What is Happening in State Title V Nutrition Services? Helene Kent, RD, MPH Joan Eden, RD, MS Kristin Biskeborn, RD, MPH.

What is Happening in State What is Happening in State Title V Nutrition Services? Title V Nutrition Services?

Helene Kent, RD, MPH

Joan Eden, RD, MS

Kristin Biskeborn, RD, MPH

Session ObjectivesSession Objectives

1. Provide an overview of the MCH Title V Block Grant highlighting the opportunities and challenges it offers for nutrition services.

2. Describe how two states have funded state and local nutritionists through the MCH Block grant.

3. Describe different roles of nutritionists funded through MCH.

4. Identify ways to use the State MCH Needs Assessment Process and the National and State Performance Measures to address nutrition issues.

5. Discuss strategies for maximizing MCH funded nutrition services through planning and coordination with other programs.

Title V and Title V and Nutrition ServicesNutrition Services

MilestonesMilestones

• 1921 Shepard-Towner Act Maternity and Infancy Act • 1935 Title V of the Social Security Act• 1946 National School Lunch Act • 1953 ASTPHND • 1964 Food Stamp Act • 1966 Child Nutrition Act • 1970 Food Stamp Act • 1972 National School Lunch Act Amendments • 1979 Dietary Guidelines for Americans• 1980 Healthy People

Title VTitle V

to provide and to assure mothers and children (in particular those withlow income or with limited availability of health services) access toquality maternal and child health services; [and]

…to reduce infant mortality and incidence of preventable diseases andhandicapping conditions among children, to reduce the need forimpatient and long-term care services, to increase the number ofchildren (especially preschool children) appropriately immunizedagainst disease and the number of low income children receivinghealth assessments and follow-up diagnostic and treatments services,and otherwise to promote the health of mothers and infants byproviding prenatal, delivery, and postpartum care for low income, pregnant women, and to promote the health of children byproviding preventive and primary care services for low incomechildren;

Title VTitle V

To improve the health of all mothers and children consistent with the applicable health status goals and national health objectives established by the Secretary under the Public Health Service Act for the year 2000….

Title VTitle V

• Is Broad

• Can Take a Lifespan Perspective

• Promotes Health

• Tailored to Each State or Territory

Opportunities and ChallengesOpportunities and Challenges

• Take Leadership

• See the Forest and the Trees

• Seek the Opportunities

• Breakdown the Barriers

• Be Creative

• Build on what Exists

• Communicate

TopicsTopics

• Improve Overall Wellness of Women and Children

• Breastfeeding• Healthy Weight• Preconception/Interconception• Folate

https://performance.hrsa.gov/mchb/mchreports/Search/search.asp

Helene Kent, RD, MPHHM Kent Consulting

7543 East 6th Place

Denver, Colorado 80230

Phone: 303 364-1546

Email: [email protected]

What is Happening In Colorado’s What is Happening In Colorado’s MCH Title V Nutrition Services?MCH Title V Nutrition Services?

Prevention Services Division Prevention Services Division Organizational ChartOrganizational Chart

Division Director

DeputyDirector

Office of Maternaland Child Health

Office of Policyand FiscalAnalysis

NutritionServicesSection

ChronicDiseaseSection

StateTobaccoEducation

andPreventionPartnership

Section

Oral, Ruraland

PrimaryCare

Section

Women’sHealthSection

Child andAdolescent

SchoolHealthSection

Children &Youth w ithSpecial

Health CareNeedsSection

Injury andSuicide

PreventionSection

OfficeManager

Prevention ServicesDivision Director

Deputy Director

Office of Maternaland Child Health

Office of Policy and FiscalAnalysis

NutritionServicesSection

ChronicDiseaseSection

State TobaccoEducation and

PreventionPartnership

Section

Oral, Rural andPrimary Care

Section

Women’sHealthSection

Child andAdolescent

School HealthSection

Children &Youth with

Special HealthCare

NeedsSection

Injury andSuicide

PreventionSection

WICProgram

CACFPProgram

Physical Activityand Nutrition

Program

ComprehensiveCancer

Prevention andControl

Program

CardiovascularHealth

Program

ColoradoCentral Cancer

Registry

DiabetesControlProgram

AsthmaProgram

LocalPrograms

YouthPrograms

State LevelInitiatives

Oral Health

Rural andPrimary Care

FamilyHealthLine

PrenatalProgram

FamilyPlanningProgram

ColoradoWomen’s

Cancer ControlInitiative

Child Health

Children’sTrust Fund/

FamilyResourceCenters

Nurse HomeVisitor

Youth Services

School Health

AdolescentHealth

AbstinenceEducationProgram

HCP Program

DataIntegration &Information

Systems(NEST & IRIS)

