Early Intervention: Federal Requirements and Model Programs Using Title V to Improve Outcomes for Young Children and The

1. Early Intervention: Federal Requirements and Model ProgramsUsing Title V to Improve Outcomes for Young Children and Their Families Deborah Klein Walker, EdD Principal Associate Health Services Research and Evaluation Abt Associates ABCD II Consortium Network August 2004

2. Outline of Presentation • Review Public Health Model Guiding Principles and System of Care • Outline Components of Title V (Maternal and Child Health Block Grant) • Examples of Early Childhood Services and Links to Title V

3. GOAL Develop and enhance systems of care in neighborhoods and communities which promote: • Healthy Children in • Healthy Families in • Healthy Communities

4. MCH PUBLIC HEALTH FOCUS • Communicable Diseases • “New Morbidity” • “New Social Problems” • Healthy Communities

5. HEALTHY PEOPLE 2010 GOALS: • Promoting Healthy Behaviors • Promote Health and Safe Communities • Improve Systems for Personal and Public Health • Prevent and Reduce Diseases and Disorders

6. OUTCOMES • Infant Mortality • Immunization • Child Fatalities • Teen Births

7. OUTCOMES • Children in Poverty • Low Birth weight • Child Abuse • Single Parents

8. The Public Health (and MCH) Focus on Improved Health Outcomes Assumes a System of Care Must Be in Place

9. Early Childhood System Sectors • Health • Education • Social Services • Child Care

10. PUBLIC HEALTH (MCH) GOALS FOR A SYSTEM OF CARE • Community-Based • Family Centered • Consumers Engaged as Partners With Professionals • Coordinated • Comprehensive • Prevention-Oriented • Early and Continuous Availability

11. PUBLIC HEALTH (MCH) GOALS FOR A SYSTEM OF CARE • Cultural, Language and Socioeconomic Sensitivity • Non-Categorical Approach • Quality of Care Standards • Flexible and Adaptable • Integration with Criminal Justice, Employment, Housing, etc.

12. HEALTH FINANCING IS NECESSARY BUT NOT SUFFICIENT

13. KEY PUBLIC HEALTH (MCH) ROLE SYSTEMS DEVELOPMENT AT ALL GOVERNMENT LEVELS

14. PUBLIC HEALTH CORE FUNCTIONS • ASSESSMENT • POLICY DEVELOPMENT • ASSURANCE Future of Public Health, Institute of Medicine, 1988

15. ASSESSMENT STRATEGIES • Monitor Health Status • Needs Assessment • Surveillance • Diagnosis and Investigation • Program Monitoring and Evaluation • Quality Improvement Systems

16. POLICY DEVELOPMENT STRATEGIES • Leadership and Advocacy • Planning • Collaborative Partnerships • Ensure Financing • Ensure Public/community Participation • Legislation • Innovations

17. ASSURANCE STRATEGIES • Education and Training • Direct Services • Public Information, Education, Referrals • Community Mobilization • Licensing, Regulation, Certification • Standards Setting and Guidelines • Program Monitoring and Evaluation

18. TITLE V BLOCK GRANT • Social Security Act - 1935 • Amended in 1960’s, 1981, 1989, 1996 • Federal/State/Local Partnership • Point of Accountability for ALL “MCH Population” • Available in All States • Core Public Health Functions Used for Systems Development

19. MATERNAL AND CHILD HEALTH TITLE V SOCIAL SECURITY ACT 1935 Enacted 1960’s - 70’s Expansion 1981 Block Grant 1989 OBRA 1996 Welfare Reform

20. TITLE V PURPOSE • To improve the health of ALL mothers and children • Provide and assure access to quality maternal and child health services… • Reduce infant mortality, preventable diseases…promote health of low income children... • Provide rehabilitation services to those <16 who receive SSI (Title XVI) benefits to the extent such services are not provided under Title XIX… • Promote family-centered, community-based , coordinated care for children with special health care needs

21. MAJOR STATE / FEDERAL MCH/Title V ROLES • Promote MCH through public health core functions • Support development of community-based child and family systems • Coordinate child health care and administer supplemental health services • Enable access for MCH underserved populations

22. What Title V Agencies are Called • Maternal and Child Health • Maternal, Child and Family Health • Child and Family Health • Youth and Family Health • Family Health • Family and Community Health

23. Title V Conditions • 85% to state block grant; 15% for SPRANS (Special Projects of Regional and National Significance) • States must provide a $3 match for every $4 federal dollars • Must conduct a statewide needs assessment every 5 years

24. Title V Conditions • Maintenance of effort required to be level at least equal to the level provided in FY1989 • States must use: • At least 30% of MCH Block Grant funds for preventive and primary care services for children • At least 30% for services for children with special health care needs

25. MCH PYRAMID OF HEALTH SERVICES Direct Health Care Services Enabling Services Population-Based Services Infrastructure Building Services:

26. MCH REPORTING SYSTEMS • National MCH Outcome Measures • National MCH Performance Measures • State-determined MCH Performance Measures • National Health Status Indicators

