Association of State Public Health Nutritionists Annual Meeting June 11, 2018 Laura Kavanagh, MPP Acting Associate Administrator Maternal and Child Health Bureau (MCHB) Health Resources and Services Administration (HRSA)
HRSA Overview • Mission: To improve health and achieve health equity through access to quality services, a skilled workforce, and innovative programs • Provides grants and cooperative agreements to more than 3,000 awardees, including community and faith-based organizations, colleges and universities, hospitals, state, local, and tribal governments , and private entities • Serves tens of millions of people, including people living with HIV/AIDS, pregnant women, mothers and their families, and those unable to access quality health care 2
HRSA-wide Efforts • Priority Workgroup on Childhood Obesity o Representatives from across HRSA Bureaus and Offices o Develop innovative and collaborative solutions to address childhood obesity o Several pilot projects underway • RD Collaborative o Part of a HRSA-wide effort convening staff clinicians to leverage skills and expertise 3
HRSA Supports Primary Care Community Health Centers • Roughly 1,400 centers operate more than 10,400 service delivery sites across the U.S. and territories • Nearly 26 million people rely on a HRSA-funded health center for care, including 1 in 10 children • Health centers exceed national averages for pediatric patients who receive weight assessment and counseling for nutrition and physical activity à In 2016, 62.9% of patients ages 3 to 17 had BMI % and counseling documented Health Workforce • Improves the health of underserved and vulnerable populations • Strengthen the health workforce and connect skilled professionals to communities in need • Approximately 10,200 National Health Service Corps and 1,900 NURSE Corps clinicians provide care to over 12 million people nationwide, including over 3.5 million rural residents 4
HRSA Supports Rural Health • The Federal Office of Rural Health Policy provides policy support to the Office of the Secretary and supports a number of rural health programs, including rural health networks and telehealth • Rural grantees are addressing childhood obesity through: o Delta States Rural Development Network Program o School-based Telehealth Network Grant Program • Rural research projects o Create County- and Census Tract-Level Estimates of Childhood Obesity in the United States o Identifying Obesogenic Communities in the United States • Childhood Obesity Toolkit for Rural Areas 5
HRSA Supports Maternal and Child Health • Title V MCH Block Grant Program o Title V programs include strategies specific to childhood obesity prevention o Of the 15 National Performance Measures, two are obesity-prevention/ management related: Breastfeeding (NPM 4; 50 states/jurisdictions selected) and Physical Activity (NPM 8; 27 states/jurisdictions selected) • Children’s Healthy Weight Collaborative Improvement and Innovation Network (CoIIN) o Platform for sharing and testing evidence-informed and evidence-based best practices across communities and states in order to address a common issue o Strengthen states' efforts to address the National Performance Measures and National Outcome Measure related to obesity management and prevention o Support the implementation of policies and practices related to nutrition, physical activity, and breastfeeding 6
HRSA Supports Maternal and Child Health • Childhood Obesity Grand Challenge – Using Technology to Prevent Childhood Obesity in Low-Income Families and Communities o Use innovative challenge mechanism to engage with non- traditional partners to the develop multiple novel and scalable interventions o Currently in the Design Phase o Expert Panel consists of key stakeholders 7
HRSA Supports Maternal and Child Health • MCH Nutrition Training Program o Currently fund 6 Centers of Excellence in MCH Nutrition o Training focuses on leadership in pediatric and maternal nutrition and is designed to provide both clinical and public health approaches to working with MCH populations o Expanding program; new cycle begins July 1 st with 8 grantees o Childhood Obesity Enhancement projects • Partnership with ASPHN o Provide national and state leadership o Bolster the public health nutrition workforce o Promote intersection between clinical, public health, and community nutrition o Coordinate MCH Nutrition Council 8