GeneticsProgram

NewbornHearing

Screening &Intervention

Program

InjuryPrevention

InjuryEpidemiology

SuicidePrevention

Child FatalityReview

ArthritisProgram

Prenatal Plus

Office Manager

ColoradoMedical Home

Initiative

Funding for Nutrition Services in the Division

Trends in MCHTrends in MCH

• 1980s Primarily Direct Services• Prenatal Medical Care• Well Child Clinics• Dental Care • Specialty Care for CSHCN

Trends in MCHTrends in MCH

• Prenatal Diet Counseling• Breast Feeding Promotion &

Counseling• Child Feeding & Anticipatory

Guidance

Nutrition Services

Trends in MCHTrends in MCH

• Core Public Health Functions• 10 Essential Public Health Services

OBRA 89

• Medicaid Expansion

IOM Report – Towards the Future of Public Health

MCH Pyramid

DIRECT HEALTH CARE

SERVICES: (GAP FILLING)

Examples: Basic Health Services,

and Health Services for CSHCN

ENABLING SERVICES: Examples:

Transportation, Translation, Outreach, Respite Care, Health Education, Family

Support Services, Purchase of Health Insurance, Case Management, Coordination with Medicaid,

WIC, and Education

POPULATION-BASED SERVICES: Examples:

Newborn Screening, Lead Screening, Immunization, Sudden Infant Death Syndrome Counseling, Oral Health,

Injury Prevention, Nutrition and Outreach/Public Education

INFRASTRUCTURE BUILDING SERVICES: Examples:

Needs Assessment, Evaluation, Planning, Policy Development, Coordination, Quality Assurance, Standards Development, Monitoring, Training, Applied Research, Systems of Care, and Information Systems

MCH PYRAMID

Trends in MCHTrends in MCH

• GPRA in 1993

• National/ State-Defined Performance Measures

• 5-year Needs Assessment

• Focus on Priorities

• SCHIP

Trends in MCHTrends in MCH

• What is missing from Medicaid/SCHIP benefits? • Will providing direct care for a small number of

individuals improve our performance measures?• If not, what will?• Use priorities and Performance Measures to

engage stakeholders

Result in Colorado

Look at big picture

• Plan more strategically

1.    Improve healthy birth outcomes for pregnant women (Subpriorities: appropriate weight gain, smoking cessation, prematurity prevention, elimination of physical abuse, improved oral health care, no drug or alcohol use, and early prenatal care)

2.     Improve access to health care for MCH populations (Subpriorities: primary care, specialty care, mental health, oral health)

3.      Improve immunization rates for all children

4.      Reduce the adolescent fertility rate (Subpriority: Latina Population)

5.      Reduce the rates of child and adolescents motor vehicle injury and death

6.      Improve preconceptual health among women (Subpriority: pregnancy intendedness)

7.      Reduce the incidence of overweight and obesity among children and adolescents

8.      Improve the mental health of MCH populations (Subpriorities: depression, suicide)

9.      Improve the health of children (Subpriority: health and safety in child care, breastfeeding, abuse and neglect)

10.  Reduce the use of tobacco, alcohol, and other drugs among MCH populations

The following is a list of the ten priorities selected through the MCH prioritization process. They are listed in rank order from

the priority determined the most important.

