Assessing for Multiple Behavioral Risk Factors: Lessons Learned from HRSA- Funded Programs

1. Assessing for Multiple Behavioral Risk Factors: Lessons Learned from HRSA- Funded Programs Karen Hench U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB) Division of Healthy Start and Perinatal Services (DHSPS) May 26, 2010 USPHS Scientific and Training Symposium

2. Health Resources and Services Administration (HRSA): Mission • Provides national leadership, program resources and services needed to improve access to culturally competent, quality health care. • The primary Federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable.

3. Maternal and Child Health Bureau (MCHB): Mission • Provides national leadership and works in partnership with States, communities, public-private partners, and families to: • strengthen the maternal and child health infrastructure; • assure availability and use of medical homes; and, • build knowledge and human resources …in order to assure continued improvement in the health, safety, and well-being of the maternal and child health population.

4. Maternal and Child Health Bureau (MCHB): Population The MCH population includes America's • women, • infants, • children, • adolescents, and • their families, including • fathers, and • children with special health care needs.

5. Healthy Start (HS) • Presidential Initiative in 1991 to improve health care access and outcomes for perinatal women and infants, promote healthy behaviors, and address causes of infant mortality. • Authorizing Legislation - Title III, Section 330H of the Public Health Service Act (42 U.S.C. 254c-8). • Grants for areas with high rates of infant mortality.

6. Healthy Start Projects • 99 communities across 37 States. • District of Columbia • Puerto Rico • Over 90% of all Healthy Start families are African American, Hispanic, or Native American

7. Title V – SPRANS* and Healthy Start Risk Reduction Projects • Alcohol Screening • Family Violence Assessment & Coordinated Intervention • Maternal & Infant Mental Health/Perinatal Depression Screening • Multiple Risks Screening in Women’s Health • Women’s Overweight/Obesity Reduction • Worksite Breastfeeding Support • 1st Time Motherhood and Doula-Delivered Perinatal Care * SPRANS = Special Projects of Regional and National Significance

8. Perinatal Alcohol Use Data*: Women Aged 15 - 44 Prenatal alcohol use can cause physical, cognitive, & behavioral disorders; premature delivery; and miscarriage. No known safe level of alcohol consumption during pregnancy and lactation. 2006 & 2007 Rate of ‘Past Month Alcohol Use’: Non-pregnant and Pregnant women Recent mothers Not recent mothers (Rate = 11.6 %) (Rate = 42.1%) (Rate = 54.0 %) White = 14.5 % White = 52.1% White = 61.1% Black = 15.7 % Black = 31.9 % Black = 44.6 % Hispanic = 4.1 % Hispanic = 22.9% Hispanic = 41.6 % *Source: SAMHSA, 2002-2007 NSDUHs

9. Perinatal Depression Data* *Gaynes, Gavin, Meltzer-Brody, et al (2005) AHRQ • Rate of depression, during pregnancy or within first 12 months after delivery (major & minor depression) = 5 to 25 % • Perinatal depression is the leading cause of disease-related disability among women and negatively impacts women, their children and families.

10. Domestic Violence (DV) Statistics • Nearly 1/3 of US women will be physically abused by a current or former partner sometime during their lives. • Between 0.9-20.1% of pregnant women experience DV as compared to 7% with preeclampsia or gestational diabetes. (Gazmararian, 1996) • Pregnant women are at twice the risk of battery; at four times the risk if the pregnancy is unplanned/unwanted. • The leading cause of death among pregnant women is homicide.

11. Potential Risk to Developing Child • Violence may involve other siblings, family or household members. • Witnessing violence may perpetuate the cycle of violence into adulthood. • Child abuse is associated with depression, substance abuse, poor school performance, and high-risk sexual activity.

