Peter C. van Dyck, MD, MPH Associate Administrator for Maternal and Child Health

Health Resources and Services Administration

Maternal and Child Health Bureau

Annual MeetingAssociation of State and Territorial Public Health

Nutrition Directors

June 10, 2008Peter C. van Dyck, MD, MPH

Associate Administrator for Maternal and Child HealthHealth Resources and Services Administration

June 2008 2

MCH Bureau

June 2008 3

MCH Budget for 2007 and 2008 (millions)

MCHBG…$693.0….$693.0….$750.0….$673.0….$666.2 State..….$566.5...$578.9…..$568.9...$566.5…$556.6 SPRANS...$99.9…$102.2…..$100.4..…$79.9.….$78.6 CISS………$10.6…$11.9......$10.1….…$10.6…...

$10.4 Earmark...$16.0…------….….$70.6…...$16.0…...$20.6

FY2007

2008(PB)

1-numbers may not add due to rounding

2008(H)2008(S)2008(APPR)

June 2008 4


Healthy Start...$101.5...$100.5...$120.0...$101.5…$99.7 Hearing…….….....$9.8…...-----.……$11.0.…$12.0….$11.8 EMSC……….…….$19.8.....-----…….$22.3..…$20.0.…$19.5 TBI………….………$8.9…...-----….….$8.9……$10.0…..$8.8 Sickle Cell….…....$2.2…...$2.2………$2.2.….$3.2…….$2.7 Family to Family.$3.0…...$4.0………$4.0…..$4.0…….$4.0 Autism………….….-----…...-----……..$0.0…...$37.0….$36.4

FY2007

2008(PB)


2008(H) 2008(S)2008(A)

June 2008 5


SPRANS Earmarks Oral Health…...$4.80…$0.0….$12.0…….$4.8……$4.72 Sickle Cell…..…$3.84…$0.0…...$4.0…….$3.84.…$3.77 Epilepsy…….....$2.88...$0.0……$5.8..….$2.88….$2.83 Genetics….….…$1.92…$0.0..….$3.8..….$1.92….$1.89 Mental Health..$1.54…$0.0…….$0.0…...$0.0……$0.0 Fetal Alcohol.…$0.99…$0.0…….$0.0…...$0.99….$0.97 1rst Mother……..-----….-----……..-----..…$1.54….$1.51 Prepare Birth…..-----….-----…...$15.0….…-----…..$4.9 Autism……………-----…..-----……$30.0…….-----…..$0.0

2007


2008(PB)2008(H)2008(S)2008(A)

June 2008 6

MCH Bureau

June 2008 7

MCHB Data MCH Block Grant – Title V Information System

(TVIS) https://performance.hrsa.gov/mchb/mchreports

Discretionary Grants – Discretionary Grants Information System (DGIS) https://perfdata.hrsa.gov/MCHB/DGISReports/

default.aspx Chartbooks and Reports on Women’s and

Children’s Health http://www.mchb.hrsa.gov/data/chartbooks.htm

Evaluation and Epidemiological Surveys, Reports, Resources and Training http://mchb.hrsa.gov/programs/dataepi/

June 2008 8

DGIS Released in April 2008

Companion information system to TVIS. Tracks performance measurement and program

data for MCHB’s discretionary grants (e.g., Financial data, grantees’ reporting on a total of 36 National Performance Measures, Project Abstracts, and other program data.)

Data collection began in October 2004. Nearly two years of complete data has been collected and is available for viewing at the DGIS website: https://perfdata.hrsa.gov/MCHB/DGISReports/default.aspx

June 2008 9

DGIS Web Reports

June 2008 10

DGIS - 37 Discretionary Performance Measures

08) Percent of graduates of MCHB long-term training programs that demonstrate field leadership after graduation.

33) The degree to which a State system for nutrition services has been established for MCH populations.

