Denise Higgins, Chief Family & Community Health Bureau MT Department of Public Health & Human Services [email protected] April 26, 2013.

State Health Resources for Women & Children

Denise Higgins, ChiefFamily & Community Health Bureau

MT Department of Public Health & Human [email protected]

April 26, 2013

Conference Objective

Identify at least 5 currently available resources for Women

and Children in the State of Montana

Essential Public Health ServicesMonitor health status to identify and solve community

health problems. Diagnose and investigate health problems and health

hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships and action to identify and

solve health problems. Develop policies and plans that support individual and

community health efforts. Enforce laws and regulations that protect health and

ensure safety. Link people to needed personal health services and assure

the provision of health care when otherwise unavailable. Assure competent public and personal health care

workforce. Evaluate effectiveness, accessibility, and quality of personal

and population-based health services. Research for new insights and innovative solutions to

health problems.

Maternal & Child Health

MCH is the professional and academic field that

focuses on the determinants, mechanisms and

systems that promote and maintain the health,

safety, well-being, and appropriate development of

children and their families in communities and

societies, in order to enhance the future health and

welfare of society and subsequent generations.

What does MCH include?Determinants of

healthDisparitiesPregnancy healthPre-conception healthReproductive healthChild healthChildren with special

health care needsSchool health

Adolescent healthOral healthNutritionHealth policiesInternational healthHealth care and

insuranceAdvocacy

Pyramid of Services Infrastructure Building Services form the

foundation of the program. These services create the capacity on which all other MCH services rely, such as maintaining data systems, ensuring a well-trained workforce, and establishing integrated, coordinated systems of care.

Population-Based Services reach the entire MCH population, providing disease prevention and health promotion services such as universal screening programs and public information campaigns.

Enabling Services help vulnerable populations—children and families who are poor, have special health care needs, or are at risk of poor health outcomes—access needed services and optimize health benefits.

Direct Health Care Services provide gap-filling primary and preventive health care services that would not otherwise be available through other funding sources or providers.

*difference is statistically significant

Risk Factors

Mother’s smoking status by age, Montana residentsMontana Office of Vital Statistics, 2008-2010.

(Note: scale is not to 100)<19 20-29 30-39 40+0

10

20

30

40

per

cen

t

Risk Factors

Five-Year Infant Mortality Rates and Fetal Mortality Ratios, Montana Residents, 1962-2011

Prenatal care initiation, low birth weight, and preterm birth in Montana, by age of mother,

Montana Office of Vital Statistics, 2009

Initiation of prenatal care in

the 3rd trimester or no

care

Low birth weight infant

Preterm infant Smoking during pregnancy

0

5

10

15

20

25

30

9.67.4 8.5

25.9

5.17.1

9.1

14.9

15-19

20+

per

cen

t

Source: Montana Office of Vital StatisticsSource: Montana Office of Vital Statistics

14.9

Access and Outcomes

Teen (15-19) birth rates by race, 2 year averages, Montana

Montana Office of Vital Statistics, 2002-2011

Teen Pregnancy

American Indian White0

20

40

60

80

100

MTUS

Per

10

00

pop

ula

tion

29.5

38.7

23.5

Teen (15-19) birth rates by race, MT and USMontana Office of Vital Statistics, 2010

85.7

Teen Pregnancy

By 2017, increase the number of women aged 15-44 years who receive reproductive health care services at Title X clinics from 26,480 to 28,000. (HP 2020 Target: 78.8%)

By 2017, increase the percentage of women who reported entering prenatal care in the first trimester from 72% to 80%. (HP 2020 Target: 78% )

By 2017, increase the percentage of women who report abstaining from smoking during pregnancy from 83% to 90%. (HP 2020 Target: 98%)

By 2017, decrease the rate of live births per 1000 that are preterm from .88 per 1000 live births to .5 per 1000 live births. (HP 2020 Target: 1 per 1000 live births)

Promote the Health of Mother, Infants and Children:

Decreasing teen pregnancy and teen births can be achieved in two ways Contraceptive use among sexually active teensDelay/decrease initiation of sexual activity

Draw the Line/Respect the Line(6th, 7th and 8th grade youth)Focuses on postponing sexual activityAddresses social pressures, communication

and negotiation skills

Evidence-based Interventions

Delaying initiation of sexual activity and pregnancy prevention• Reducing the Risk (High school youth)