12. Synthesis of Title V – SPRANS* and Healthy Start Risk Reduction Projects • What was the Synthesis Project? • Who conducted the Synthesis Project? • Why did they conduct it? • When did it start & when did it finish? • Where will it go from here? * SPRANS = Special Projects of Regional and National Significance

13. Cross-Cutting Lessons Learned Client-level Findings

14. Cross-Cutting Lessons Learned Provider-level Findings

15. Cross-Cutting Lessons Learned System-level Findings

16. Synthesis of Title V – SPRANS and Healthy Start Risk Reduction Projects • Conclusions • Recommendations

17. Contact Information CAPT Karen Hench, RN, MS Deputy, Division of Healthy Start and Perinatal Services MCHB, HRSA, DHHS Rm. 18-12 5600 Fishers Lane Rockville, MD 20857 (301) 443-0543 Khench@hrsa.gov

18. Participating Grants and Contracts

19. Alcohol Screening Grants 7/99 - 6/02 Massachusetts Department of Public Health Puerto Rico Department of Health Illinois Department of Human Services, Nebraska Department of Health and Office of Family Health Human Services Alcohol Replication Grants 9/02 - 9/05 Illinois Department of Human Services, Massachusetts Department of Public Health Office of Family Health Domestic Violence Grants 5/00 - 4/03 Illinois Department of Human Services, Washington State Department of Health Office of Family Health Montefiore Medical Center, Department Johns Hopkins Bayview Medical Center, of Family Medicine (New York) Center for Addiction and Pregnancy (MD) Family Violence Grants 6/02 - 5//05 Illinois Department of Human Services, Philadelphia Public Health Department (PA) Office of Family Health North Carolina Department of Health Multnomah County Department of Human and Human Services Services (Oregon)

20. Innovative Approaches Grants 4/00 – 5/03 Massachusetts Department of Public Health, Bureau of Family and Community Health Positive Health Project, Inc. (New York) Mariposa Community Health Center, Inc.(AZ) Behavioral Risk Assessment Grants 6/03 – 5/06 Boston Public Health Commission (MA) Children’s Research Triangle (IL) Medical and Health Research Association of New York City, Inc. Healthy Start Alcohol Screening Technical Assistance 2000 – 2004 Children’s Research Triangle (Illinois) Healthy Start & Women’s Health Family Violence Srning TA 2005 – 2006 Family Violence Prevention Fund (California)

21. Healthy Start Depression Expansion Grants 7/01 – 5/05 Mobile County Health Department (Alabama) Healthcare Consortium of Illinois Fresno County Department of Community Jefferson County Fiscal Court (Kentucky) Health (California) District of Columbia Department of Healt Alameda County Health Services Agency/ City of New Orleans (Louisiana) Department of Health (California) Fund for Public Health in New York, Inc. District of Columbia Department of Detroit Public Health Department (Michigan) Human Services Cleveland Department of Health (Ohio) Pinellas County Health Department (Florida) Palmetto Health Alliance (South Carolina) University of Southern Florida Children’s Northwest Indiana Health Department Center South Carolina State Office of Rural Health Augusta Richmond County Community Access Community Health Network (Illinois) Partnership (Georgia) Baltimore Healthy Start (Maryland) Southern New Jersey Perinatal Cooperative, Inc. Health Start, Inc, Pittsburgh (PA) State of Illinois Department of Human Services Philadelphia Department of Health (PA) Boston Public Health Commission (MA) Maternal and Child Health Coalition (MO) The Trustees of Columbia University (NY) Tulsa City-County Health Department (OK) Aberdeen Area Tribal Chairman’s Health Virginia Department of Health, Office Board (South Dakota) of Family Health Services

22. Healthy Start Depression Specific Grants 7/01 – 5/05 Community Foundation of Greater New Haven Washington Psychiatric Foundation Black Health Coalition of Wisconsin Florida State University State of Hawaii Department of Health Visiting Nurse Services (Iowa) Inter-Tribal Council, Inc. (Michigan) SIDS Resources, Inc. (Missouri) Healthy Start Depression Screening Technical Assistance 2003 – 2005 Michael O’Hara, MD Synthesis Project Officer:Karen Hench KHench@HRSA.gov 301-443-0543