# Presentation: 343155

## Setting New Priorities for 2005-2010What has changed since 2000?

**Victoria A. Freeman, RN, DrPH**
**Priscilla A. Guild, MSPH**
**Cecil G. Sheps Center for Health Services Research**
**University of North Carolina at Chapel Hill**

**AMCHP Skills Building Session****March 3, 2007**

**Notes:**
Thank you for inviting me
Talk about priority needs
Here with my colleague Priscilla Guild

## Using Needs Assessment to Identify Priority Needs

**Notes:**
By way of background

All starts with the Needs Assessment required of the 59 MCH state and jurisdictional grantees

As you know, use this NA process to look at the needs of your MCH population, your resources

In the end, come up with 7 or 10 priority needs that will guide your efforts for the next 5 years

## Purpose of Study

- Review priority needs - how have they changed?
- Review selected State Needs Assessments
- Review performance measures

**Notes:**
We at the Sheps Center have a contract with the MCH Bureau to do 3 things:

Look at the priority needs as a whole - how have they changed since the last NA

Review selected NA with an eye to see how priorities shifted and why

Third to review performance measures associated with the newly developed priority needs

TODAY, focus on the first part

## Priority Needs Review Process

- Start with individual priority needs statements
- 7-10 needs for each of 59 states or jurisdictions - average of 9.4
- For 2000 _and_ 2005
- 556 needs statements + 559 needs statements = 1115 needs statements

**Notes:**
This is what we did - keep in mind, wanted to look at the entirety of the priority needs not look at comparison across years for individual states

But we had to start with each priority needs statement

So that was 7 to 10 for each of the states

Average was 9.4

For 2 years - 2000 and 2005

That equaled 556 and 559 for a total of 1115 needs statements

What do these needs statements look like?

## Reduce injuries 

to

Work with health care partners to improve access to care and quality of care for all MCH populations in all aspects of care including ensuring cultural competency and a prepared PH workforce. 

- to
- Work with health care partners to improve access to care and quality of care for all MCH populations in all aspects of care including ensuring cultural competency and a prepared PH workforce.

**Notes:**
Range from the simple - at least in terms of wording to the complex

None that were one word - but possible that their were 2 word ones

Last one isn’t real - I made it up - but it could be

## For each priority need...

- What is the health or health care issue?
- Is the issue further described or delineated?
- What MCH population is the target of the need?
- Are there specific subpopulations whose needs are being addressed?

**Notes:**
For each

Issue - could be injury, health, access to health care, breastfeeding

Issue detail - within the broader category, were their specific categories

What is the target population - is this a CSHCN issue, maternal and infant?

Specific subpops - by age group, race, ethnicity

## Reduce low birth weight births among African-American women

## Reduce low birth weight births among African-American women

- Issue:  Pregnancy outcomes

## Reduce low birth weight births among African-American women

- Issue:  Pregnancy outcomes
- Issue Detail:  Low birth weight

## Reduce low birth weight births among African-American women

- Issue:  Pregnancy outcomes
- Issue Detail:  Low birth weight
- Issue:  Disparity reduction

## Reduce low birth weight births among African-American women

- Issue:  Pregnancy outcomes
- Issue Detail:  Low birth weight
- Issue:  Disparity reduction
- Population:  Maternal and infant

## Reduce low birth weight births among African-American women

- Issue:  Pregnancy outcomes
- Issue Detail:  Low birth weight
- Issue:  Disparity reduction
- Population:  Maternal and infant
- Subpopulation:  African-American women

**Notes:**
So you  get the picture

We did this for all 1115 needs

## Create a Priority Needs database
Health or health care issues mentioned most often
Deduplicate by state - only count a state once even if it had multiple needs addressing one issue
What were the issues identified by most states in 2005?
How did 2005 needs compare to 2000 in terms of the number of states specifying such a need?

- Health or health care issues mentioned most often
- Deduplicate by state - only count a state once even if it had multiple needs addressing one issue
- What were the issues identified by most states in 2005?
- How did 2005 needs compare to 2000 in terms of the number of states specifying such a need?

