Illinois Department of Public Health Office of Women s Health and Family Services Paradigm Shift Dr. Brenda Jones/Deputy and Title V Director

Illinois Department of Public Health Office of Women s Health and Family Services Paradigm Shift Dr. Brenda Jones/Deputy and Title V Director

Objectives Introduction to the Office of Women s Health and Family Services (OWHFS) Program Updates Understanding MCH Title V Program MCH Rural Health Issues MCH Needs Assesstment

Programs Illinois Breast and Cervical Screening Family Planning Regional Perinatal Network Children with Special Health Care Needs Asthma (MCH) CDPH Mini Block Grant (MCH) Coordinated School Health Education School Based Health Centers Illinois Subsequent Pregnancy Prevention Teen Pregnancy Primary Prevention 3

Program Updates

Illinois Breast and Cervical Cancer Screening Program The Illinois Breast and Cervical Cancer Program (IBCCP) offers free mammograms, breast exams, pelvic exams and Pap tests to all uninsured Illinois women regardless of income. Since the IBCCP launched in October 1995, the program has screened more than 182,976 women. The Department of Healthcare and Family Services covers treatment for most women diagnosed with breast or cervical cancer under IBCCP. More than 7,500 women have been referred for treatment (includes RTTA).

IBCCP and Medicaid Expansion 77% of IBCCP caseload is eligible Exact # s migrating are difficult to attain at this point in time because: Lead agencies are actively enrolling We cannot know until our clients drop out of the program Working with Medicaid to capture enrollees Variation in enrollment across counties

ACA Migration Efforts Surveyed agencies to assess ACA preparation and needs 31 out of 35 Agencies responded & identified educational needs as most important at that time Hosted a keynote session on ACA at our annual conference Provided direction to 35 Leads at our annual meeting Ongoing collaboration with 35 Lead agencies throughout the State to disseminate information on ACA 70 phone calls to collect migration information and provide support

Lead Agency Migration Response Significant variation across counties on migration efforts with some counties seeing no impact and others reporting drastic impact Agencies are reporting the following related to ACA enrollment: Women believe they are automatically enrolled so they are not actively enrolling Women are choosing not to enroll because they can t afford the deductible/co pay Women are confused about the process and are afraid to give out personal information

Lead Agencies, Navigators and ACA 32 agencies have navigators, 3 refer to local navigators Agencies report a fair amount of time is spent in educating and connecting clients to ACA Preliminary information suggests that navigators reach clients by: sending information packets to clients who are due for screenings, sometimes following up with phone calls directly asking clients coming in for services whether they have applied or if they are going to apply for ACA

Need for IBCCP Undocumented women Women may opt out of ACA for various reasons, including deductibles, lack of knowledge related to medical systems, access to technology Continue to work with our Medicaid State Partners for answers

FP National Implication IOM recommended that OFP develop and implement a multiyear evidence based strategic plan. IOM also made specific recommendations to improve program management and administration. For example, IOM recommended that: methods of allocating funds be examined and improved, drug purchasing sources be consolidated, clinics administrative burden be reduced, a single method be adopted for determining criteria for eligible services, transparency be increased, workforce needs be assessed, and program guidelines be evidence based

Family Planning Updates FY15 Family Planning Grant Application Conducting research on grant based systems versus fee for service systems; Staffing update Reviewing how ACA impacts providers; Reaching out to providers who do not have EMR records; Reviewing various types of preconception and interconception education materials; and Reviewing of Ahlers reports to ensure that we are on target with our clinical services.

Teen Pregnancy Address rural teen pregnancy and STI rates Staff updates Comprehensive Sexual Education (emphasize parent teen communication) Look at barriers in Family Planning Clinics Motivational Interviewing

Regionalized Perinatal Network Establishment of a system of performance measures, targets, and goals to improve public health practices Reevaluation of the current process and system of designating perinatal levels of care in the state s maternity hospitals Development and implementation of referral and transport policies and mechanisms to ensure that every mother and newborn receives risk appropriate care Support of culturally humble and linguisticallyappropriate care

There are so many MCH Programs, Why is Title V Special? Title V was established in 1935, longest standing public health legislation in the US Only national program accountable for comprehensive systems of preventative, primary care and specialty services for the MCH Population 16

