State MCH indicators of life course

Report
State MCH indicators of life course
Tegan Callahan, AMCHP
Caroline Stampfel, AMCHP
Andria Cornell, AMCHP
Bill Sappenfield, USF
Presentation Goals
• Share process for development of Life Course Measures
• Review summary final indicators selected
• Discuss public feedback received
• Share immediate project next steps
2
Growing focus on life course
2010
•Concept Paper
2011
•SSDI guidance
2012
•Kellogg funding
3
Purpose of metrics project
Develop tools to help state MCH programs and their
partners emphasize a life course health perspective
throughout:
• Assessment of risks, capacity, & services
• Planning programs
• Monitoring and evaluation of outcomes
• Engaging and educating partners
4
When a final set of life course indicators exists, what
will the impact be for the health of moms, kids, and
families throughout your communities?
“Support MCH program priorities to
improve health outcomes, integrate
and coordinate care systems,
eliminate racism, and move toward
equity.”
5
When a final set of life course indicators exists, what
will the impact be for the health of moms, kids, and
families throughout your communities?
“Help state health departments…come
out of their silos and think outside the
box to better design programs and
interventions that impact the life
course trajectory for mothers, children,
and families.”
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Process: Phase 1
Expert Panel convened
2012
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How is Life Course defined for this project?
Core principles of a life course approach
A life course approach is based on a theoretical model that takes
into consideration the full spectrum of factors that impact an
individual’s health, not just at one stage of life (e.g. adolescence),
but through all stages of life (e.g. infancy, childhood, adolescence,
childbearing age, elderly age).
Life course theory shines light on health and disease patterns –
particularly health disparities – across populations and over time.
Life course theory also points to broad family, social, economic and
environmental factors as underlying causes of persistent inequalities
in health for a wide range of diseases and conditions across
population groups
Developmental Framework
Risk
• Experiences and exposures
that indicate risk for future
life course outcomes
Services
• Risk reduction and health
promotion from services
provided over time to MCH
populations
Outcomes
• Outcomes that reflect or
summarize an adverse life
course trajectory.
Capacity
• Community and
organizational capacity to
address life course
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Expert Panel convened
Expert Panel meeting
Knowledge transfer
2012
2013
Final indicators
August 2013
State Teams Selected
Proposed indicators
Screened indicators
Write indicators
Select indicators
Public comments—Review
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Phase 2: State Teams Members
Florida
North Carolina
Nebraska
Iowa
Michigan
Louisiana
Massachusetts
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Domain
Perinatal/
Early
Childhood/
Adolescent
Infancy Childhood School age
Young
adult
Adult
Risk
Services
Outcomes
Capacity
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Criteria: Data
1. Data Availability: Can the indicator be calculated in
state and local public health agencies?
2. Quality: Accuracy and reliability including
consistency of data quality and reporting across
jurisdiction.
3. Simplicity: Level of complexity in both calculating
and explaining the indicator.
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Criteria: Life Course
1. Implications for equity: How well the indicator reflects
and has implications for equity-related measures such
as social, psychosocial, and environmental conditions,
poverty, disparities, and racism.
2. Public health impact: Impact of a positive change in the
indicator due to program or policy interventions.
3. Ability to leverage resources or realignment: How well
the indicator reflects programs, services, and policies
that expand beyond the traditional MCH focus?
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Criteria: Life Course
4. Improve the health and wellness of an individual
and/or their children (intergenerational health): How
well the indicator reflects the time and trajectory
components of the life course theory with an emphasis
on indicators that address critical and transitional
periods throughout life.
5. Consistent with evidence base: How well the indicator
is connected to our current, scientific understanding of
life course health.
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Selection Progress
413 proposals
(discussion/screening)
104 write ups
(scoring/voting)
Considered, not
selected
59
Life Course Indicators
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Challenges
• Data availability at a state and local level
• Availability of non-traditional MCH data
• Data quality, simplicity
• Overlap with other measures
• Issues/root causes highlighted by other measures
• Research is still in the early stages
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Public Comment Results
 Changes to numerators/denominators
 Alternative data sources
 Confirmation of process
 Delineation of FAQs
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The Final Set
59 indicators across 12 categories
•
•
•
•
•
•
•
•
Childhood experiences (3)
Community health policy (2)
Community wellbeing (6)
Discrimination and
segregation (5)
Early life services (3)
Economic experiences (3)
Family wellbeing (11)
Health care access and
quality (8)
• Mental health (4)
• Organizational
measurement capacity (3)
• Reproductive life
experiences (8)
• Social capital (3)
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Overlap Between Indicators
Title V
measures
Preconcepti
on health
indicators
Healthy
People
Objectives
CDC
winnable
battle
Chronic
disease
indicators
NQF
United
Health
Rankings
16
8
36
6
14
9
6
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Final Web-based Resource: Fall 2013
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Final Web-based Resource: Fall 2013
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“Short List”
Domain
Risk/
Outcome
Indicator
Adverse childhood experiences among children (NSCH)
Experiences of race-based discrimination among pregnant women (PRAMS)
Experiences of discrimination among children (NSCH)
Households with a high level of concentrated disadvantage (ACS)
Children living in households where smoking occurs inside the home (NSCH)
Children or adults who are currently overweight or obese (NSCH, YRBSS,
BRFSS, PRAMS)
Depression among youth (YRBSS)
Household food insecurity (USDA ERS)
Preterm births (NVSS)
Stressors during pregnancy (PRAMS)
Incarceration Rate (BOJ, NPSP)
Capacity/
Services
Children who receive services in a medical home (NSCH)
4th graders scoring proficient or above on math and reading (NAEP)
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www.amchp.org/lifecourseindicators

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