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Maternal Child Health Newsletter 8/6/04

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Maternal Child Health Newsletter 8/6/04

Postby laura » Fri Aug 06, 2004 01:14 pm

by laura (5139 Posts), Fri Aug 06, 2004 01:14 pm

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MCH Alert
Tomorrow's Policy Today
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National Center for Education in Maternal and Child Health
Search past issues of the MCH Alert and other MCH Library resources at
http://www.MCHLibrary.info/databases/search.lasso

August 6, 2004

1. Report Highlights Changes in SCHIP Enrollment
2. Authors Investigate National Vaccination Coverage Among Children Ages
19 through 35 Months
3. Study Assesses Effectiveness of Interventions on Primary Care Health
Professionals’ Behaviors
4. National Survey Explores Need for and Use of Mental Health Services
Among Children and Adolescents Involved with Child Welfare
5. Article Examines Health Professional Self-Efficacy and Adolescent
Preventive Services

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1. REPORT HIGHLIGHTS CHANGES IN SCHIP ENROLLMENT

SCHIP Program Enrollment: December 2003 Update is the latest in a series
of reports published by the Kaiser Commission on Medicaid and the
Uninsured on enrollment trends in the State Children's Health Insurance
Program (SCHIP). The report is based on data provided by the SCHIP
directors, Medicaid directors, and other state officials responsible for
data and statistical reporting. The report highlights changes in SCHIP
enrollment from June through December 2003 and includes information on
SCHIP coverage for adults, policy and program changes in SCHIP programs
in state fiscal year 2004, and the outlook for SCHIP in state fiscal
year 2005. An overview, summary, and conclusion are also presented. This
report as well as a press release; a related case study report; and the
July 23, 2004, webcast of a policy briefing that included panelists from
Texas, Maryland, Florida, and Indiana are available at
http://www.kff.org/medicaid/kcmu072304pkg.cfm.

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2. AUTHORS INVESTIGATE NATIONAL VACCINATION COVERAGE AMONG CHILDREN AGES
19 THROUGH 35 MONTHS

National Immunization Survey (NIS) results for 2003 indicated "the
highest coverage ever for all vaccines," state the authors of a report
published in the July 30, 2004, issue of Morbidity and Mortality Weekly
Report. The NIS provides estimates of vaccination coverage among
children ages 19 through 35 months for each of the 50 states and 28
selected urban areas. This report summarizes NIS results for 2003.

The NIS used a quarterly random-digit-dialing sample of telephone
numbers for each of 78 survey areas. Responses were weighted to
represent the population of children ages 19 through 35 months. During
2003, vaccination records were obtained for 21,210 children. The overall
response rate for eligible households was 62.7%.

The authors found that

* National vaccination coverage with greater than or equal to one dose
of varicella increased from 80.6% in 2002 to 84.8% in 2003.

* Coverage for greater than or equal to three doses of pneumococcal
conjugate vaccine increased from 40.9% in 2002 to 68.1% in 2003.

* Coverage for greater than four doses of pneumococcal conjugate
vaccine, reported for the first time in 2003, was 36.7%.

* In 2003, substantial differences remained in estimated vaccination
coverage among states. Estimated coverage with the 4:3:1:3:3 series
ranged from 94.0% in Connecticut to 67.5% in Colorado.

* The range in coverage among the 28 urban areas was less than that
among the states. Among the 28 urban areas, the highest estimated
coverage for the 4:3:1:3:3 series was 88.8% in Boston, Massachusetts,
and the lowest was 69.2% in Houston, Texas.

The authors conclude that "maintaining the gains in vaccination coverage
achieved during the 1990s among these children poses a continuing
challenge for public health practitioners." They state that "continued
vigilance is needed to maintain high levels of coverage, and sustained
efforts will be required to reduce geographic disparities in coverage."

Barker L, Santoli J, McCauley M, et al. 2004. National, state, and urban
area vaccination coverage among children aged 19-35 months -- United
States, 2003. Morbidity and Mortality Weekly Report 53(29):658-661.
Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5329a3.htm.

