Nutrition, Breastfeeding and Physical Activity State Title V Program Efforts Children’s Healthy Weight CoIIN In Person Learning Session January 8 – 9, 2019 Michele Lawler, MS, RD Director, Division of State and Community Health (DSCH) Maternal and Child Health Bureau (MCHB) Health Resources and Services Administration (HRSA)
Title V of the Social Security Act Maternal and Child Health (MCH) Services Block Grant 2
Title V MCH Services Block Grant Supports State formula block grants (85%) Overview and discretionary grants (15%) Authorizes appropriations to States “to improve the health of all mothers and children”. 59 States and jurisdictions apply annually and receive Title V MCH Block Grant funding. Purpose is to create Federal/State partnerships that support service systems for addressing the needs of maternal and child health populations. 3
Title V MCH Services Block Grant Overview Consistent with the block grant concept, states have discretion in determining how to best invest their federal Title V funds to most effectively complement state-supported efforts in addressing the unique needs of each individual state’s MCH population. State flexibility is balanced with financial and performance accountability. Every $4 of federal Title V funding received by a state must be matched by at least $3 of state and/or local money. The combined Title V MCH federal-state partnership investment totaled more than $6 billion in FY 2017. 4
Title V MCH Services Block Grant Updated Application/ Annual Report Guidance released by HRSA in December 2017 for preparation of the State fiscal year (FY) 2019 MCH Block Grant Applications/ FY 2017 Annual Reports. 5
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) 6
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 Children with Special Health Care Needs (CSHCN) • States choose at least five of the 15 NPMs across the five population domains (one in each domain). • Each State-identified priority need must be addressed by an NPM or a State Performance Measure (SPM). • 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. 7
MCH Services Block Grant Data-Driven Programming and Accountability Title V Performance Measure Framework ESMs NPMs NOMs Evidence-based/ National National informed Strategy Performance Outcome Measures Measures Measures Evaluation Logic Model Process Inputs/ Short, Medium Long Term Outputs Term Outcomes Outcomes 8
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 9
State MCH Block Grant Program Title V MCH Services Block Grant National Performance Measures No. National Performance Measure 1 Percent of women, ages 14 through 44, with a preventive medical visit in the past year 2 Percent of cesarean deliveries among low-risk first births 3 Percent of very low birth weight (VLBW) infants born in a hospital with a Level III+ Neonatal Intensive Care Unit (NICU) 4 A) Percent of infants who are ever breastfed and B) Percent of infants breastfed exclusively through 6 months 5 A) Percent of infants placed to sleep on their backs, B) Percent of infants placed to sleep on a separate approved sleep surface, C) Percent of infants placed to sleep without soft objects or loose bedding 6 Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year 7 7.1 Rate of hospitalization for non-fatal injury per 100,000 children, ages 0 through 9; and 7.2 Rate of hospitalization for non-fatal injury per 100,000 adolescents, ages 10 through 19 8 8.1 Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day; and 8.2 Percent of adolescents, ages 12 through 17, who are physically active at least 60 minutes per day 9 Percent of adolescents, ages 12 through 17, who are bullied or who bully others 10 Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year 11 Percent of children with and without special health care needs, ages 0 through 17, who have a medical home 12 Percent of adolescents with and without special health care needs, ages 12 through 17, who received services necessary to make transitions to adult health care 13 13.1 Percent of women who had a dental visit during pregnancy; and 13.2 Percent of children, ages 1 through 17, who had a preventive dental visit in the past year 14 14.1 Percent of women who smoke during pregnancy; and 14.2 Percent of children, ages 0 through 17, who live in households where someone smokes 15 Percent of children, ages 0 through 17, who are continuously and adequately insured 10
Title V Information System (TVIS) 11
Title V Information System (TVIS) Title V Federal-State Partnership National Performance Measures – Selection Breakdown 12
Title V Information System (TVIS) 13
Title V Information System (TVIS) New Features • TVIS narrative searches by keyword lists the number of states referencing a noted keyword and enables the user to select one of more of the listed states. • Users can search by keyword for Priority Needs, Evidence-based or –Informed Strategy Measures (ESMs) and State Performance Measures (SPMs) 14
TVIS – Narrative Search 15
TVIS – Priority Needs 16
TVIS – Priority Needs 17
TVIS – Priority Needs 18
TVIS – ESMs 19
TVIS – State Performance Measures (SPMs) 20
TVIS – State Performance Measures (SPMs) 21
TVIS – NPM #4 Data NPM 4: A) Percent of infants who are ever breastfed B) Percent of infants breastfed exclusively through 6 months. Indicators – National 22
TVIS – NPM #8 Data NPM 8.1 Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day. Indicators -- National 23
TVIS – NPM #8 Data NPM 8.2 Percent of adolescents, ages 12 through 17 who are physically active at least 60 minutes per day. Indicators -- National 24
TVIS – NOM #20 Data NOM 20: Percent of children, ages 2 through 4, and adolescents, ages 10 through 17, who are obese (BMI at or above the 95 th percentile). Indicators -- National 25
Noted Resources/Activities in State ESMs NPM #4 (Breastfeeding) NPM #8 (Physical Activity) • Provider Training • Provider Training and Certification • Early Care, Licensed Child Care and School-based Physical • Baby-Friendly Hospitals Activity Programs • Evidence-Based Home • Evidence-based Physical Activity Visitation Program Curricula • Breastfeeding Peer • Healthy Lifestyle Messaging and Counselors Marketing Materials • Ten Steps to Successful • Alignment with Statewide Initiatives for Active Living and Breastfeeding Healthy Eating • Partnerships • Community Environmental Policy Changes and Partnerships 26
Contact Information Michele Lawler , Director Division of State and Community Health Maternal and Child Health Bureau (MCHB) Health Resources and Services Administration (HRSA) Phone: (301) 443-2204 Email: mlawler@hrsa.gov Web: mchb.hrsa.gov 27
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