Peter C. van Dyck, MD, MPH Associate Administrator for Maternal and Child Health

1. Annual MeetingAssociation of State and Territorial Public Health Nutrition DirectorsJune 10, 2008 Peter C. van Dyck, MD, MPH Associate Administrator for Maternal and Child Health Health Resources and Services Administration

2. MCH Bureau BUDGET

3. MCH Budget for 2007 and 2008 (millions) FY2007 2008(PB) 2008(H) 2008(S) 2008(APPR) • MCHBG…$693.0….$693.0….$750.0….$673.0….$666.2 • State..….$566.5...$578.9…..$568.9...$566.5…$556.6 • SPRANS...$99.9…$102.2…..$100.4..…$79.9.….$78.6 • CISS………$10.6…$11.9......$10.1….…$10.6…...$10.4 • Earmark...$16.0…------….….$70.6…...$16.0…...$20.6 1-numbers may not add due to rounding

4. MCH Budget for 2007 and 2008 (millions) FY2007 2008(PB) 2008(H) 2008(S) 2008(A) • Healthy Start...$101.5...$100.5...$120.0...$101.5…$99.7 • Hearing…….….....$9.8…...-----.……$11.0.…$12.0….$11.8 • EMSC……….…….$19.8.....-----…….$22.3..…$20.0.…$19.5 • TBI………….………$8.9…...-----….….$8.9……$10.0…..$8.8 • Sickle Cell….…....$2.2…...$2.2………$2.2.….$3.2…….$2.7 • Family to Family.$3.0…...$4.0………$4.0…..$4.0…….$4.0 • Autism………….….-----…...-----……..$0.0…...$37.0….$36.4 1-numbers may not add due to rounding

5. MCH Budget for 2007 and 2008 (millions) 2007 2008(PB) 2008(H) 2008(S) 2008(A) SPRANS Earmarks • Oral Health…...$4.80…$0.0….$12.0…….$4.8……$4.72 • Sickle Cell…..…$3.84…$0.0…...$4.0…….$3.84.…$3.77 • Epilepsy…….....$2.88...$0.0……$5.8..….$2.88….$2.83 • Genetics….….…$1.92…$0.0..….$3.8..….$1.92….$1.89 • Mental Health..$1.54…$0.0…….$0.0…...$0.0……$0.0 • Fetal Alcohol.…$0.99…$0.0…….$0.0…...$0.99….$0.97 • 1rst Mother……..-----….-----……..-----..…$1.54….$1.51 • Prepare Birth…..-----….-----…...$15.0….…-----…..$4.9 • Autism……………-----…..-----……$30.0…….-----…..$0.0 1-numbers may not add due to rounding

6. MCH Bureau DATA

7. MCHB Data • MCH Block Grant – Title V Information System (TVIS) • https://performance.hrsa.gov/mchb/mchreports • Discretionary Grants – Discretionary Grants Information System (DGIS) • https://perfdata.hrsa.gov/MCHB/DGISReports/default.aspx • Chartbooks and Reports on Women’s and Children’s Health • http://www.mchb.hrsa.gov/data/chartbooks.htm • Evaluation and Epidemiological Surveys, Reports, Resources and Training • http://mchb.hrsa.gov/programs/dataepi/

8. DGIS Released in April 2008 • Companion information system to TVIS. • Tracks performance measurement and program data for MCHB’s discretionary grants (e.g., Financial data, grantees’ reporting on a total of 36 National Performance Measures, Project Abstracts, and other program data.) • Data collection began in October 2004. Nearly two years of complete data has been collected and is available for viewing at the DGIS website: https://perfdata.hrsa.gov/MCHB/DGISReports/default.aspx

9. DGIS Web Reports

10. DGIS - 37 Discretionary Performance Measures • 08) Percent of graduates of MCHB long-term training programs that demonstrate field leadership after graduation. • 33) The degree to which a State system for nutrition services has been established for MCH populations.