FY 2006 Priorities Chosen

Nutrition Services in the Health Care Program Nutrition Services in the Health Care Program for Children with Special Needs (HCP)for Children with Special Needs (HCP)

Started as a 3 year MCHB SPRANS grant

Purpose: to develop screening/ assessment tools and a process to identify CSHCN at nutritional risk

Screening tool used statewide in child health clinics and in rural specialty clinics

· Assessment and counseling done in 10 pilot communities

 · Data showed half the children screened were at

nutrition risk and that counseling decreased risks · Project discontinued when SPRANS grant was

over 

Nutrition Services in the Health Care Program Nutrition Services in the Health Care Program for Children with Special Needs (HCP)for Children with Special Needs (HCP)

New Challenges and OpportunitiesNew Challenges and Opportunities

Mandate to new HCP Director:

• Move money out of the State Office into the community

Interests:• Begin to build community capacity and to

encourage collaboration and cooperation

• Add new benefits including nutrition

New RD Positions in HCPNew RD Positions in HCP

• Shared positions with hospitals, Community Center Boards, Community Health Centers, schools, Part C

• .5 FTE position at the state • Ten .2 - .5 FTE positions in the community

• Counseling, feeding equipment and therapy, supplemental feeding products

• Provided TA in community, needs assessment

For more information about the HCP For more information about the HCP

Nutrition Program contact:Nutrition Program contact:

Shirley Babler, R.D.HCP Nutrition Services Manager

Health Care Program for Children with Special Needs (HCP)

Prevention Services Division

Colorado Department of Public Health and Environment

PSD-HCP-A4

4300 Cherry Creek Drive South

Denver, Colorado 80246-1530

303-692-2455

[email protected]

Nutrition Services in the Nutrition Services in the Women’s Health ProgramWomen’s Health Program

• Prenatal Plus Program– Case management program for pregnant women to

reduce low birth weight– Focusing on inadequate weight, smoking and psycho-

social risks

Low Birth Weight ProjectLow Birth Weight Project

• Began with a SPRANS grant to look at the risk factors involved in Colorado’s high low birth weight rate

• Funded 3 local projects; collected data

• After funding ended, used MCH Block Grant funding to expand the project to more sites

Low Birth Weight ProjectLow Birth Weight Project

• In 2000 published Tipping the Scales: Weighing in on Solutions to the Low Birth Weight Problem in Colorado

• Report available in PDF format at: http://www.cdphe.state.co.us/fc/lbwreport.pdf

Medicaid FundingMedicaid Funding

• Report provided data to convince Medicaid that for every dollar spent on interventions to resolve the risks of smoking and inadequate weight gain, $2.48 could be saved on illness and conditions associated with having a low birth weight baby.

• Medicaid agreed to fund the program for at-risk pregnant women

LBW Project Becomes Prenatal PlusLBW Project Becomes Prenatal Plus

• Multi-disciplinary case management program• Model care package – 8 office visits + 2 home visits• 27 projects statewide • 24 mostly part-time RDs• Other team members are MSWs and RNs• Low birth weight rate for women at nutrition risk was

8.8% for those who gained adequately in the program vs. 14.6% for those who didn’t

For More Information on For More Information on Prenatal Plus contact:Prenatal Plus contact:

Mandy McCulloch, RDWomen’s Health Section

Colorado Department of Public Health and EnvironmentPSD-WH-A5

4300 Cherry Creek Drive SouthDenver, Colorado 80246-1530

 Phone: 303-692-2495FAX: 303-691-7900

E-mail: [email protected]:

http://www.cdphe.state.co.us/pp/womens/PrenatalPlus.asp

Health Baby is Worth the WeightHealth Baby is Worth the Weight

• A social marketing campaign to decrease low birth weigh and increase the number of pregnant women who gain adequately

• Geared towards educating providers

• Primary message is that inadequate weight gain is modifiable

Practice RecommendationsPractice Recommendations

• 1990-Institute of Medicine outlined specific weight gain recommendations for pregnancy based on four body mass index categories (underweight, normal, high, obese)

• Recommendations allow for the most optimal outcomes for both infant and mother

• Campaign provides several tools (i.e. combined BMI/gestational wheel) to allow for quick and easy assessment/counseling on prenatal weight gain.

Campaign Roll OutCampaign Roll Out

• Train-the-trainer model for 6 local health dept. and Kaiser with goal of training 100 providers each.

• Training at various professional conferences and MCH statewide video-conference.