MCH Programs Must Anticipate issues and problems and advocate for this population; Assure continuity of care across the life cycle; Assure full services to those at increased risk, or with special health care needs; and Focus on the physical, mental and emotional health of all women and children 17

Triple Aim Better Care Healthy People/Healthy Communities Affordable Care 18

The Title V MCH Block Grant Access to prenatal care Health Equity Birth defects, infections like cytomegalovirus Maternal medical conditions that affect pregnancy like diabetes, obesity, and hypertension Unnecessary C sections and labor induction Premature birth and low birthweight babies Breastfeeding Infant mortality, including infant sleep related death Perinatal depression 19

Rural Health Issues in Maternal and Child Health Prepared By: Amanda Bennett & Deb Rosenberg For: Brenda Jones Rural Health Conference Presentation March 2014

RURAL ILLINOIS

Illinois Total Population, Census 2010 Over 1.5 million (~12% of the population) people live in rural Illinois.

Illinois Population Change 2000 2010 Between 2000 and 2010, the population size in many rural counties decreased.

Other Issues in Rural Areas Poverty The average income is lower for rural households than urban households $43,000 in urban areas $35,000 in rural areas Healthcare Access 51 Critical Access Hospitals in rural areas 221 Medicare Certified Rural Health Clinics 46 Federally Qualified Health Centers in rural areas

Continued for Southern Illinois on next slide

MATERNAL & INFANT HEALTH

% Non Medically Indicated Early Deliveries (NMIED) among early term births (37 38 weeks gestation), By Region, Provisional Birth Certificates 2010 12 40% Percent of Early Term Births 35% 30% 25% 20% 15% 10% 5% 0% 2010 2011 2012 Cook County Collar Counties Other Urban Counties Rural Counties In 2012, hospitals in rural counties had the highest NMIED rate, but the difference between regions has decreased over time.

Pregnancy Risk Assessment Monitoring System (PRAMS) Mail and phone survey of new mothers 2 6 months after delivery of live birth 1500 2000 women surveyed each year Asks questions about prenatal, delivery, and post partum experiences and behaviors Data are weighted to represent population of Illinois

Pregnancy Risk Assessment Monitoring System (PRAMS) County of Residence was used to group Illinois into 4 regions Cook County Collar Counties: DuPage, Lake, Kane, McHenry, Will Other Urban Counties: Champaign, DeKalb, Kendall, Kankakee, Macon, Madison, McLean, Peoria, Rock Island, Sangamon, St. Clair, Tazewell, & Winnebago Rural Counties: all other counties About 14% of women delivering live births lived in rural counties in 2007 2009

Pregnancy Risk Assessment Monitoring System (PRAMS) All data presented are based on 2007 2009 PRAMS data, courtesy of: Illinois PRAMS, Illinois Center for Health Statistics, Illinois Department of Public Health (IDPH) Centers for Disease Control and Prevention (CDC)

Demographics for Rural New Mothers, PRAMS 2007 09 88.3% are non Hispanic White 42.5% are 24 years or younger 14.1% are 19 years or younger 56.4% are married 22.8% have a college degree 68.6% are low income (approximately <200% FPL)

Demographics for Rural New Mothers, PRAMS 2007 09 Compared to those in urban areas, new mothers in rural Illinois are: More likely to be non Hispanic White More likely to be young (<24 years old or younger) Less likely to have a college degree More likely to be low income

12 10 % Illinois Infants Who Were Low Birth Weight (<2500 grams), By Region, PRAMS 2007 09 % Live Births 8 6 4 2 0 8.0 6.5 7.2 6.2 Cook County Collar Counties Other Urban Counties Rural Counties Rural Counties have the lowest rate of low birth weight among all regions in Illinois (though not statistically significant)

% Unintended Pregnancies Among Women Delivering a Live Birth, By Region, PRAMS 2007 09 % Live Births 50 40 30 20 10 0 45.2 35.3 45.8 45.7 Cook County Collar Counties Other Urban Counties Rural Counties Nearly 50% of live births in rural counties resulted from unintended pregnancies. This was similar to most other regions in Illinois.

