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From: MCH Alert []  
To: MCH Alert 
Subject: MCH Alert 
Sent: 3/5/99 10:04 AM 
Importance: Normal 
MCH Alert
Tomorrow's Policy Today

National Center for Education in Maternal and Child Health

March 5, 1999

1. Researchers Find That Women Welcome Pediatrician Screening and Referral for
Their Own Health Care
2. Study Examines Maternal Psychological Distress After Birth of Very Low
Birthweight Infant
3. Boost for Kids Partnership Available to Reduce Program Barriers and Improve
Outcomes for Children
4. Spring DataSpeak Conference Schedule Announced
5. AHCPR Releases Chart Book, Prevention Materials on Minority Health


Researchers examining unmet maternal needs in a pediatric setting found that
women who accompany their children at pediatric visits not only have their own
major health needs and face access barriers, but also almost uniformly accept
a pediatric role in screening and referral to adult primary care.  The study,
in the journal Pediatrics, set out to characterize 1) the prevalence and
cumulative burden of maternal health behaviors and conditions, 2) maternal
access to a source of comprehensive adult primary care, and 3) maternal
perceptions of a pediatric role in screening and referral.  Researchers
surveyed 559 women bringing a child 18 months or younger to one of four
pediatric sites between July 1996 and May 1997.   Sites included an outpatient
program in an academic hospital, a community health center and two managed
care sites.

Findings include:
* Two-thirds of women bringing their children for pediatric care had health
problems regardless of the site of care.
* Across all sites, greater than 85% of mothers reported they would "would
welcome" or "not mind" a pediatric screening and referral for their own health
*  Acceptance of a pediatric referral role did not differ between those women
with and without health conditions.

The authors acknowledge that "the clinical response to these findings must be
shaped by the serious time constraints clinicians already face."  They suggest
that a screening and enhanced referral approach could work well with other
strategies, such as counseling or selected treatment in the pediatric setting.
 Approaches would necessarily reflect the particular pediatric setting, but
considerations could include: "colocation of child and adult health services
in clinical facilities, availability of office support staff, emerging
partnerships between academic hospitals and private practices, and shared
delivery and information systems of managed care organizations."

Kahn, Robert S., et al.  "The Scope of Unmet Maternal Health Needs in
Pediatric Settings." Pediatrics. 1999; 103(3): 576-581.


A study in this week's Journal of the American Medical Association examined
maternal psychological distress and parenting stress after the birth of a very
low birthweight infant (VLBW).  Researchers studied mothers periodically over
a three year period who had given birth to low-risk VLBW infants, high-risk
VLBW infants, and term infants.  While initially mothers of low-risk and
high-risk VLBW infants suffered more psychological distress than term mothers,
by three years, mothers of high-risk VLBW children did not differ from mothers
of term children regarding distress symptoms, though parenting stress remained

The article includes the following results:
* A surprising finding was that mothers of low-risk infants with VLBW were
similar after the neonatal period to mothers of term infants on all measures
and, by three years, had the lowest levels of distress.  The authors speculate
that this may be due to "maternal relief after an initial period of fear and
* Severity of maternal depression was related to lower child developmental
outcomes in both VLBW groups (high-risk and low-risk).

The authors note that the findings have health policy implications, perhaps
countering concerns that survival of VLBW infants with neurodisabilities may
lead to "intolerable family burden."  They state, "These positive findings are
congruent with other studies that found...positive attitudes toward saving
high-risk infants with VLBW in parents of children who had VLBW births."  The
researchers conclude that the impact of VLBW birth depends on child medical
risk status, age and developmental outcome, and that follow-up programs should
contain psychological screening and support services for mothers of VLBW
infants in the immediate postnatal period, and monitoring of mothers of
high-risk VLBW infants.

Singer, Lynn T., et al. "Maternal Psychological Distress and Parenting Stress
After the Birth of a Very Low-Birth-Weight Infant." Journal of the American
Medical Association. 1999; 281(9): 799-805. 


Vice President Gore's National Partnership for Reinventing Government has
launched a new initiative, Boost for Kids, to partner with states and
localities to improve outcomes for children and families.  A maximum of 10
performance partnerships will be formed that will allow state and community
leaders to gain greater flexibility in program administration, and to work
with federal representatives to address barriers, integrate services, use
funding more effectively, and share lessons learned.

The initiative does not provide additional federal funds, but it will
* Facilitate consolidated planning and reporting and provide greater
flexibility in administering grant funds with related goals as allowed under
current law;
* Recommend changes to pool administrative savings from discretionary grant
programs to create local "Boost For Kids Investment Funds" -- to turn dollars
saved in administration to improving outcomes for children to the extent
allowed under current law;
* Help communities use data to achieve better outcomes for children;
* Provide increased access to federal data and geographic information and
assistance of federal data experts in devising strategies for collecting and
analyzing data on outcomes such as child insurance coverage, immunization,
housing, food security, traumatic injury rate, youth crime rate, and school
* Share lessons learned electronically and through a "How To" manual on ways
to use flexibility to improve outcomes for children; and
* Give national recognition to state and local partners for their results, and
work to improve the health, safety, living conditions, and well-being of

Potential partners must submit a brief Expression of Interest by March 12.
They may be submitted by mail, fax or electronically to: Boost For Kids,
National Partnership for Reinventing Government, 750 17th Street NW, Suite
200, Washington, DC 20006; Fax: (202) 632-0390; Email:

Further information is available on the National Partnership for Reinventing
Government's web site at <>.