Decrease sexual initiationDecrease sexual risk taking Increase contraception use for sexually active teens

Teen Outreach Program(High school youth)After-school service program that focuses on positive

self-image, life management skills and goal setting

Evidence-based Interventions

MCH in MontanaFunding to 54 local County Health

DepartmentsImmunizations

Women’s and Men’s HealthWICHome VisitingChildren with Special Health Care NeedsNewborn Hearing and Metabolic ScreeningClinical GeneticsRecruitment, Retention, Loan Repayment

Montana WIC• WIC contracts with 27 Regional

Programs to offer the WIC program benefits to women, infants, and children throughout MT

• Nutrition education, breastfeeding support, food packages

• Serve an average of 20,000 participants each month

Who we serve• Pregnant, breastfeeding and postpartum women

• Infants & children up to 5 years old

• <185% poverty level

• Adjunctively eligible: Medicaid, TANF, SNAP, free/reduced school lunch

• Live in Montana

• At nutritional risk

• Refer all pregnant women

Nutritional Services

At certificationScreen income, check residence and ID, physical presenceCollect anthropometric & biochemical data (ht, wt, hgb)Collect dietary, socioeconomic and medical data = Assess/Risk CodeProvide client centered education based on riskCreate care plan including referrals, follow up schedule and ed. topics

Follow upRefer to care plan, f/u on education, referrals, goals, current education

Mid-year assessmentAnthropometrics, brief assessment & education

Montana WIC Program

1400 Broadway, Cogswell Bldg. C305PO Box 202951

Helena, MT 59620-2951Telephone: 800-433-4298 or

(406) 444-5533 www.wic.mt.gov

Women’s & Men’s HealthWomen’s & Men’s Health• 14 Title X clinics around the state• Resources on:• Family Planning• Teen pregnancy prevention• Health education & outreach• Information on breast & cervical health• Men’s health• STI/HIV prevention

Who is a Title X patient?Who is a Title X patient?• Anyone can receive services from a Title X Family Planning

Clinic. However, for those services to be subsidized by Title X funds, the patient must be:

– Females or males who want to avoid unintended pregnancies or achieve intended pregnancies.

– Post-menopausal women are not eligible for Title X services

since they are unable to become pregnant and would not need contraceptive counseling. There is no such limit for men as they do not have a definite end to their reproductive years.

– Adolescents may be served confidentially* as long as they receive counseling on the following:

• Importance of family involvement • Abstinence• Sexual coercion• Confidentiality• STI/HIV prevention

*MCA 41-1-402: Validity of consent of minor for health services

Patient ServicesPatient Services• Reproductive Health exams for

men and women• Testing

– STI– HIV– Pregnancy

• Contraception• Cancer Screening

– Breast– Cervical– Colo-rectal

• Referral that includes– Pregnancy– Weight management– Primary care– Abnormal breast and pap

follow-up– Mental health

• Education and counseling that

includes

• Birth control methods

• Adolescent counseling

(parental involvement,

sexual coercion,

abstinence, confidentiality

and STI/HIV and

pregnancy prevention)

• Tobacco cessation

• Nutrition and physical

activity

• Immunization

• Reproductive Life Plans

Women’s and Men’s Health Section Montana Department of Public Health and Human Services

1400 E Broadway A116 Helena MT 59620

Phone: 406-444-0983Fax: 406-444-2606

www.dphhs.mt.gov/publichealth/wmh/womensreproductive.shtml

Maternal and Early Childhood Home Visiting

Evidence-based models • Nurse-Family Partnership

– Missoula & RiverStone Health

• Parents As Teachers– Lake, Flathead, Lincoln and Mineral

Referral networks with local health departments

Nurse-Family Partnership

• Focus: Healthy pregnancy, knowledgeable and responsible parenthood, and personal growth and development

• Clients: First time, low income pregnant women, to the child’s second birthday

• Enrollment timing: By the end of the 28th week of pregnancy

• Visits: weekly (1st 4 weeks and 1st 6 weeks postpartum), otherwise every other week, then monthly when child is 21-24 months

• Nurse home visitor

Parents as Teachers• Focus: parenting education, family support,

school readiness, building protective factors within the family

• Clients: identified by community, recommend enrolling prenatally or in infancy; served until the child turns 3 or 5

• Visits: Every week to every other week• Personal visits and group connections• Parent educator

Domains• Child health• Maternal health• Child development and school readiness• Family economic self-sufficiency• Linkages and referrals• Parenting practices• Child maltreatment• Juvenile delinquency, family violence, and crime

Maternal and Infant Home VisitingMontana Department of Public Health and Human Services

1400 E Broadway B102Helena MT 59620

Phone: 406-444-6940Fax: 406-444-2606

www.dphhs.mt.gov/publichealth/homevisiting/miechv.shtml

Children’s Special Health Services

• Partner with regional sites to assure access to pediatric specialty care.

