State MCH indicators of life course Tegan Callahan

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. ” 6

Process: Phase 1 Expert Panel convened 2012 7

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 9

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 10

Phase 2: State Teams Members Florida North Carolina Nebraska Iowa Michigan Louisiana Massachusetts 11

Domain Perinatal/ Early Childhood/ Adolescent Infancy Childhood School age Young adult Adult Risk Services Outcomes Capacity 12

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. 13

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? 14

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. 15

Selection Progress 413 proposals (discussion/screening) 104 write ups (scoring/voting) Considered, not selected 59 Life Course Indicators 16

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 17

Public Comment Results Changes to numerators/denominators Alternative data sources Confirmation of process Delineation of FAQs 18

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) 19

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 20

Final Web-based Resource: Fall 2013 21

Final Web-based Resource: Fall 2013 22

“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) 4 th graders scoring proficient or above on math and reading (NAEP) 23

www. amchp. org/lifecourseindicators