June 2008 11

TVIS - MCH Block Grant 18 National Performance

Measures

11) The percent of mothers who breastfeed their infants at 6 months of age. (Revised in 2006 from “The percent of mothers who breastfeed their infants at hospital discharge.”)

14) Percentage of children, ages 2 to 5 years, receiving WIC services with a Body Mass Index (BMI) at or above the 85th percentile. (New performance measure beginning in 2006.)

June 2008 12

TVIS - Obesity/OverweightState Performance

Measures

Total number of obesity State performance measures reported and number of States reporting on such a measure increased significantly between 2002 and 2005.

2002 200520 measures reported 45 measures reported by 19 States by 37 States

FY 2006 – 42 measures reported by 35 States(NPM #14 added in 2006 application)

June 2008 13

TVISState Performance

Measures

Nutrition and Physical Activity In 2006:

47 States with 73 Performance Measures (Obesity Measures Included)

25 States with 31 Measures Not Related to Obesity

In 2000 41 States with 60 Performance Measures

(Obesity Measures Included)

June 2008 14

Changes in MCH Priorities Between 2000 and 2005

Among new priority areas identified in 2005, there was a substantial increase in the number of States that identified the need to reduce overweight and obesity.

2000 2005 Obesity and Overweight 10 States 33 States

Nutrition/Physical Exercise 9 States 15 States

(Under contract funding from MCHB, report prepared by Cecil G. Sheps Center for Health Services Research, UNC at Chapel Hill, Meeting State MCH Needs: A Summary of State Priorities and Performance Measures, January 2008.)

June 2008 15

2005 State MCH Priority Needs

State has Nutrition/Physical Activity priority need

State has Obesity/Overweight priority need.

State has Obesity /Overweight and Nutrition/Physical Activity priority need

State and Jurisdictional MCH Agencies with Obesity & Overweight and Nutrition & Exercise as Priority Needs in Their 2005 Needs Assessment

June 2008 16

Healthy People 2010 Progress Review

Nutrition and Overweight

1 Presentation by Dr. Edward Sondik, NCHSWebsite: http://www.cdc.gov/nchs/about/otheract/hpdata2010/focusareas/fa19-nutrition2.htm

Summary Presented at April 3, 2008 Meeting1: Weight status objectives for children,

adolescents and adults moved away from their targets.

Fruit, vegetable and grain objectives, total usual sodium intake showed little or no progress.

Total usual calcium intake moved toward the target.

The weight status and diets of Americans remain an important public health and economic concern.

June 2008 17

MCHBNutrition Strategic Plan

June 2008 18

Child and Adolescent Overweight and Obesity

Expert Panel Convened in February 2005 to Develop Recommendations for the Prevention, Assessment, and Treatment of Child and Adolescent Overweight/Obesity (AMA in collaboration with HRSA and CDC)

Committees’ recommendations were released in Pediatrics Journal supplement in 2007.

June 2008 19

Healthy Tomorrows Partnership for Children

Program

Promotes child health by encouraging communities to: Enhance prevention programs; and Make health care for every child more

accessible.

A total of 54 projects are currently funded in 44 States, Guam and Puerto Rico.

10 innovative, community-based grants have a focus on child health issues, such as obesity prevention, healthy lifestyle and physical activity.

June 2008 20

Reexamination of IOM Pregnancy Weight

Guidelines Funding provided by HRSA (along with

other Federal agencies and the March of Dimes) to support an Ad Hoc Committee to review and update the 1990 IOM pregnancy weight gain recommendations.

Committee will also recommend ways to encourage the adoption of the revised guidelines through consumer education, implementation strategies for practitioners, and public health strategies.

June 2008 21

Reexamination of IOM Pregnancy Weight

Guidelines Report will be issued at the end of the 22-

month project (Summer 2009). January 2008 - Sponsor Meeting March 10-11,2008 – Irvine, CA

Meeting 1: “Biological, Behavioral, and Social Determinants of Gestational Weight Gain and Pregnancy Outcome.”