11. TVIS - MCH Block Grant 18 National Performance Measures • 11) The percent of mothers who breastfeed their infants at 6 months of age. (Revised in 2006 from “The percent of mothers who breastfeed their infants at hospital discharge.”) • 14) Percentage of children, ages 2 to 5 years, receiving WIC services with a Body Mass Index (BMI) at or above the 85th percentile. (New performance measure beginning in 2006.)

12. TVIS - Obesity/OverweightState Performance Measures • Total number of obesity State performance measures reported and number of States reporting on such a measure increased significantly between 2002 and 2005. 20022005 20 measures reported 45 measures reported by 19 States by 37 States FY 2006 – 42 measures reported by 35 States (NPM #14 added in 2006 application)

13. TVISState Performance Measures Nutrition and Physical Activity • In 2006: • 47 States with 73 Performance Measures (Obesity Measures Included) • 25 States with 31 Measures Not Related to Obesity • In 2000 • 41 States with 60 Performance Measures (Obesity Measures Included)

14. Changes in MCH Priorities Between 2000 and 2005 • Among new priority areas identified in 2005, there was a substantial increase in the number of States that identified the need to reduce overweight and obesity. 20002005 • Obesity and Overweight 10 States 33 States • Nutrition/Physical Exercise 9 States 15 States (Under contract funding from MCHB, report prepared by Cecil G. Sheps Center for Health Services Research, UNC at Chapel Hill, Meeting State MCH Needs: A Summary of State Priorities and Performance Measures, January 2008.)

15. 2005 State MCH Priority Needs State and Jurisdictional MCH Agencies with Obesity & Overweight and Nutrition & Exercise as Priority Needs in Their 2005 Needs Assessment State has Nutrition/Physical Activity priority need State has Obesity/Overweight priority need. State has Obesity /Overweight and Nutrition/Physical Activity priority need

16. Healthy People 2010 Progress Review Nutrition and Overweight Summary Presented at April 3, 2008 Meeting1: • Weight status objectives for children, adolescents and adults moved away from their targets. • Fruit, vegetable and grain objectives, total usual sodium intake showed little or no progress. • Total usual calcium intake moved toward the target. • The weight status and diets of Americans remain an important public health and economic concern. 1 Presentation by Dr. Edward Sondik, NCHS Website: http://www.cdc.gov/nchs/about/otheract/hpdata2010/focusareas/fa19-nutrition2.htm

17. MCHBNutrition Strategic Plan OVERWEIGHT AND OBESITY

18. Child and Adolescent Overweight and Obesity • Expert Panel Convened in February 2005 to Develop Recommendations for the Prevention, Assessment, and Treatment of Child and Adolescent Overweight/Obesity (AMA in collaboration with HRSA and CDC) • Committees’ recommendations were released in Pediatrics Journal supplement in 2007.

19. Healthy Tomorrows Partnership for Children Program • Promotes child health by encouraging communities to: • Enhance prevention programs; and • Make health care for every child more accessible. • A total of 54 projects are currently funded in 44 States, Guam and Puerto Rico. • 10 innovative, community-based grants have a focus on child health issues, such as obesity prevention, healthy lifestyle and physical activity.

20. Reexamination of IOM Pregnancy Weight Guidelines • Funding provided by HRSA (along with other Federal agencies and the March of Dimes) to support an Ad Hoc Committee to review and update the 1990 IOM pregnancy weight gain recommendations. • Committee will also recommend ways to encourage the adoption of the revised guidelines through consumer education, implementation strategies for practitioners, and public health strategies.

21. Reexamination of IOM Pregnancy Weight Guidelines • Report will be issued at the end of the 22-month project (Summer 2009). • January 2008 - Sponsor Meeting • March 10-11,2008 – Irvine, CA Meeting 1: “Biological, Behavioral, and Social Determinants of Gestational Weight Gain and Pregnancy Outcome.” • June 5-6,2008 – Washington, DC Meeting 2: “Implications of Weight Gain for Pregnancy Outcomes: Issues and Evidence.”