Prenatal Care (PNC) Women in rural counties were similar to other regions on issues related to PNC: 81.9% received PNC in 1 st trimester 82.9% received adequate PNC 86.1% received PNC as early as they wanted it Among rural women who received PNC later than wanted, the top 3 reasons for the delay were: 33.6% couldn t get an appointment 20.0% didn t have Medicaid card yet 19.1% didn t have enough money or insurance to pay for visit

% of Illinois Infants Who Did Not Have a Doctor Visit in the First Week of Life, By Region, PRAMS 2007 09 % Infants 14 12 10 8 6 4 2 0 8.2 4.9 8.5 9.8 Cook County Collar Counties Other Urban Counties Rural Counties Infants in Rural Counties are more likely than infants in other regions to NOT receive a doctor visit in the first week of life

Well Baby Healthcare Source of Care for Infants in Rural Counties: 67.0% Doctor or HMO 18.1% Hospital 7.6% Community Health Center 6.2% Health Department Clinic

Postpartum Contraception 12.6% of rural women were NOT using contraception at the time of survey after their delivery The rate of postpartum contraception use was similar across regions of the state

% New Mothers 40 35 30 25 20 15 10 Smoking Rates Among New Mothers in Illinois, By Region, PRAMS 2007 09 Women in rural counties are more likely to smoke before, during, and after pregnancy than women in other regions. 5 0 3 Months Before Pregnancy During Third Trimester Post Partum Cook County Collar Counties Other Urban Counties Rural Counties

% Illinois New Mothers Who Breastfed Their Infants, By Region, PRAMS 2007 09 % Infants 90 75 60 45 30 15 0 79.2 83.3 74.2 65.3 Cook County Collar Counties Other Urban Counties Rural Counties Mothers in rural Illinois counties are less likely to breastfeed their infants than mothers in other regions. Only 65% of rural mothers ever breastfed their infants.

% Illinois New Mothers Who Initiated Breastfeeding That Continued For 12 Weeks, By Region, PRAMS 2007 09 % Infants 70 60 50 40 30 20 10 0 59.7 63.8 60.3 49.9 Cook County Collar Counties Other Urban Counties Rural Counties Mothers in rural Illinois counties are also less likely to continue breastfeeding. Only about 50% of rural mothers who started breastfeeding continue for at least 12 weeks.

% Infants % Illinois New Mothers Who Initiated Breastfeeding That Continued Exclusively For 12 Weeks, By Region, PRAMS 2007 09 70 60 50 40 30 20 10 0 25.3 31.0 33.6 27.7 Cook County Collar Counties Other Urban Counties Rural Counties Mothers in rural Illinois counties are also less likely to exclusively breastfeed than women in some other regions, but do not have the lowest rate.

Barriers to Breastfeeding Among rural women who did not breastfeed, the most common reasons were: 50.6% I didn t like breastfeeding 23.8% I went back to work or school 22.1% I had other children to take care of Among rural women who breastfed, the most common reasons for stopping were: 43.5% I thought I was not producing enough milk 26.5% Breast milk alone did not satisfy my baby 24.8% My baby had difficulty breastfeeding

% Illinois New Mothers Diagnosed with Depression After Delivery, By Region, PRAMS 2007 09 % New Mothers 16 14 12 10 8 6 4 2 0 7.2 6.2 11.4 12.7 Cook County Collar Counties Other Urban Counties Rural Counties New mothers in rural counties are more likely to be diagnosed with postpartum depression than mothers in other regions.

% Illinois New Mothers with Diagnosed Depression Who Received Any Treatment, By Region, PRAMS 2007 09 % Women w/diagnosed Depression 100 80 60 40 20 0 58.7 65.6 73.8 84.5 Cook County Collar Counties Other Urban Counties Rural Counties Among new mothers diagnosed with depression, those in rural counties are most likely to receive treatment (either medications or counseling) for their depression.

% New Mothers Percent of Illinois New Mothers Who Were Physically Abused By Husband/Partner Before or During Pregnancy, By Region, PRAMS 2007 09 8 7 6 5 4 3 2 1 0 3.5 2.7 4.4 5.2 Cook County Collar Counties Other Urban Counties Rural Counties About 5% of rural mothers experienced physical abuse by a partner before or during their pregnancies. This rate is higher than that seen in other regions, but not statistically significant.