June 5-6,2008 – Washington, DC Meeting 2: “Implications of Weight Gain for Pregnancy Outcomes: Issues and Evidence.”

June 2008 22

Innovative Approaches To Promoting

a Healthy Weight in Women

Purpose: To develop creative, innovative approaches that are effective in reducing the prevalence of overweight/obesity in women.

Efforts must target women in communities with limited access to preventive health services, particularly women of color, who are disproportionately affected by this risk factor.

12 Grantees have been funded for approximately $150,000/year for 3 years. (3 Grants awarded in 2004; 4 Grants awarded in 2005; and 5 Grants awarded in 2006.)

June 2008 23

National Business Group on Health

MCHB nutrition staff serve on the Obesity Institute, an initiative that encourages members to: Network with other corporate leaders to

raise awareness about the health and cost consequences of obesity.

Identify and test solutions to obesity that have a positive return on investment.

Advance health plans’ and vendors’ efforts to implement solutions.

June 2008 24

National Business Group on Health

The Obesity Institute has established a new committee - Leadership Committee on Innovation in Health Behavior Change.

Mission is to: 1) Understand perceptions and overcome

resistance to behavioral change messages and products; and

2) Identify the best new ideas with application to corporate health improvement and risk reduction programs.

June 2008 25

MCHBNutrition Strategic

Plan

June 2008 26

Breastfeeding Support

Systems Support Liaison to the U.S. Breastfeeding Committee

Provider Support Academy of Breastfeeding Medicine AAP Breastfeeding Promotion in Physicians’

Office Practices (BPPOP) Focus is on educating and supporting future and

practicing physicians and health care professionals in culturally effective breastfeeding promotion and support – directed at achievement of Healthy People 2010 goals.

June 2008 27

Breastfeeding Provider Support - BPPOP

Current Activities: Finalizing breastfeeding curriculum and

tools for medical residency training programs, which have been tested and are currently undergoing evaluation.

Creating a micro-site off the www.aap.org/breastfeeding website to house curriculum materials.

Performing cost-benefit analysis on curriculum implementation.

June 2008 28

The Business Case for Breastfeeding

New HRSA resource kit developed to improve lactation support in the workplace.

June 2008 29

Business Case for Breastfeeding

Goals are to:

1) Increase awareness among employers of

the economic benefits of breastfeeding; 2) Outline manageable and flexible models

for implementing or enhancing a worksite breastfeeding support program, and

3) Increase the number of U.S. employers that utilize a worksite breastfeeding support program.

June 2008 30

Impact of Employmenton Breastfeeding

Full-time employment shortens breastfeeding duration(Fein & Roe 1998)

Most women wean before end of first month back at work(Cardenas 2005)

Common challenges: Maintaining milk production Job settings not always

conducive to milk expression Lack of empathy/support

June 2008 31

U.S. Breastfeeding Rates

75

50

25

40

17

73.8

41.5

20.9

30.5

14.2

0

10

20

30

40

50

60

70

80

Initiation 6 months 12 months Exclus - 3mos

Exclus - 6mos

Healthy People 2010 Goal 2004 Rate

Source: Centers for Disease Control and Prevention

June 2008 32

Women in the Workforce

60 percent of women work outside the home.

Mothers are the fastest growing segment of the U.S. workforce: 55 percent with children under age 3 are

employed. 62 percent with children under age 6 are

employed. 78 percent are employed full-time. Growth rate has increased by 80 percent

over the last 20 yearsU.S. Department of Labor, Commission on Leave (2007). FMLA Survey.

June 2008 33

Women in the Work Force

70.6

6359.9

70.1

6259.3

76.171

66.266.6

60.256.8

5248.1

60.5

0

10

20

30

40

50

60

70

80

With Children Children Under Age 6 Children Under Age 3

Women Caucasian African Am Asian Hispanic

17

June 2008 34

Disparities in Breastfeeding

Women of lower Socioeconomic Status (SES) have lower rates of breastfeeding among all racial/ethnic groups.