27. MCH TITLE V PERFORMANCE MEASURES SYSTEM • Implemented for FY99 Application to the MCH Block Grant (July 1998) • Determined by State / Federal Process • 18 Core Performance Measures in 4 Areas: • Direct Health Care Services (Gap Filling) • Enabling Services • Population-Based Services • Infrastructure Building Services • 6 Core Outcome Measures • Up to 10 State Negotiated Measures

28. MCH OUTCOME MEASURES • Infant Mortality Rate (IMR) per 1,000 live births. • Ratio of black IMR to the white IMR • Neonatal Mortality Rate per 1,000 live births • Post-neonatal Mortality Rate per 1,000 live births • Perinatal Mortality Rate per 1,000 births • Child Death Rate per 100,000 children aged 1-14

29. MCH eGOV VISION PRINCIPLES • Maximize user-friendly access to all MCH information systems • Assure data subject confidentiality within a public health context • Coordinate or integrate information systems where possible and appropriate, while utilizing shared national standards.

30. MCH POPULATION-BASED POTENTIAL DATA SOURCES • Surveys (YRBS, BRFS, SLAITS, PRAMS, etc.) • Vital Statistics • Surveillance Systems / Disease Registries (e.g., Birth Defects, Immunization, Cancer, etc.) • Program / Service Management Information Systems

31. State and Local Area Integrated Telephone Survey (SLAITS) • Developed by National Center of Health Statistics (CDC) • Random-digit-dial telephone survey conducted by Abt Associates • CSHCN module sponsored by MCHB to assess prevalence and monitor indicators of care for CSHCN in all 50 states and DC • Child health module sponsored by MCHB to document child health access and outcomes in all 50 states and DC

32. What Does It Mean To “Assure”? • Guarantee • Pledge • Promise • Vow • Confirm • Insure • Comfort • Console • Reassure

33. Assurance Functions of MCH “ public health agencies assure their constituents that services necessary to achieve agreed upon goals are provided, either by encouraging actions by other entities (public or private), by requiring such action through regulation or by providing services directly ” (Institute of Medicine, The Future of Public Health, 1988)

34. CHARACTERISTICS OFMCH ASSURANCE ROLES • Prevention focused • Applies to the entire MCH population • Depends on the success of assessment efforts • Relies on sound policy development • Relates to MCH systems development role • Implies advocacy and leadership • Implies accountability for the outcome

35. MCH ASSURANCE EXAMPLES • Direct provision of the service • Payment or contracting for the service • Set voluntary standards • Legislative required standards • Provide education and training to providers • Evaluate effectiveness of services

36. MCH ASSURANCE EXAMPLES • Active regulation of the services • Quality assurance mechanisms • Monitor system compliance • Monitor compliance with service standards • Education of the public about services

37. MCH ASSURANCE EXAMPLES • Facilitate public accountability • Population-based data gathering and reporting • Facilitate active public/private partnerships towards shared accountability for MCH outcomes

38. EXAMPLES OF MCH PARTNERS OUTSIDE OF HEALTH AGENCY • Consumers/Families • Researchers • Advocacy Groups • Policymakers • Business/Industry • Public and Private Agencies • Providers • Professional Groups

39. EARLY CHILDHOOD STATE INITIATIVES • CHIP - Child Health Insurance Expansions • Home Visiting Expansions • Education Reform • Child Care Expansions • Social Services Changes • Welfare Reform • Planning/Integration Efforts

40. STARTING POINTS • Promote Responsible Parenthood • Guarantee Quality Child Care Choices • Ensure Good Health and Protection • Mobilize Communities to Support Young Children and Their Families

41. CHALLENGES Coordination and Linkage • Federal-state-local • Cross systems • Academia to practice Capacity • Community • Provider

42. CHALLENGES Financing • Health • Education • Child care • Jobs Attitudes and Commitment • Public • Business • Parents

43. IMPLEMENTATION OF PUBLIC POLICY NEEDS • Knowledge Base • Political Will • Social Strategies

44. KEY FEDERAL LEGISLATION • SSA Title V - MCH Block Grant • SSA Title IV - Welfare, Child Support, Foster Care • SSA Title XVI - Supplemental Security Income (SSI) • SSA Title XIX - Medicaid

45. KEY FEDERAL LEGISLATION • SSA Title XXI - SCHIP • OBRA ‘93 Family Preservation • Child Care Block Grant • Individuals with Disabilities Education Act (IDEA) • Head Start

46. KEY FEDERAL LEGISLATION • Supplemental Nutrition Program for Women, Infants and Children (WIC) • Public Health Service Act • Community and Migrant Health Centers (Sections 329 & 330) • Family Planning (Title X)

47. CRITICAL PARTNERS FOR IMPROVING MCH OUTCOMES • Parents and Families • Providers • Purchasers and Insurers

48. FUTURE GOALS FOR TITLE V • Funded to Meet All Goals • Recognized as Point of Accountability at State and Federal Levels • Linked to All Child and Family Service Sectors • Supported by General Public • Supported by Local, State and National Organizations