# Presentation: 515039

## California 2005 Needs Assessment: 

**California 2005 Needs Assessment: **
**Process is as Important as the Data **
**March 3, 2007       **
**Shabbir Ahmad, DVM, M.S., Ph.D.**

**Notes:**
Welcome and Introductions:

## Strategies and Lessons from California’s MCAH Five-Year Needs Assessment

**Shabbir Ahmad, DVM, MS, PhD**
**Chief, Epidemiology and Evaluation Section**
**Representing a dedicated team at the**
**Maternal, Child and Adolescent Health/Office of Family Planning Branch**
**Primary Care and Family Health Division**
**California Department of Health Services**

## California Demographic Characteristics: 2005

**State Projected Total Population****	****	****	****36.8 million**
**Hispanic****	****	****	****	****	****13.2 million (36%)**
**Non-Hispanic****	****	****	****	****	****23.6 million (64%)**
**White****	****	****	****	****  ****	****   15.9 million (43%)**
**Asian/Pacific Islander****	****	****    ****	****     4.2 million (11%)**
**African American****	****	****	****    ****	****     2.5 million (7%)**
**Multi-Race****	****	****	****	****     0.7 million (2%)**
**American Indian****	****	****	****	****     0.3 million (1%)**
**California Resident Women Births****	****	****	****548,700 **
**13.2% of 2004 US Births**
**Births to Resident Hispanic Women****	****	****	****52% of total births**
** **
**Paid by Medi-Cal**
**Prenatal Care ****	****	****	****	****46% of total births**
**Delivery****	****	****	****	****	****46% of total births**
**Unintended Births to California Women ****	****	****	****40.6%**

- Data Sources: State of California, Department of Health Services, 2005 Birth Statistical Master File; National Vital Statistics Reports, Vol. 55, No. 1, September 29, 2006, Table 11; California Department of Finance 2000-2050 Population Projections; MIHA Survey, 2004.

## Rural counties are defined by the state Rural Health Policy Council as having a population of less than 250 persons per square mile and do not contain an incorporated area with a population greater than 50,000.

**California Counties by Urban & Rural Designation**

**Urban**

**Rural**

## Each local health jurisdiction received $10K for developing local MCAH priorities

**Total Number of Resident Births by County, 2005**

## Compartmentalize Needs Assessment

## Major MCAH Needs Assessment Components

**Have local jurisdictions conduct a needs assessment**
**State Title V Agency summarize local level **_**needs**_** and **_**priorities**_
**Provide summary to local jurisdictions and stakeholders**
**Analyze both local jurisdiction qualitative information and statewide quantitative epidemiologic data**
**Assess State Title V Agency capacity**
**Involve external stakeholders, state administrators, and Branch staff in the prioritization of needs**
**Obtain public input on needs assessment report**

## Conceptual Framework

- Decentralize statewide needs assessment process by having each local jurisdiction conduct a needs assessment
- Key Goals
**Build local jurisdiction needs assessment capacity**
**Obtain extensive stakeholder input at the local level**
**Identify “needs” that may have been missed by only analyzing statewide surveillance data systems**
**Focus local MCAH efforts by having each jurisdiction identify 2-7 priority areas they will focus on during the next five years**

## Key Collaborators

- Local MCAH Programs
- UC San Francisco, Family Health Outcomes Project (FHOP)
- Assist in development of needs assessment guidelines
- Training (community assessment, planning, etc.)
- Data analysis and development of surveillance tables
- Extensive technical assistance to local jurisdictions
- Ensure completeness of local needs assessments
- Facilitate statewide external stakeholder meeting

## Support Provided for Local MCAH Needs Assessments

- Provide training on conducting needs assessments and ongoing technical support to local jurisdictions
- Provide _specific_ needs assessment guidelines with page limits in order to ensure:
**Consistency of reporting format across jurisdictions**
**Comprehensive local needs assessment process**
- Provide trend data to local jurisdictions for 27 health status indicators stratified by race/ethnicity:
**Minimize local data collection/analysis burden**
**Ensure standardized reporting**

