 78.8% 78.8% Hispanic 80.5% 78.0%

11. What do the data tell us? % Women with No or Unknown PNC By Race / Ethnicity, 2002 Race/Eth.Ohio Franklin Co. White 1.5% 6.0% Black 5.1% 12.0% Hispanic 2.9% 7.4%

12. What do the data tell us? • CHD Perinatal Periods of Risk (PPOR) Analyses – CityMatCH (www.citymatch.org) Collaborative *Inadequate PNC is a statistically significant risk factor for Very Low Birth Weight births for Black moms * Very Low Birth Weight and Preterm Births are a significant cause of Infant Death

13. Franklin County Infant Mortality1979-2002* Rate by Race Black:White gap largest in 1999 and 2002.

14. What do the data tell us? • Council on Healthy Mothers and Babies Wait Time Surveys • December, 2004. Average wait time 22 days • Range of wait times 9-59 days • In each survey, some providers are not even scheduling appointments

15. What do the data tell us? Goal: Wait time for 1st OB appointment will be 14 days by 2006. Goal: Wait time for 1st OB appointment will be 7 days by 2010.

16. What do the data tell us? • Pregnancy Care Connection Capacity Study Results • First appointment slots capacity • Study done through PCC Provider work group • Providers – hospital OB outpatient clinics; neighborhood health center sites; CHD clinic sites • Results • May 2003 - 1,516 appointment slots • April 2004 - 1,041 appointment slots • 31% decrease in capacity

17. Why has capacity decreased? 1. Columbus Health Department – loss of CFHS funding (27% decrease over the last 5 years) and decreased Medicaid revenue (women served not eligible) resulting in closing a site (FY04) and reducing provider hours (FY 05) 2. Neighborhood Health Centers – loss of funding resulting in clinic consolidations and reduced PNC sessions 3. Hospitals – reduction in Resident work hours and therefore reduced availability for outpatient clinics.

18. What else is affecting capacity? • All providers are serving more non English speaking patients. This results in a need for interpreters which is an increased cost, with no reimbursement; and, appointments take longer, thus reducing capacity due to fewer patients can be scheduled • Obstetric Malpractice and Liability Issues This issue is resulting in current practitioners leaving OB and fewer medical students choosing OB for their Residency

19. What are we doing? • Convened stakeholders through Council co-chaired by City Council Member • Working on and partnering to restore lost State dollars, pursue a Family Planning waiver, increase tobacco tax and invest in MCH, address secondary migration issues.

20. It may not be Title V $$, but… • Clearly work to improve the health and health system for women, children and families • Information that is being used for local and state Title V needs assessments

21. “Infant Mortality is a subject of profound social importance. The modern view has ceased to be fatalistic; infant mortality is now regarded as a preventable waste….” Julia C. Lathrop, Chief Children’s Bureau Department of Labor, 1915

22. A Final Thought “It is therefore desired to pursue this inquiry in various typical communities throughout the country so that the facts may secure popular attention. Clearly the law creating the Children’s Bureau framed by experts in child welfare, embodies the conviction that if the Government can “investigate and report” upon infant mortality, the conscience and power of local communities can be depended upon for necessary action.” Julia Lathrop, Chief Children’s Bureau Department of Labor, 1915