22. Innovative Approaches To Promoting a Healthy Weight in Women • Purpose: To develop creative, innovative approaches that are effective in reducing the prevalence of overweight/obesity in women. • Efforts must target women in communities with limited access to preventive health services, particularly women of color, who are disproportionately affected by this risk factor. • 12 Grantees have been funded for approximately $150,000/year for 3 years. (3 Grants awarded in 2004; 4 Grants awarded in 2005; and 5 Grants awarded in 2006.)

23. National Business Group on Health • MCHB nutrition staff serve on the Obesity Institute, an initiative that encourages members to: • Network with other corporate leaders to raise awareness about the health and cost consequences of obesity. • Identify and test solutions to obesity that have a positive return on investment. • Advance health plans’ and vendors’ efforts to implement solutions.

24. National Business Group on Health • The Obesity Institute has established a new committee - Leadership Committee on Innovation in Health Behavior Change. • Mission is to: • Understand perceptions and overcome resistance to behavioral change messages and products; and • Identify the best new ideas with application to corporate health improvement and risk reduction programs.

25. MCHBNutrition Strategic Plan BREASTFEEDING

26. Breastfeeding Support • Systems Support • Liaison to the U.S. Breastfeeding Committee • Provider Support • Academy of Breastfeeding Medicine • AAP Breastfeeding Promotion in Physicians’ Office Practices (BPPOP) • Focus is on educating and supporting future and practicing physicians and health care professionals in culturally effective breastfeeding promotion and support – directed at achievement of Healthy People 2010 goals.

27. Breastfeeding Provider Support - BPPOP • Current Activities: • Finalizing breastfeeding curriculum and tools for medical residency training programs, which have been tested and are currently undergoing evaluation. • Creating a micro-site off the www.aap.org/breastfeeding website to house curriculum materials. • Performing cost-benefit analysis on curriculum implementation.

28. The Business Case for Breastfeeding New HRSA resource kit developed to improve lactation support in the workplace.

29. Business Case for Breastfeeding Goals are to: • Increase awareness among employers of the economic benefits of breastfeeding; • Outline manageable and flexible models for implementing or enhancing a worksite breastfeeding support program, and • Increase the number of U.S. employers that utilize a worksite breastfeeding support program.

30. Impact of Employmenton Breastfeeding • Full-time employment shortens breastfeeding duration (Fein & Roe 1998) • Most women wean before end of first month back at work (Cardenas 2005) • Common challenges: • Maintaining milk production • Job settings not always conducive to milk expression • Lack of empathy/support

31. U.S. Breastfeeding Rates Source: Centers for Disease Control and Prevention

32. Women in the Workforce • 60 percent of women work outside the home. • Mothers are the fastest growing segment of the U.S. workforce: • 55 percent with children under age 3 are employed. • 62 percent with children under age 6 are employed. • 78 percent are employed full-time. • Growth rate has increased by 80 percent over the last 20 years • U.S. Department of Labor, Commission on Leave (2007). FMLA Survey.

33. Women in the Work Force

34. Disparities in Breastfeeding Women of lower Socioeconomic Status (SES) have lower rates of breastfeeding among all racial/ethnic groups. • African American women consistently have lower rates of BF (CDC MMWR, 2007) • African-American women are more likely to return to full time work sooner. (Cricco-Lizza, 2002; Bronner, 1996)

35. Business perspective • Designed for multiple groups • Based on research and strategy • Includes: • Resource Kit: The Business Case for Breastfeeding • Full kits and individual components available from MCHB at: www.ask.hrsa.gov or 1-888-ASK HRSA • Training and TA

36. Component 1: For Business Managers The Business Case for Breastfeeding • Target: Employers • Key content: • Bottom line benefits to supporting breastfeeding • Quick overview of what comprises a lactation support program • Available individually

37. Component 2: Easy Steps to SupportingBreastfeeding Employees • Target: Human Resource Managers • Key content: • Lactation support program options • Implementation strategies • Gaining buy-in • Promotion • Available individually

