Santa Barbara County Maternal Child and Adolescent Health 2020-2025 Title V Community Assessment Kelley Barragan, MCAH Program Coordinator Mitchell Hee, Epidemiology Intern Michelle Wehmer, Epidemiologist PHD Mission: To improve the health of our communities by . preventing disease, promoting wellness, ensuring access to needed health care, and maintaining a safe and healthy environment.
Define Title V requirements Examine local worsening and improving indicators Objectives Identify priority problems Discuss current solutions and how we, as a community, can create change
Reporting requirements mandate completion of a State annual report that specify: Needs of the State MCAH population Title V Programs and policies implemented to meet those needs Maternal & Monitor progress toward achieving federal and state Child Health performance outcome measures Block Grant Management/expenditure of funding Every 5 years a comprehensive statewide needs assessment must be conducted of the MCH population
In California - Decentralized statewide needs assessment process - each local health jurisdiction (LHJ) conducts a needs assessment Key Objectives Title V Maternal & Identify local needs and capacity Child Health Obtain stakeholder input at the local level Block Grant Focus local MCAH efforts by having each LHJ identify priority areas they will focus on during the next 5 years Develop a local five-year action plan
Analyzed FHOP (Family Health Outcomes Project) Databooks and other local epi data reports on various MCAH health indicators Incorporated data from various community needs assessments Santa Barbara County Public Health Department Community Methodology Needs Assessment 2016 Cottage Health Community Needs Assessment 2016 for 2020-2025 Dignity Health Community Needs Assessment 2016 SBC Title V Santa Barbara County Children’s Scorecard 2017 Needs Santa Barbara County First 5 Strategic Plan 2017-2021 Santa Barbara County Oral Health Needs Assessment 2019 Assessment Administered web-based survey to stakeholders on priority issues, causes, intervention/strategies, and partners Obtained feedback from community at Stakeholder Meeting via roundtable discussions
Increase health care and insurance access to low-income women and children in Santa Barbara County Increase community-wide knowledge, access and linkage of children to a dental home where possible to ensure preventive care and 2015-2020 increase access to fluoride varnish. Community Increase number of health care providers who routinely screen pregnant women and mothers of children under 2 years of age for Assessment Perinatal Mood and Anxiety Disorder (PMAD) and refer as needed. MCAH Increased number of health care providers who routinely screen priorities pregnant women and mothers of children under 2 years of age for Substance Use and refer as needed. To reduce the number of SIDS/SUID events by promoting optimal sleep environments.
• MCAH Field Nursing Unit updated policies and implemented CQI activities to ensure all eligible children, pregnant ,and postpartum women are enrolled in Medi-Cal, had access to timely care, and received dental resources and information. • Local Oral Health Collaborative developed an oral health campaign focusing on children 0-5. • Perinatal Wellness Coalition worked to update resource guide of local Substance Abuse treatment services. Highlights of • MCAH Program surveyed local CPSP providers on PMAD and SA success from screening practices and provided current recommendations and resources. 2015-2020 Needs • Partnership with Marian Regional Medical Center and other local Assessment partners to address PMADs through creation of a web-based resource directory with 211, community/provider trainings, and development Action Plans of a tool-kit. • Collaboration with SBHCC and Sansum Diabetes Research Institute to develop a pilot project with a “Centering - Like” model for GDM clients. • MCAH Program provided SIDS/Safe Sleep presentations to numerous local organizations that interact with pregnant women/0-1 y/o. • MCAH Field Nursing Unit incorporated the NEAR@Home Framework to address ACEs with distribution of training materials to other local partners
Conceptual Framework Public Health System 10 Essential Functions Source: CDC Website
Conceptual Framework Life Course Model
Conceptual Framework PHD Focus Area: Social Determinants of Health (SDOH)