HRSA Supports Maternal and Child Health • Bright Futures o HRSA-supported program with the American Academy of Pediatrics o Provides evidence-informed, age-appropriate recommendations and anticipatory guidance for preventive well-child visits for clinicians and parents o New effort: develop content-specific training and implementation tools for primary care clinicians in settings such as health centers • Focus on effective weight assessment and counseling for nutrition and physical activity • Develop and test electronic health record/health information technology tools • Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) o Gives pregnant women and families, particularly those considered at-risk, necessary resources and skills to raise children who are physically, socially, and emotionally healthy and ready to learn o Provides guidance to caregivers on nutrition and physical activity o Includes performance measures on breastfeeding, well child visits 9
HRSA Supports Maternal and Child Health • Healthy Start o Initiative targeted to the needs of vulnerable mothers and infants living in communities with exceptionally high rates of infant mortality o Healthy Start Breastfeeding Training Initiative aims to increase breastfeeding initiation and duration rates to those set in Healthy People 2020 • Research and Data o Healthy Weight Research Network o National Survey of Children’s Health 10
Title V of the Social Security Act Maternal and Child Health (MCH) Services Block Grant 11
Application/Annual Report Guidance Instructions to states/ jurisdictions for preparing and submitting an Annual Report, Application and Five-year Needs Assessment, per legislative requirements 12
Application/Annual Report Guidance Delivery of Title V services within a Guiding public health service model Principles Data-driven programming and performance accountability Partnerships with individuals/families/ family-led organizations (i.e., family partnership) 13
Application/Annual Report Guidance • Consistent with the block grant concept, the Maternal and Child Health (MCH) Application/Annual Report Guidance retains the rights of each state/jurisdiction to: o Determine its own MCH priority needs; o Develop tailored strategies for addressing the identified needs; and o Assume accountability in achieving measurable progress towards stated program goals. • Narrative and data reporting requirements in the Application/Annual Report Guidance are based on the Title V legislative requirements, with consideration given to reducing burden for states wherever possible. 14
Performance Measure Framework Characteristics • National Performance Measures (NPMs) are tied to one of five MCH population domains: o Women’s/Maternal Health o Perinatal/Infant Health o Child Health o Adolescent Health o CYSHCN • States choose at least five of the 15 NPMs across the five population domains (one in each domain). • Data from federal partners are prepopulated for NPMs and National Outcome Measures (NOMs). • States identify strategies and develop at least one related Evidence-Based or -Informed Strategy Measures (ESMs) for each selected NPM. 15
State MCH Block Grant Program NPM # National Performance Priority Areas MCH Population Domains 1 Well-woman visit Women/Maternal Health 2 Low-risk cesarean delivery Women/Maternal Health 3 Risk Appropriate Perinatal Care Perinatal/Infant Health 4 Breastfeeding Perinatal/Infant Health 5 Safe sleep Perinatal/Infant Health 6 Developmental screening Child Health 7 Injury Hospitalization Child Health and/or Adolescent Health 8 Physical activity Child Health and/or Adolescent Health 9 Bullying Adolescent Health 10 Adolescent well-visit Adolescent Health 11 Medical home Children with Special Health Care Needs, Child and Adolescent Health 12 Transition Children with Special Health Care Needs and Adolescent Health 13 Preventive Dental Visit – Pregnancy Women/Maternal Health, Child Health and/or Adolescent Preventive Dental Visit – Child/Adolescent Health 14 Smoking – Pregnancy Women/Maternal Health, Child Health and/or Adolescent Smoking – Household Health 15 Adequate insurance Child Health, Adolescent Health and/or Children with Special Needs 16
Title V Information System (TVIS) 17
Title V Information System (TVIS) 18
NPM #4 – Title V Information System 19
NPM #8 – Title V Information System 20
NOM #20 – Title V Information System 21
ESMs - Title V Information System 22
Priority Needs - Title V Information System Narrow Select the Region(s), search State(s) or with a Key National Word Download the results to Select one Excel for or more further Domain(s) analysis 23
Priority Needs - Title V Information System Key Word Search: Nutrition 24
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