• Website developed (separate sites for providers and consumers; “Ask a Dietitian Site”)

2005-2006 Expansion2005-2006 Expansion

• Developing new materials for campaign aimed at consumers

• Expansion of train-the-trainer model to all local health departments and Rocky Mountain HMO

For more information about the Healthy For more information about the Healthy Baby is Worth the Weight Campaign Baby is Worth the Weight Campaign

contact:contact:

Stephanie Beaudette, M.Ed. RDWomen’s Health Section

Colorado Department of Public Health and EnvironmentPSD-WH-A5

4300 Cherry Creek Drive SouthDenver, Colorado 80246-1530

 Phone: 303-692-2487FAX: 303-691-7900

E-mail: [email protected]

Web Site: www.healthy-baby.org

SummarySummary

• MCH provides broad, flexible funding• The use of SPRANS funding can help get programs

going• Involvement in the MCH NA and the Strategic

Planning processes provide opportunities to look at state nutrition needs and issues

• Sometimes moving outside of nutrition positions into other leadership positions creates opportunities to expand nutrition

What is Happening in South Dakota’s What is Happening in South Dakota’s MCH Nutrition Services?MCH Nutrition Services?

South Dakota South Dakota Department of HealthDepartment of Health

Division of Health and Medical Services

Family Health Health PromotionCommunity

Health Services

MCH/CSHSWIC

Nutrition/PAOral HealthCSH

CHNsRDNutr Educators

Nutrition ServicesNutrition Services

• Contract RDs all CSHS clinics• Field staff direct service—time

study– Challenge demands of WIC and

other programs

• Infrastructure/Population-based services—state office—time study– Nutrition/PA – School Health

SD Nutrition Performance SD Nutrition Performance MeasuresMeasures

• Breastfeeding Initiation

• Obesity School Aged Child and Adolescent • Obesity Preschool Child• Breastfeeding Duration

• Past Performance Measure– Eating Disorders

HOW?HOW?

• Demonstrate Need

• Method of Measurement/Evaluation

South Dakota South Dakota Department of HealthDepartment of Health

School Height & Weight ReportFor South Dakota StudentsStarted 1998-1999

Optional ParticipationOptional Participation

• 1998-1999: 110 schools; 16,723• 1999-2000: 95 schools; 15,062• 2000-2001: 86 schools; 12,493• 2001-2002: 130 schools; 16,781• 2002-2003: 145 schools; 20, 449• 2003-2004: 196 schools; 28,699• 2004-2005: ???

Win-WinWin-WinState• State data• Opportunities to

build support for individual and environmental change

• Build case for funding

School (person submitting data, bldg principal, support)

• State Report• Analyzed school

data• District data• Trends• Height Weight

Equipment

South Dakota School Height South Dakota School Height and Weight 2003-2004 and Weight 2003-2004

School YearSchool YearAt Risk For Overweight and Overweight

Body Mass Index By AgeAge Number Of

StudentsAt Risk For Overweight

Overweight At Risk For Overweight

and Overweight Combined

5-8 years 8,952 15.1% 13.0% 28.1%

9-11 years 9,767 16.7% 17.7% 34.4%

12-14 years 6,347 16.5% 17.0% 33.5%

15-19 years 2,179 16.6% 14.9% 31.5%

Total 27,245 16.1% 15.8% 31.9%

HP2010 Goal Overweight 5%

Data SourcesData Sources

• Preschool Obesity– WIC PedNSS– Head Start (planning)

• Breastfeeding Initiation– WIC (used initially)– Newborn Screening Initiative (now)– Birth Certificate (planned)

• Breastfeeding Duration– WIC (used initially) – Perinatal Health Risk Assessment Survey and/or– NIS

Activities

BreastfeedingBreastfeeding

• All DOH programs same standards/training

• Gap-filling counseling

• MCH breastpumps to loan

• Resource materials

PediatricPediatric ObesityObesity

• School Height Weight Data• Trainings• Resources—Bright Futures• CSH and DOE

– “Minds in Motion”– “SD Schools Walk”

• Team Nutrition—USDA Wellness Policy

The state’s largest wellness centersState Parks

11 Disk Golf Courses

Croquet Sets

Volleyball

Bocce

Family Fun Opportunities

Plan to Promote Nutrition and Plan to Promote Nutrition and Physical Activity to Prevent Physical Activity to Prevent Obesity and Other Chronic Obesity and Other Chronic

DiseaseDisease

• MCH Director on main team

• Pediatric campaign

• Mini-grants to School Health Councils

ContactContact

Kristin Biskeborn, MPH, RD, LNState Nutritionist

South Dakota Department of Health300 S Courtland, Ste. 109Chamberlain, SD  57325

Phone: 605/734-4551Fax:  605/734-4552

Email: [email protected]