Readers: Two additional reports of interest to the MCH community were
published in this issue of Morbidity and Mortality Weekly Report.
Racial/Ethnic Disparities in Neonatal Mortality -- United States,
1999-2001 is available at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5329a2.htm. Violence-Related
Behaviors Among High School Students -- United States, 1991-2003 is
available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5329a1.htm.

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3. STUDY ASSESSES EFFECTIVENESS OF INTERVENTIONS ON PRIMARY CARE HEALTH
PROFESSIONALS’ BEHAVIORS

"Changing primary care providers' behavior should be approached in a
comprehensive and contextual manner considering the large social and
political forces such as group norms, professional regulations, and
environmental considerations that include practice location,
demographics, setting, and patient issues," state the authors of an
article published in the summer 2004 issue of the Journal of Public
Health Dentistry. The authors explain that while the oral health status
of American children and young adults has improved significantly over
the last three decades, the burden of oral disease is still high among
underserved low-income population groups. The authors contend that given
the current problems with access to dental care among these groups,
there is a need to involve nondental primary care health professionals
in oral health. The objective of this article is to present findings
from a systematic review of the effectiveness of educational
interventions on the adoption of new practice behaviors by primary care
health professionals. Interventions are divided into the following
types: (1) the dissemination of educational materials, (2) continuing
medical education (CME), (3) educational outreach visits, (4) the
influence of local opinion leaders, and (5) reminders.

Using the Cochrane Library and MEDLINE, the authors conducted a search
for systematic reviews of interventions that aimed to promote the
adoption of new practice behaviors by primary care health professionals.
The search included reviews published between January 1988 and March
2003. Eleven reviews met the inclusion criteria.

The authors found that

* Evidence for the effectiveness of disseminating educational materials
was inconclusive.

* Traditional CME methods such as lectures or workshops did not
effectively change primary care health professionals' practice
behaviors. It was indicated that small, more targeted interactive group
discussion and teleconferencing sessions might be more effective.

* The two studies available indicated that educational outreach visits
were effective in increasing the delivery of preventive services as well
as in reducing inappropriate prescribing practices.

* It is not clear whether interventions relying on local opinion
leaders' influence were effective.

* Manual (not computerized) reminders effectively promoted the adoption
of preventive practices among primary care health professionals.

The authors conclude that "considering the strategic position of primary
care providers in improving oral health of underserved populations, this
area deserves much greater attention and research."

Woosung S, Ismail AI, Tellez M. 2004. Efficacy of educational
interventions targeting primary care providers' practice behaviors: An
overview of published systematic reviews. Journal of Public Health
Dentistry 64(3):164-172.

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4. NATIONAL SURVEY EXPLORES NEED FOR AND USE OF MENTAL HEALTH SERVICES
AMONG CHILDREN AND ADOLESCENTS INVOLVED WITH CHILD WELFARE

"Applying the population estimates obtained in this survey,
approximately 814,300 . . . children had a substantial need for mental
health services, but only about 192,175 were receiving these critical
services," state the authors of an article published in the August 2004
issue of the Journal of the American Academy of Child & Adolescent
Psychiatry. The article describes a study to identify factors related to
the need for and use of mental health services among a nationally
representative sample of children who were investigated by child welfare
agencies after reported maltreatment.

Data for the study were drawn from the National Survey of Child and
Adolescent Well-Being. The study sample included 3,803 children and
adolescents ages 2-14 for whom investigations and/or assessments had
been completed between October 1999 and December 2000. Study measures
included need for mental health services, mental health services use
within the past 12 months, types of alleged maltreatment (physical
abuse, sexual abuse, emotional abuse, neglect), types of placement (in
home versus out of home), and child welfare worker risk assessment.

The authors found that

* Almost half (47.9%) of the children and adolescents had clinically
significant emotional or behavioral problems, yet only 15.8% received
any mental health specialty services in the 12 months preceding the survey.

