Early Intervention: Federal Requirements and Model

ProgramsUsing Title V to Improve

Outcomes for Young Children and Their Families

Deborah Klein Walker, EdDPrincipal Associate

Health Services Research and EvaluationAbt Associates

ABCD II Consortium NetworkAugust 2004

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

GOAL

Develop and enhance systems of care in neighborhoods and communities which promote:

Healthy Children in Healthy Families in Healthy Communities

MCH PUBLIC HEALTH FOCUS

• Communicable Diseases

• “New Morbidity”

• “New Social Problems”

• Healthy Communities

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

OUTCOMES

• Infant Mortality

• Immunization

• Child Fatalities

• Teen Births

OUTCOMES

• Children in Poverty

• Low Birth weight

• Child Abuse

• Single Parents

The Public Health (and MCH)

Focus on Improved Health

Outcomes Assumes a System

of Care Must Be in Place

Early Childhood System Sectors

• Health

• Education

• Social Services

• Child Care

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

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.

HEALTH FINANCING IS

NECESSARY BUT NOT

SUFFICIENT

SYSTEMS DEVELOPMENT AT ALL

GOVERNMENT LEVELS

KEY PUBLIC HEALTH (MCH) ROLE

PUBLIC HEALTH CORE FUNCTIONS

• ASSESSMENT

• POLICY DEVELOPMENT

• ASSURANCE

Future of Public Health, Institute of Medicine, 1988

ASSESSMENT STRATEGIES

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

POLICY DEVELOPMENT STRATEGIES

• Leadership and Advocacy

• Planning

• Collaborative Partnerships

• Ensure Financing

• Ensure Public/community Participation

• Legislation

• Innovations

ASSURANCE STRATEGIES

• Education and Training

• Direct Services

• Public Information, Education, Referrals

• Community Mobilization

• Licensing, Regulation, Certification

• Standards Setting and Guidelines

• Program Monitoring and Evaluation

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

MATERNAL AND CHILD HEALTH TITLE V SOCIAL SECURITY ACT

1935 Enacted

1960’s - 70’s Expansion

1981 Block Grant

1989 OBRA

1996 Welfare Reform

TITLE V PURPOSE

• To improve the health of ALL mothers and childrenProvide 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

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

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

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

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

MCH PYRAMID OF HEALTH SERVICES

Direct Health Care Services

Enabling Services

Population-Based Services

Infrastructure Building Services:

MCH REPORTING SYSTEMS

• National MCH Outcome Measures

• National MCH Performance Measures

• State-determined MCH Performance Measures

• National Health Status Indicators

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 ServicesPopulation-Based ServicesInfrastructure Building Services

• 6 Core Outcome Measures• Up to 10 State Negotiated Measures

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

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.

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

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

What Does It Mean To “Assure”?

• Guarantee• Pledge• Promise• Vow• Confirm• Insure• Comfort• Console • Reassure

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)

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

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

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

MCH ASSURANCE EXAMPLES

• Facilitate public accountability

• Population-based data gathering and reporting

• Facilitate active public/private partnerships towards shared accountability for MCH outcomes

EXAMPLES OF MCH PARTNERS OUTSIDE OF HEALTH AGENCY

• Consumers/Families

• Researchers

• Advocacy Groups

• Policymakers

• Business/Industry

• Public and Private Agencies

• Providers

• Professional Groups

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

STARTING POINTS

• Promote Responsible Parenthood

• Guarantee Quality Child Care Choices

• Ensure Good Health and Protection

• Mobilize Communities to Support Young Children and Their Families

CHALLENGES

Coordination and LinkageFederal-state-localCross systemsAcademia to practice

CapacityCommunityProvider

CHALLENGES

FinancingHealthEducationChild careJobs

Attitudes and CommitmentPublicBusinessParents

IMPLEMENTATION OF PUBLIC POLICY NEEDS

• Knowledge Base

• Political Will

• Social Strategies

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

KEY FEDERAL LEGISLATION

• SSA Title XXI - SCHIP

• OBRA ‘93 Family Preservation

• Child Care Block Grant

• Individuals with Disabilities Education Act (IDEA)

• Head Start

KEY FEDERAL LEGISLATION

• Supplemental Nutrition Program for Women, Infants and Children (WIC)

• Public Health Service ActCommunity and Migrant Health Centers

(Sections 329 & 330)Family Planning (Title X)

• Parents and Families

• Providers

• Purchasers and Insurers

CRITICAL PARTNERS FOR IMPROVING MCH OUTCOMES

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