Stress Overall, the levels of stress experienced by rural women were similar to those in other regions Among rural women, the most common stressors in the 12 months prior to delivery were: 35.5% moved to new address 29.9% close family member sick & went into hospital 28.3% argued w/ husband/partner more than usual 21.9% had lots of bills she couldn t pay

% Illinois New Mothers with Unmet Needs for Dental Care During Pregnancy, By Region, PRAMS 2007 09 % New Mothers 15 12 9 6 3 0 7.7 5.8 9.0 11.9 Cook County Collar Counties Other Urban Counties Rural Counties Rural women had the highest rates of unmet dental care needs during pregnancy. Nearly 12% of women needed to see a dentist for a problem, but did not have a dental visit during pregnancy.

CHILD HEALTH

National Survey of Children s Health (NSCH) Phone survey of parents of children ages 0 17 2007 NSCH has rural urban variable Uses Rural Urban Commuting Area codes: Census tract based categories developed from work commuting flows and relationships between towns and cities 10.9% of Illinois children (~350,000 children) lived in rural areas in 2007

% Illinois Children Ages 0 17 Receiving Care Meeting Medical Home Standard, By Region, NSCH 2007 100 80 % Children 60 40 20 0 53.4 75.4 Urban Rural Rural children were more likely than urban children to receive care consistent with the medical home model promoted by the American Academy of Pediatrics.

% Illinois Children Ages 0 17 Who Live With A Smoker, By Region, NSCH 2007 50 40 % Children 30 20 10 0 25.2 32.0 Urban Rural Nearly one third of rural children live with a smoker, potentially exposing them to secondhand smoke.

Access to Children s Healthcare Rural children were similar to urban children on many other indicators of healthcare Among Rural Children: 12.5% did not have a preventative medical visit in last year 21.8% did not have a preventative dental visit in last year 4.7% had unmet needs for healthcare services 20.9% did not have adequate health insurance

Current Priorities Improve data collection Integrate medical and community based services Promote healthy families and communities Expand availability and access to medical homes Address oral health needs Address mental health needs Promote healthy weight and nutrition Promote successful transition of children with SHCN to adulthood 55

MCH Block Grant Needs Assessment Title V requires an assessment of the needs for the following, every five years: Preventive and primary care Services for Children with Special Health Care Needs Goal of Needs Assessment: Improved outcomes form MCH populations Strengthened Partnerships 56

Quantitative Data UIC is producing a quantitative data book on Illinois MCH needs The data book will include several National and State indicators that are required in the Title V needs assessment Researchers will collaborate with data groups to evaluate the State s progress in alleviating 2010 MCH needs and identifying emerging Illinois MCH challenges

Qualitative We will be scheduling community focus groups within our seven health regions. The information collected from community focus groups will guide Needs Assessment priorities. Discussions will be facilitated by trained professionals from the community so participants feel comfortable with voicing their opinions. We will also include note takers, list common concerns and empower participants to determine which needs are most important. Upon conclusion, participants and the OWHFS staff will come together to discuss how to effectively maintain communication so we can continue to receive community input for the Needs Assessment.

CollN Local Health Depts. RHOs IDPH Children with Special Health Care Needs/ Disabilities Access Health ILPQC Dept. of Children and Family Services Title V Needs Assess ment Mental Health Providers Early Childhood Development Centers Immunizations Before/After Care Programs School Based Health Centers IPHA Community Orgs IPHNA

Illinois County Maternal and Child Health Assessment Survey Survey will be forward from Regional Health Officials to County Health Departments. The assessment survey will identify the following: County MCH needs and priorities Challenges to disadvantaged women in your region (i.e. language barriers, access to transportation, disabilities Strategic health partnerships Times, dates and locations for hosting focus groups Focus group facilitators Media contacts

Focus Group Outcomes Collect and integrate qualitative information into the Title V Maternal & Child Health Block Grant Needs Assessment Learn about the unique challenges facing your region and set performance objectives Engage stakeholders and strengthen partnerships with agencies and organizations that have an interest in the well-being of maternal and child health needs

Brenda Jones DHSc, RN, MSN, WHNP BC Deputy/Title V Director Office of Women's Health and Family Services Email: brenda.l.jones@illiois.gov Office Number: (312) 814 1884

Questions