## Local MCAH Needs Assessment Guideline Components

**Convene a planning group**
**Obtain stakeholder input: consumers, local MCAH programs; providers; health, social service and educational providers**
**Complete the Community Assessment**
**Community health profile and resources assessment**
**Review required and other health status indicators**
**Assess local MCAH program capacity**
**Identify MCAH population needs**
**Identify 2-7 local MCAH priority areas**
**Take into account local capacity to address identified needs**
**Conduct a preliminary problem analysis for one priority**

## Supplemental Data Sources Used by Local Jurisdictions to Identify Needs

- Secondary Research Data and Reports (500+ citations)
**Academic journals, state/federal agencies, interest groups**
**Reports by other local health and social service groups**
- Local Program and Jurisdiction Data (100+ citations)
**MCH program data, foster care placements, FIMR, etc.**
- Local Surveys
**Over 5,000 individuals surveyed, such as school administrators, clients, providers, and family members**

## Local Health Jurisdiction Stakeholder Participation

- Over 1,600 stakeholders participated in local needs assessment meetings
**City or county representatives**
**Social service agency representatives**
**Health care provider representatives**
**Elementary school administrators**
**University or college academicians**
**Local residents in the community**
**Other organization representatives**

## Case Study 1: Perinatal Substance Abuse

- Data on perinatal substance was very limited and no data was provided to local jurisdictions.  Perinatal substance abuse, however, was one of the most common problems and priorities identified.
- Data Sources used by Local Jurisdictions
**Provider surveys**
**Foster care placement information**
**Key informant interviews / Stakeholder input**

## Case Study 2: Pregnancy-Related Mortality

- Data on pregnancy-related mortality was very complete.  Pregnancy-related mortality, however, was one of the most rare events at local level.
- Data Sources used by State
- Linked birth, death and patient discharge dataset
- Pregnancy-related mortality surfaced as one of the priority for state MCAH program

## State Level Coding of Local Needs and Priorities

- “Problems” and “priorities” identified by local needs assessments were coded separately
- Problems and priorities were coded two ways to understand the nature of the problems
**General thematic areas (Substance Abuse, Mental Health, etc.)**
**Specific topics (Perinatal Substance Abuse, Post-Partum Depression, etc.)**
- Local jurisdictions identified 122 specific problems, of which 81 were identified by local jurisdictions as a priority area
**“****Access to Care” – 23 different specific topics**
**“****Breastfeeding” – 3 different specific topics**

## Local Needs AssessmentProcess and Timeline

**Comprehensive list of potential MCAH  indicators**
** ****(January 2003)**

**Ranking of MCAH  indicators by Local MCAH Jurisdictions**
**(April 2003)**

**Guidelines for Local MCAH needs assessment (27 indicators)**
** ****(August 2003)**

**FHOP provided local level MCAH data**
** ****(2003-2004)**

**FHOP provided training in needs assessment methods**
** ****(2003-2004)**

**MCAH Directors held local stakeholder meetings**
** ****(2003-2004)**

**MCAH Directors submitted local needs assessment report**
** ****(August 2004)**

**MCAH & FHOP summarized the local needs assessment**
** ****(March 2005)**

**Statewide MCAH Stakeholder meeting and Public Input**
** ****(April-May 2005)**

**Seven MCAH priority needs are identified**
** ****(April-May, 2005)**

## Enhance preconception care and work toward eliminating disparities in infant and maternal morbidity and mortality. 

Promote healthy lifestyle practices among MCAH populations and reduce the rate of overweight children and adolescents. 

Promote responsible sexual behavior to decrease the rate of teenage pregnancy and sexually transmitted infections. 

Improve mental health and decrease substance abuse among children, adolescents, and pregnant or parenting women. 

Improve access to medical and dental services, including the reduction of disparities.

Decrease unintentional and intentional injuries and violence, including family and intimate partner violence. 

Increase breastfeeding initiation and duration (make breastfeeding the norm).