**Once all 1115 priority needs statements were classified...**

**Notes:**
Create a little database

Look at the frequency of different issues

Deduplicate by state

Make a list

## Most Common Needs in 2005 - part 1

|  |  | Number of States
2005 vs 2000 |
| --- | --- | --- |
| Healthy lifestyles |  | 44 vs 21 |
| Health improvement
Access to health care |  |  37 vs 36 |
| Oral health improvement
Access to oral health care |  | 34 vs 33 |
| Injury prevention |  | 33 vs 41 |
| Mental health improvement
Access to mental health care |  | 27 vs 14 |

**Notes:**
Healthy lifestyles - zoomed to the top, more than twice the number of states - talk more about it

Health - a major initiative - more than half the states - for this and other types of health care, saw 2 things, improving health, improving care - 2 sides to the same coin, so we lumped them together

Oral health and care - similar to general health, and essentially unchanged

Injury prevention - the top issue in 2000 in terms of number of states but less frequently mentioned in 2005

Mental health - up big, # of states doubled - talk about it later

## Most Common Needs in 2005 - part 2

|  |  | Number of States
2005 vs 2000 |
| --- | --- | --- |
| Medical home / 
care coordination |  | 27 vs 17 |
| Legal and illegal substance use |  |  26 vs 34 |
| Pregnancy outcomes |  | 26 vs 28 |
| Disparity reduction |  | 26 vs 28 |
| Pregnancy, fertility, birth rates |  | 25 vs 35 |
| Prenatal, preconceptional, interconceptional care |  | 21 vs 19 |

**Notes:**
Medical home /care coordination - another big up

Substance abuse - lots of references to tobacco use here - down

Pregnancy outcomes and disparity - while literally down if you are counting states - essentially unchanged

Preg rates truly down - reflect success in addressing needs or just shifting of priorities

PNC - flat but some interesting trends

## More states
Healthy lifestyles
Mental health and mental health care
Medical home / care coordination
Unchanged
PNC, Pre- and Interconceptional care
Health and health care
Oral health and oral health care
Disparity reduction
Pregnancy outcomes
Fewer states
Injury prevention
Legal and illegal substance abuse
Pregnancy, fertility, birth rates

- Healthy lifestyles
- Mental health and mental health care
- Medical home / care coordination
- Unchanged
- PNC, Pre- and Interconceptional care
- Health and health care
- Oral health and oral health care
- Disparity reduction
- Pregnancy outcomes
- Fewer states
- Injury prevention
- Legal and illegal substance abuse
- Pregnancy, fertility, birth rates

**Notes:**
Just a different summary here - 

3 areas where there was noticable increase in # of states
Areas unchanged
And areas were fewer states

Not our goal to say why - 

Want to look at some of the ones at the top to give you a little more detail

## Healthy Lifestyles

- 44 states in 2005 vs 21 in 2000
- Healthy lifestyles - general
- Reduce obesity and overweight
- 25 states vs 10 states
- Promote nutrition and/or exercise
- 17 states vs 7 states

**Notes:**
Healthy Lifestyles -

• specific statement regarding healthy lifestyles with or without defining what that was - in 2000 almost always obesity and overweight or nutrition - now more areas included - sexual health, computer and tv for children
• more likely to specify reducing obesity and overweight than promoting nutrition and exercise
• targeting children mostly but also other MCH populations including adults and even some citizens of the states

## Mental Health

- 27 states in 2005 vs 14 in 2000
- Improve mental health
- 15 states vs 5 states
- Access to mental health care
- 13 states vs 10 states

**Notes:**
Again # of states doubled

Just as likely to state the goal in terms of improving mental health as improving access

Again, this crossed all MCH populations and ranged from the specific -such as improve counseling for pregnant women to broad - interagency collaboration to bring attention to mental health issues for MCH populations

## Medical Home / Care Coordination

- 27 states in 2005 vs 18 in 2000
- Increase in emphasis on medical home or care coordination for populations other than CSHCN

**Notes:**
Less than 1/3 in 2000 mentioned pops other than CSHCN

By 2005, not only an increase in this concept as a priority but increased mention of other MCH pops

Could be pregnant women, also saw children in general

## Prenatal CarePreconceptional CareInterconceptional Care

- 21 states in 2005 vs 19 in 2000
- PNC down (14 vs 16)
- Increased emphasis on preconceptional and interconceptional care  (10 vs 3)

**Notes:**
While we might saw there was no change in this category - there was a big jump in pre and inter

Reflecting emphasis on this area

## State MCH Agency Needs

- Not all needs were targeted at specific MCH populations
- 38 states specified needs
- integrated systems of care
- data systems
- interagency collaboration
- cultural competence
- public health workforce preparation
- and more.

**Notes:**
Just want to say one more thing about prioirty needs

While many were very issue specific and population specific

There were broader needs expressed by 38 states in 2005 as there had been by the same number in 2000

These are some of the issues - varied as the states themselves and likely reflect some serious self-evaluation

No clear trend here with the possible exception of the need for data for program planning which was mentioned in 2005 but not as often as it had been in 2000. 

Want to look at this a little more closely to see if there are trends and common needs that can be addressed

## For more information:Victoria A. Freeman, RN, DrPHvictoria_freeman@unc.edu

**Notes:**
That’s about it - late, thanks for staying and staying awake

Here is my contact information

Happy to answer questions