Community Medical Center, Missoula St. Vincent’s, Billings Great Falls Clinic, Great Falls

Ensuring a broad range of Pediatric Specialty Clinics

• Cystic Fibrosis Team Clinic• Cerebral Palsy/Spasticity• Cleft/Craniofacial Team Clinic• Endocrine Clinic• Epilepsy Clinic• Genetic Evaluation &

Outreach Services – Shodair Hospital

• Hemophilia Clinic• High Risk Infant Follow-up

Clinic• Juvenile Rheumatoid Arthritis

• Metabolic Clinic (PKU)• Muscular Dystrophy• Nephrology Clinic• Neurology Clinic• Neural Tube Defects/Spina

Bifida Clinic • Neurology Outreach Clinic• Orthopedic Clinic• Pulmonary Clinic• Rehabilitation Clinic• Rheumatology Clinic• Urology

Travel Distance for CF Patients who Attend CF Team Clinics

ELIGIBILITY

1. Age- birth through 18 years of age.2. Is diagnosed with special health care

needs. OR

3. At risk for chronic physical, developmental, behavioral, or emotional conditions.

AND 4. Requires health and related services of a type or amount beyond that required by children of the same age.

Financial Assistance• CSHS

o $2,000 capo Financial and clinical criteriaoCan be renewed annually

• Genetic Testing oClinical criteriao For genetic laboratory testingoAll ages qualify

Children’s Special Health Services

Montana Department of Public Health and Human Services PO Box 202951

Helena MT 59620-2951(406) 444-3622 (local)

(800) 762-9891 (toll free in state)Fax: (406) 444-2750Email: [email protected]

www.cshs.mt.gov

Early Hearing Detection and Intervention (EHDI) National

Goals

• Goal 1: All newborns will be screened for hearing loss before one month of age, preferably before hospital discharge.

• Goal 2: All infants who screen positive will have a diagnostic audiologic evaluation before 3 months of age.

• Goal 3: All infants identified with a hearing loss will receive appropriate early intervention services before 6 months of age.

NBHSI Program Partners

• Montana School for the Deaf and the Blind• Parents• NBHS Stakeholders Group• 28 Birth Hospitals• Midwives• Pediatric Audiologists• Hearing Conservation Program Audiologists (Montana

Office of Public Instruction)• Montana Part C Program• Montana Physicians• County Health Departments/Home Visiting Programs

Hearing Conservation Program Audiologists, 2013, Montana

Carl Clark Jeff Griffin

Sharon Nash

Shey Mayland

Sharlene Schmidt

Sue Roller Sue Bressler

Tina Hoagland

Tina Berg

Susan Kalarchik

Counties Providing Hearing Screenings, 2013, Montana

NBHS Pilot Sites

Home Visiting Sites Providing Hearing Screening

Home Visiting Sites Who Plan To Implement Hearing Screening

Pediatric Audiologists, 2013, Montana

Greg Freeman**, M.S. CC-A

Leah Jacobsen,Au.D.

Ruth Fugleberg, M.C.S.D.

Hillary Carter**, Au.D.

Ashley Anderson**, Au.D.

Kristy Foss, M.C.S.D.Janice Johnson, Au.D.Kelsey Mann**, Au.D.

Tracy Hayden, Au.D.Crystal Dvorak**, Au.D.

** New Pediatric Audiologists since 2011

Primary Care OfficePrimary Care Office main focus is to use

available data, i.e. Medicaid/Medicare visits to determine areas of the state that are in need of primary care doctors, dentists, nurses, and other health care professionals. These areas may be eligible to apply for Federal Funding by working with the Primary Care Association.

Information source for loan repayment options for primary care and mid-level health care professionals to work in health shortage areas.

Questions?