Conceptual Framework PHD Focus Area: Health Equity Source: Robert Wood Johnson Foundation https://www.rwjf.org/en/library/infographics/visualizing-health-equity.html#/download
Conceptual Framework PHD Focus Area: Adverse Childhood Experiences (ACEs)
Overview of SBC Add picture of SBC Demographics Source: visitcalifornia.com
Santa Maria 23.9% Balance Of County 31.2% SBC Guadalupe Population by 1.6% City, 2016 Lompoc (N = 447,073) 9.8% Carpinteria 3.1% Solvang 1.2% Goleta Buellton 7.0% 1.1% Santa Barbara 21.1% Source: California Department of Finance, Population Estimates, 2016
Multi-Race 2.4%, Asian 5.1%, 5.1 API 0.1%, 0.1 2.4 American Indian 0.3%, 0.3 Black 1.7%, 1.7 SBC Population by Race and Hispanic 44.4%, 44.4 Ethnicity, 2016 White 45.9%, 45.9 Source: Census Data 2016
Santa Barbara Santa Maria Lompoc SBC Population Race and Ethnicity by Hispanic 38.2% Hispanic 52.8% Hispanic 73.4% City, 2016 White 54.5% White 34.1% White 19.5% Black 1.4% Black 5.3% Black 0.8% American Indian 0.3% American Indian 0.5% American Indian 0.1% Asian 3.5% Asian 3% Asian 5.1% API 0% API 0.4% API 0.1% Multi-Race 2% Multi-Race 3.8% Multi-Race 0.9% Other 0.1% Other 0.1% Other 0.1% Source: Census Data 2016
<5 65+ 6.5% 14.0% SBC Population by 5-24 45-64 32.0% Age Group, 22.9% 2016 25-44 24.6% Source: Census Data 2016
Santa Maria Lompoc Santa Barbara 8.7% 5.5% 9.5% 9.8% 10.5% SBC 17.1% Population 18.7% 26.0% 24.3% 29.0% 33.7% Age Groups by 24.2% City, 2016 28.3% 27.6% 27.2% <5 5-24 25-44 45-64 65+ Source: Census Data 2016
70.0 68.0 Birth Rate (per 1,000 population) 66.0 64.0 SBC Birth 62.0 Rate, 2007- 60.0 58.0 2016 56.0 54.0 52.0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Source: SBC PHD Vital Records; State of California, Department of Finance, State and County Population Projections by Race/Ethnicity, Detailed Age, and Gender, 2010-2060. Sacramento, California, January 2018.
Black Unknown 1% American 1% Asian Indian 5% 0% Race and Ethnicity of Mothers who White 28% gave Birth in Hispanic 65% 2016, N=5501 Source: CA Birth Statistical Master File, 2016
Santa Barbara County Medi-Cal Clients Source: 2017 Santa Barbara County Children’s Scorecard, p.33
Local Versus State Medi-Cal Delivery 70.0 Rate of Delivery with 58.4 60.0 Rates by Local vs. 50.0 MediCal 40.0 State and 43.4 30.0 Ethnicity 20.0 10.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 CA SBC By Ethnicity Highlights: 100.0 Rate of Delivery with 78.0 80.0 Hispanics have a higher MediCal 60.0 rate of Medi-Cal 63.0 40.0 deliveries than Whites 23.1 20.0 Locally and in CA. 20.1 0.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 CA White SBC White CA Hispanic SBC Hispanic Source: CA Birth Statistical Master File,
Education level: Education Level The percentage of births to mothers with an education level and Public below GED (does not include 17 births where an address was withheld and removes births where mother education was not Assistance, 2016 answered): North County 50.3% (1224/2431) Highlights: Middle County 20.4% (187/915) North County mothers have less formal education South County 14.0% (213/1521) than Mid or South County Public Assistance: mothers. Medi-Cal Births by SBC Geographic Area (5,501 births in 2016) show that 61.1% of births are to women on Medi-Cal North County has a higher county-wide. percentage of births to Medi-Cal recipients than 79.4% of births in North County were to Medi-Cal recipients. Mid or South County Source: Vital Records Birth Stat Master File, 2016.
SBC Population by Age 0-18 Poverty 50.0 Rate of Individuals in 47.0 48.0 46.0 Poverty 44.0 44.7 42.0 40.0 38.0 36.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Highlights: CA SBC The rate of Children and SBC Females by Age 18-64 Females living in poverty Rate of Individuals in 50.0 36.4 is higher in SBC than CA. 40.0 Poverty 30.0 33.7 20.0 10.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 CA SBC Source: Small Area Health Insurance Estimates
14.0 Unemployment 12.0 per 100 People in the Employment 10.0 Unemployment Rate Market 8.0 6.2 6.0 Highlight: 5.3 4.0 Unemployment rates have been decreasing 2.0 the past several years and SB is doing better 0.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 than CA. CA SBC Source: Office of Attorney General ; CA Department of Finance
MCAH Health Indicators
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