African American women consistently have lower rates of BF (CDC MMWR, 2007)

African-American women are more likely to return to full time work sooner. (Cricco-Lizza, 2002; Bronner, 1996)

June 2008 35

Business perspective Designed for multiple groups Based on research and

strategy Includes:

Resource Kit: The Business Case for Breastfeeding

Full kits and individual components available from MCHB at: www.ask.hrsa.gov or 1-888-ASK HRSA

Training and TA

June 2008 36

Component 1: For Business Managers

The Business Case for Breastfeeding

Target: Employers Key content:

Bottom line benefits to supporting breastfeeding

Quick overview of what comprises a lactation support program

Available individually

June 2008 37

Component 2: Easy Steps to Supporting

Breastfeeding Employees

Target: Human Resource Managers

Key content: Lactation support program

options Implementation strategies Gaining buy-in Promotion


June 2008 38

Component 3: Tool Kit

Target: Human Resource Managers

Key Content: CD-ROM with reproducible templates Worksite policy Assessment and feedback

forms Promotional items Resource Guide Employer Snapshots

June 2008 39

Component 4: Employees’ Guide to Breastfeeding and

Working

Target: Pregnant and Breastfeeding Employees

Key content: Combining breastfeeding

and employment Ways to talk with

supervisor and colleagues about breastfeeding needs


June 2008 40

Component 5: Outreach Marketing Guide

Target: Lactation educators and outreach workers

Key content: Conducting effective

outreach w/businesses Supporting working mothers “Outreach Marketing

Resources” CD-ROM PowerPoint presentation Templates for outreach

letters Legislative language Lesson plans

June 2008 41

Training Workshops State Breastfeeding Coalitions (SBCs)

January 2008 – 10 SBCs trainedCalifornia Connecticut Georgia HawaiiIndiana Louisiana Oregon R.I.

Texas Utah 2009-2010 – additional SBCs to be

trained

Healthy Start Communities 2008 – 6 Healthy Start communities

Baltimore Washington, D.C. BirminghamDublin, GA Michigan Inter-Tribal Fresno, CA

2009-2010 – additional HS trainings

June 2008 42

National Business Group on Health (NBGH)

Recently issued a Model Benefit Plan for Maternal and Child Health (supported by MCHB and the Office on Women’s Health.)

Preventive Postpartum Care Recommendation: Breastfeeding counseling and support by

credentialed lactation consultants. MCHB is providing supplemental funding

to NBGH to adapt Resource Kit for work with large Fortune 500 companies.

June 2008 43

MCH Bureau

June 2008 44

The Community-Based Doula Program

Purpose: to provide first time motherhood demonstration programs to urban and rural communities to support community-based Doulas.

This approach identifies and trains indigenous community workers to mentor pregnant women during the months of pregnancy, birth and at least twelve (12) weeks post-partum, (optimally one year post-partum).

June 2008 45


Up to (6) awards will be made to urban and rural community-based organizations to support community-based Doula activities to improve infant health, strengthen families and provide support to ensure family success.

Funding for the rural portion of the demonstration should focus on the best ways of delivering supportive services, including delivery outside the hospital setting both before and after the birth of the child.

Priority will be given to applications which emphasize breastfeeding initiation and retention.

June 2008 46


Up to (1) award will be made to an organization with expertise in replicating community-based Doula programs, to offer outreach, training, technical assistance and evaluation services to the Doula grantees in order to maximize project effectiveness and quality care across all projects.

HRSA’s Maternal and Child Health Bureau was allotted $1.4 million to launch the Community-Based Doula Initiative through the Consolidated Appropriations Act 2008 (P.L. 110-161) .

June 2008 47

First-Time Motherhood/New Parent Initiative

Purpose: Develop, implement, evaluate and disseminate novel social-marketing approaches that:

Concurrently increase awareness of existing preconception/interconception, prenatal care, and parenting services/programs, and

Address the relationship between such services, health/birth outcomes, and a healthy first year of life.