38. Component 3: Tool Kit • Target: Human Resource Managers • Key Content: CD-ROM with reproducible templates • Worksite policy • Assessment and feedback forms • Promotional items • Resource Guide • Employer Snapshots

39. Component 4: Employees’ Guide to Breastfeeding and Working • Target: Pregnant and Breastfeeding Employees • Key content: • Combining breastfeeding and employment • Ways to talk with supervisor and colleagues about breastfeeding needs • Available individually

40. Component 5: Outreach Marketing Guide • Target: Lactation educators and outreach workers • Key content: • Conducting effective outreach w/businesses • Supporting working mothers • “Outreach Marketing Resources” CD-ROM • PowerPoint presentation • Templates for outreach letters • Legislative language • Lesson plans

41. Training Workshops • State Breastfeeding Coalitions (SBCs) • January 2008 – 10 SBCs trained California Connecticut Georgia Hawaii Indiana Louisiana Oregon R.I. Texas Utah • 2009-2010 – additional SBCs to be trained • Healthy Start Communities • 2008 – 6 Healthy Start communities Baltimore Washington, D.C. Birmingham Dublin, GA Michigan Inter-Tribal Fresno, CA • 2009-2010 – additional HS trainings

42. National Business Group on Health (NBGH) • Recently issued a Model Benefit Plan for Maternal and Child Health (supported by MCHB and the Office on Women’s Health.) • Preventive Postpartum Care Recommendation: • Breastfeeding counseling and support by credentialed lactation consultants. • MCHB is providing supplemental funding to NBGH to adapt Resource Kit for work with large Fortune 500 companies.

43. MCH Bureau NEW GRANT PROGRAMS

44. The Community-Based Doula Program • Purpose: to provide first time motherhood demonstration programs to urban and rural communities to support community-based Doulas. • This approach identifies and trains indigenous community workers to mentor pregnant women during the months of pregnancy, birth and at least twelve (12) weeks post-partum, (optimally one year post-partum).

45. The Community-Based Doula Program • Up to (6) awards will be made to urban and rural community-based organizations to support community-based Doula activities to improve infant health, strengthen families and provide support to ensure family success. • Funding for the rural portion of the demonstration should focus on the best ways of delivering supportive services, including delivery outside the hospital setting both before and after the birth of the child. • Priority will be given to applications which emphasize breastfeeding initiation and retention.

46. The Community-Based Doula Program • Up to (1) award will be made to an organization with expertise in replicating community-based Doula programs, to offer outreach, training, technical assistance and evaluation services to the Doula grantees in order to maximize project effectiveness and quality care across all projects. • HRSA’s Maternal and Child Health Bureau was allotted $1.4 million to launch the Community-Based Doula Initiative through the Consolidated Appropriations Act 2008 (P.L. 110-161) .

47. First-Time Motherhood/New Parent Initiative • Purpose: Develop, implement, evaluate and disseminate novel social-marketing approaches that: • Concurrently increase awareness of existing preconception/interconception, prenatal care, and parenting services/programs, and • Address the relationship between such services, health/birth outcomes, and a healthy first year of life. 

48. First-Time Motherhood/New Parent Initiative • The target population should include women and men who are from populations disproportionately affected by adverse pregnancy outcomes in their community including racial/ethnic minorities.  • Organizations should also outreach to providers who service populations disproportionately affected by adverse pregnancy outcomes in their community including racial/ethnic minorities.  

49. First-Time Motherhood/New Parent Initiative • Services promoted through the public awareness campaign should augment programs that have already been implemented by States to encourage a healthy first year of life and promote educational and social support services for expectant mothers/new parents.  • Applicants may choose to create Statewide, countywide or targeted public awareness campaigns. 

50. First-Time Motherhood/New Parent Initiative • HRSA’s Maternal and Child Health Bureau was allotted approximately $4.8 million for this activity through the Consolidated Appropriations Act 2008 (P.L. 110-161) . • Only one application per State will be accepted. • Up to ten (10) awards are anticipated.