**Promote healthy lifestyle practices among MCAH populations and reduce the rate of overweight children and adolescents. **
**Promote responsible sexual behavior to decrease the rate of teenage pregnancy and sexually transmitted infections. **
**Improve mental health and decrease substance abuse among children, adolescents, and pregnant or parenting women. **
**Improve access to medical and dental services, including the reduction of disparities.**
**Decrease unintentional and intentional injuries and violence, including family and intimate partner violence. **
**Increase breastfeeding initiation and duration *****(******make breastfeeding the norm******).***

***Priorities in blue indicate those included in this year’s action plan***

**2006-2010 MCAH/OFP Priorities**

## State Performance Measures: to measure progress

**SPM #1. Percent of children (0-21 years) enrolled in CCS who have a designated medical home.****SPM #2.  Ratio of pediatric cardiologists authorized by the CCS program to children (0-14 years) receiving cardiology services from these pediatric cardiologists.****SPM #3.  Percent of women (18-44 years) who reported 14 or more “not good” mental health days in the past 30 days.****SPM #4.  Percent of women who reported drinking any alcohol in the 1****st**** or 3****rd**** trimester of pregnancy.****SPM #5.  Rate of deaths per 100,000 adolescents (15-19 years) caused by motor vehicle accidents.****SPM #6.  Incidence of neural tube defects (NTDs) per 10,000 live births plus fetal deaths among counties participating in the California Birth Defects Monitoring System.**** SPM #7. Percent of newly referred CCS clients whose cases opened within 30 days of referral.****SPM #8. Percent of births resulting from an unintended pregnancy.****SPM #9. Percent of 9****th**** grade students who are not within the Healthy Fitness Zone for Body Composition.****SPM #10. % of women reporting IP physical, sexual, or psychological abuse in the past 12 months.****SOM #1. The pregnancy-related mortality rate per 100,000 live births.**

## Development of Implementation PlanProcess and Timeline (Phase II)

**Internal Planning Meetings**
** ****(September 2006)**

**MCAH/OFP Management and Program Supervisors’ Input**
**(October/November 2006)**

**On-site meetings with local MCAH representatives**
** ****(January 2007)**

**Input from MCAH County Health Directors**
** ****(February/March 2007)**

**Review and input from recognized MCAH experts**
** ****(April 2007)**

**Statewide MCAH Stakeholder meeting**
** ****(March 2007)**

**Public input via web-based posting**
** ****(May-June 2007)**

**MCAH Implementation Plan**
** ****(April-May, 2007)**

## January 31, 2007TO:             TITLE V STAKEHOLDERSSUBJECT:  TITLE V MATERNAL, CHILD AND ADOLESCENT HEALTH                     FIVE-YEAR IMPLEMENTATION PLAN (PHASE II)                    STAKEHOLDERS’ MEETING

- I invite you to participate in a meeting sponsored by the California Department of Health Services (CDHS); Maternal, Child and Adolescent Health/Office of Family Planning (MCAH/OFP) Branch to review and discuss implementation objectives and strategies
- for priorities identified through the 2005-2006 Title V Needs Assessment.  Your input will contribute to the five-year implementation plan that will be submitted this July as part of California’s 2007-08 Title V Maternal and Child Health Block Grant application.  **The meeting will be held on Tuesday, March 20, 2007, from 10:00 a.m. to 4:00 p.m., in Sacramento, **and will be facilitated by the Family Health Outcomes Project of the University of California, San Francisco.

- State of California-Health and Human Services Agency
- Department of Health Services

## Title V
Five Year Needs Assessment
is indeed a
CONTINUOUS PROCESS
(The cycle started in Jan 2003 and will end in Sep/Oct 2007)

- Five Year Needs Assessment
- is indeed a
- CONTINUOUS PROCESS
- (The cycle started in Jan 2003 and will end in Sep/Oct 2007)

## Recommendations for 2010 Needs Assessment

_**Recommendations**_
**Needs assessment efforts in large states need to be decentralized.**
**Clear, concise guidelines need to be provided to local jurisdictions**
**Emphasize the need for local jurisdictions to obtain stakeholder input. **
**Technical assistance, training, and data need to be provided to local jurisdictions.**
**Qualitative analysis of local needs assessment data should organize the needs/priorities by both general subject areas as well as specific sub-topics.  Both levels of information are important.**
**Most priority areas are inter-related.  Use the needs assessment process to bring together other state departments.  Areas of common interest will be identified among all stakeholders and collaborative efforts will be strengthened.**
_**Lessons Learned**_
**Small jurisdictions may find the needs assessment hard to complete.   We will be assessing our guidelines to identify areas to delete while still ensuring the needs assessment is comprehensive.**
**Enhance analysis of local level MCAH capacity and **_**report findings back to jurisdictions**_**.**

## Questions?