* Although children and adolescents with clinical need were 2.5 to 3.5
times more likely to receive mental health services than those who were
not in the clinical range, only one fourth (11.7%) of those in the
clinical range had received any mental health services.

* Children ages 2-5 who were sexually abused were approximately four
times more likely to receive mental health services than children in
this age group who had experienced neglect.

* African-American children ages 6-10 were less likely to receive mental
health services than white children in this age group.

* Children ages 6-10 living at home (versus out of home) were
significantly less likely to receive mental health services, even after
controlling for clinical need.

* Adolescents ages 11-14 living at home (versus out of home) were also
less likely to receive mental health services, whereas having a parent
with severe mental illness increased their likelihood for receiving
services.

"The need for serious attention to the mental health needs of these
youths is apparent and the potential to intervene effectively is within
reach," conclude the authors. They suggest that "this can become a
reality when a true partnership is established between the child mental
health and child welfare service systems."

Burns BJ, Phillips SD, Wagner HR, et al. August 2004. Mental health need
and access to mental health services by youths involved with child
welfare: A National Survey. Journal of the American Academy of Child &
Adolescent Psychiatry 43(8):960-970.

Readers: At the request of Representative Henry A. Waxman and Senator
Susan Collins, the U.S. House of Representatives' Special Investigations
Division surveyed every juvenile detention facility in the United States
to assess what happens to youth when community mental health services
are not readily available. The results of the survey are presented in
the report, Incarceration of Youth Who Are Waiting for Community Mental
Health Services in the United States. The report covers the period from
January 1 to June 30, 2003, and is available at
http://www.house.gov/reform/min/pdfs_108_2/pdfs_inves/pdf_health_mental_health_youth_incarceration_july_2004_rep.pdf.

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5. ARTICLE EXAMINES HEALTH PROFESSIONAL SELF-EFFICACY AND ADOLESCENT
PREVENTIVE SERVICES

"The findings suggest that education that focuses on improving the
delivery of adolescent preventive services needs to focus not only on
increasing knowledge and skill but also on increasing clinicians'
competence that they can effectively use the skills," state the authors
of an article published in the August 2004 issue of the Journal of
Adolescent Health. The article examines the relationship between health
professional self-efficacy to deliver preventive services and the rates
at which health professionals screen adolescents for risky health behaviors.

The study was part of the baseline phase of a longitudinal study of
preventive services for adolescents in three general outpatient
pediatric clinics within a large managed care organization in Northern
California. The study target areas for screening included tobacco use,
alcohol use, sexual behavior, seat belt use, and helmet use.

Screening rates were determined by both health professionals'
self-reported screening practices and adolescents' independent reports.
Health professionals completed two questionnaires on their screening
practices. The first questionnaire assessed their confidence in
delivering preventive services to adolescents. The second assessed the
frequency with which they had delivered preventive services to
adolescents in the past 30 days. Adolescents attending well visits
reported on what occurred during and immediately following the visit.

The sample included 66 health professionals who completed both
questionnaires and for whom there were two or more independent
adolescent reports.

The authors found that

* Health professional self-efficacy to deliver preventive services was
significantly correlated with self-reported screening practices in each
of the five target areas.

* Health professional self-efficacy to deliver preventive services was
significantly correlated with adolescents' reports of health
professionals' screening behaviors in three of the five target areas
(tobacco use, sexual behavior, and alcohol use).

* Self-reported health professional screening practices were
significantly correlated with adolescents' reports of health
professionals' screening behaviors in each of the five target areas.

"Both adolescents and providers reported highest and lowest rates of
screening in the same risk areas," state the authors. They suggest that
"perceived efficacy to identify and address risky health behaviors is
one important step in the increased delivery of adolescent clinical
preventive services."

Ozer EM, Adams SH, Gardner LR, et al. August 2004. Provider
self-efficacy and the screening of adolescents for risky health
behaviors. Journal of Adolescent Health 35(2):101-107.

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laura
Registered User
 
Posts: 5139
Joined: Tue Jan 28, 2003 12:17 pm
Location: Anchorage, AK

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