The Maternal and Child Health Information Resource Center, at the University
of Illinois at Chicago, has announced the schedule for the spring 1999
DataSpeak series.  Sponsored by the Maternal and Child Health Bureau (MCHB),
the DataSpeak conferences are designed to train MCH professionals in applying
analytic skills to their MCH work, disseminate the findings of MCHB-funded
research and provide the MCH community with current information on data and
policy.  The conferences are broadcast via telephone conference call and live
on the Internet.  All conferences are scheduled for 2-3:30pm (Eastern Time).

March 9 -- Developing Effective Performance Measures
This session will provide state Title V program officials with guidance in
developing performance measures for this year's MCH block grant applications.
Presentations will include:
 * MCH Performance Measures: A Federal Perspective
  Peter van Dyck, Maternal and Child Health Bureau
 * What Makes a Good Performance Measure?
  Michael Soto, George Washington University
 * Lessons from the Field
   Linda Bultman, TX Department of Health

April 6 -- Technical Assistance and Question & Answer Session
This session is designed to assist those who wish to participate in upcoming
DataSpeak conferences via the Internet.  Presenters will review technical
requirements, downloading necessary software, and tips for using the WebBoard
to post questions.
April 13 -- Economic Analysis in MCH: Introduction and Examples from the Field
This session will describe the use of economic analysis in determining the
cost effectiveness of maternal and child health services, using a New Jersey
study as a field example.  Presentations will include:
 * What is Economic Analysis and What Can it Do for Me?
   Renee Schwalberg, Maternal and Child Health Information Resource Center
 * Cost Effectiveness of Selected MCH Services
   Norma Gavin, Research Triangle Institute
 * Field Example: New Jersey's Analysis of the Cost Effectiveness of MCH
   Celeste Wood and Nancy Wolff, NJ Department of Health

May 11 -- Risk Adjustment for Children's Services
This session will provide information to MCH program officials about
approaches to developing risk adjustment payments for children's services.
Presentations will include an overview by Henry Ireys of Johns Hopkins
University of his study on the effectiveness of risk adjustment methods for
predicting the costs of serving children in the Washington State Medicaid

Registration information, agendas, handouts, reading materials and an archives
of prior conferences are available on the DataSpeak web site at


The federal Agency for Health Care Policy and Research (AHCPR) released a new
chartbook that highlights the substantial differences in health and health
care that exist among racial and ethnic groups.  The report, which uses data
from the 1996 Medical Expenditure Panel Survey (MEPS), focuses on three key
aspects of health: insurance coverage, access to care, and health status. 

Principal findings include:
* Hispanics of all ages were the most likely to be uninsured; nearly 3 in 10
Hispanic children had no health insurance coverage.
* Hispanics were the least likely to access private health insurance through
their jobs.
* Blacks were less likely to have private health insurance than whites.  They
were the group most likely to be publicly insured.
* Hispanics were the least likely to have a usual source of care.  Blacks and
Hispanics were more likely than others to have a hospital-based usual source
of care.
* Families headed by Hispanics were the most likely to report barriers to
obtaining health care.
* Hispanics and blacks were less likely than whites to be in excellent health
and more likely to be in fair or poor health.

Kass, BL; Weinrick, RM; Monheit, AC. "Racial and Ethnic Differences in Health,
1996." Agency for Health Care Policy and Research. 1999.

AHCPR also announced this week its intent to disseminate to Spanish-speaking
families two pocket-sized guide containing the latest recommendations for the
prevention and early detection of illnesses. The consumer guides are part of
the national "Put Prevention into Practice" campaign to increase and improve
the provision of clinical preventive services and educate the public about the
importance of prevention.

Gu’a de salud infantil (Child Health Guide) includes recommendations from
medical and public health authorities on important clinical tests and exams
for children and provides information about issues such as development,
nutrition, oral health, and physical activity.  Families are encouraged to
bring the guide to pediatric visits and use the records throughout the guide
to track each child's health.  The second publication, Gu’a de salud personal
(Personal Health Guide), contains preventive health information for adults on
blood pressure, cholesterol, cancer screening, AIDS, and other areas.

Both pocket guides are available free of charge on the AHCPR web site at
<> or by contacting the AHCPR Publications
Clearinghouse at (800) 358-9295.


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The Editors welcome your submissions, suggestions and questions, please
contact us at the address below.

EDITORS: Nancy Berglas, Jessica Grumet


National Center for Education in Maternal and Child Health
2000 15th Street North, Suite 701
Arlington, VA 22201
(703) 524-7802
(703) 524-9335 FAX
Email: OR

The MCH Alert is produced by the National Center for Education in Maternal and
Child Health under its cooperative agreement (MCU-119301) with the Maternal
and Child Health Bureau, Health Resources and Services Administration, US
Department of Health and Human Services.