June 2008 48


The target population should include women and men who are from populations disproportionately affected by adverse pregnancy outcomes in their community including racial/ethnic minorities.

Organizations should also outreach to providers who service populations disproportionately affected by adverse pregnancy outcomes in their community including racial/ethnic minorities.

June 2008 49


Services promoted through the public awareness campaign should augment programs that have already been implemented by States to encourage a healthy first year of life and promote educational and social support services for expectant mothers/new parents.

Applicants may choose to create

Statewide, countywide or targeted public awareness campaigns.

June 2008 50


HRSA’s Maternal and Child Health Bureau was allotted approximately $4.8 million for this activity through the Consolidated Appropriations Act 2008 (P.L. 110-161) .

Only one application per State will be accepted.

Up to ten (10) awards are anticipated.

June 2008 51

Combating Autism Act 2006

Background & Purpose 1 in 150 children diagnosed with Autism Need to know more & need more services Part of reauthorization of Title 1 of the

Children’s Health Act of 2000 (PL106-310) Purpose of Combating Autism Act 2006 to

improve upon previous activities by: Expanding research, increasing awareness

and integrating health, education and disability programs.

June 2008 52

HRSA’s Combating Autism Act Initiative

(CAAI)Funding Summary:

$37 Million$34 Million (after rescission)

_______________________________$20 Million LEND/Developmental Behavioral

Pediatrics (DBP) Training (SPRANS)$ 6 Million LEND Expansion$ 6 Million Autism Intervention Research (AIR)

Networks - Network on Physical Health (AIR-P) - Network on Behavioral, Mental

Health (AIR-B)$ 2+Million Information/Education/Tool Dissemination

(State Demonstration Grants, DBP, evaluation, etc.)

June 2008 53

State Autism Demonstration Grants

6 State Autism Demonstration Grants. To improve State and local

infrastructure for serving individuals with Autism Spectrum Disorders and other Developmental Disabilities.

To improve public awareness.

June 2008 54

MCH Bureau

June 2008 55

Supporting the implementation of a National Nutrition Blueprint for Action through a contract with ASTPHND. Currently, four sub-grants are being implemented.

Blueprint for Action. Nutrition and Physical Activity: Cornerstones of a Healthy Lifestyle Stakeholder consensus document that brings focus

and urgency to critical goals and strategies that will frame nutrition and physical activity for the future.

MCH Nutrition Leadership

June 2008 56

The Maternal and Child Health Training Program

Supports Nutrition Discipline Training in: Public Health Pediatrics Maternal Nutrition

FY 2008: Competition for the MCH Centers of

Excellence in Nutrition Grants Grants expected to be awarded by July 1 ,

2008.

June 2008 57

The Maternal and Child Health Training Program

MCH Leaders Develop effective MCH leaders.

Knowledge to Practice Generate, translate, and integrate new

knowledge to enhance MCH training, inform policy, and improve health outcomes.

Collaborating with Others Develop broad-based support for MCH

training Nutrition Training Grantees have a

collaborative project around overweight/obesity.

June 2008 58

Released October 2007

Bright Futures and MCHB solicit your ideas for

tools/strategies to facilitate public health implementation

[email protected]

[email protected]

First complete revision

Includes CSHCN

Accompanied by Toolkit for clinical implementation

Transparency of evidence-base

One set of guidelines for health promotion and prevention— Replaces AAP guidelines & AMA “GAPS”

June 2008 59

Bright Futures Nutrition III

Third edition of Bright Futures in Practice: Nutrition is under development. Update is supported through the Cooperative Agreement with AAP.

Document is expected to be released in late 2008.

June 2008 60

Peter C. van Dyck, M.D., M.P.H.

HRSA/MCHBhttp://mchb.hrsa.gov/

Contact

Documents

Peter C. van Dyck, MD, MPH Associate Administrator for Maternal and Child Health