The Update, September 7, 2009

The Update is a bi-weekly web newsletter published by the Iowa Department of Public Health's Bureau of Family Health. It is posted the second and fourth week of every month, and provides useful job resource information for departmental health care professionals, information on training opportunities, intradepartmental reports and meetings, and additional information pertinent to health care professionals

A Reporter's Guide to U.S. Global Health Policy

Provides basic information and data on the main diseases and conditions prevalent in low- and middle-income countries, U.S. government funding for global health, major policy issues, and initiatives among U.S. and international agencies and multilaterals

Effectiveness of a Federal Healthy Start Program in Reducing Infant Mortality

Objective: Infant mortality is an important indicator of the health status of a community. In this analysis, we aimed to evaluate temporal changes in infant mortality rates (IMR) in the Central Hillsborough Healthy Start (CHHS) program service area in Tampa, Florida compared to rates in the rest of Hillsborough County and the state. Method: We conducted a five-year (2010-2014) trends analysis using birth and infant death data extracted from the Florida Community Health Assessment Resource Tool Set (CHARTS). The number of infant deaths and live births were used to calculate and compare IMRs in the CHHS catchment area to those in the rest of Hillsborough County, and the state of Florida. Three-year centered moving averages were directly adjusted to account for differences in the racial/ethnic distribution of mothers across geographic areas. Results: Between 2010 and 2014, the IMR decreased 42.8% in the CHHS service area (from 14.5 to 8.3 per 1,000 live births) compared to decreases of 10.1% and 7.7% in the rest of Hillsborough County and the state of Florida, respectively. Additionally, the infant mortality gap in the CHHS catchment area narrowed from 72% in 2010 to 14% in 2014 compared to the rest of the state, and was eliminated when compared to the rest of Hillsborough County. Discussion: The absolute and relative decreases in IMR in the CHHS catchment area reflect the program’s effectiveness in decreasing disparity in infant mortality. The quality services provided by the CHHS program have had a significant positive impact on the families served

Serving highly vulnerable families in home-visitation programs

Home-visitation programs for families with young children are growing in popularity in the US. These programs typically seek to prevent child abuse and neglect and/or promote optimal development for infants, toddlers, and/or preschool-age children. This paper focuses on improving the capacity of home-visitation programs to meet the complex needs of highly vulnerable families with young children. Poverty, maternal depression and substance abuse, and domestic violence are noted as factors that place young children at risk for poor outcomes. The challenges of providing home-visitation services to families in which these risk factors are present are discussed. Family engagement, matching services to families’ needs, and staff capabilities are highlighted as areas in which improvements can be made to enhance home-visitation programs’ capacity to serve highly vulnerable families. Recommendations are given for improving the effectiveness of home-visitation programs in serving these families, as well for addressing policy and research issues related to the further development and evaluation of these programs.First author draf

Postpartum Depression Screening of Women Veterans in Alaska Quality Improvement Project

A Project Submitted in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCE in Nursing SciencePostpartum depression screening guidelines were updated by the American College of Obstetricians and Gynecologists and the United States Preventive Services Task Force in 2015 and 2016, respectively. Universal postpartum depression screening is recommended where previously it was not. Postpartum depression screening is relevant to the rapidly growing population of women Veterans served by the Veterans Health Administration (VA) as part of their comprehensive health care benefits. Little information was available on the postpartum depression screening practices within the Alaska VA Healthcare System. Using a quality improvement methodology, the author identified postpartum depression screening as a topic of interest. Current practice was assessed through a retrospective chart audit of all maternity consults placed during the fiscal year 2014. The chart audit revealed an 81% postpartum depression screening rate. Incomplete data limited a full statistical analysis; however, all women who returned to an Alaska VA clinic, received screening and treatment. An informational brochure was developed for women and their health care providers highlighting postpartum depression screening and treatment resources.Title Page / Abstract / Table of Contents / List of Tables / List of Appendices / Introduction / Purpose / Literature Review / Implications for Nursing Practice / Methods / Results / Discussion / Conclusion / References / Appendice

Promoting Healthy Families and Communities for Boys and Young Men of Color

This report talks about boys and young men of color who are at risk for poor health and developmental outcomes beginning at birth and persisting through childhood, adolescence, and young adulthood. As a result of household poverty and residence in segregated neighborhoods of concentrated disadvantage, they are disproportionately bombarded by environmental threats -- often without the benefits of supportive systems of prevention, protection, and care. This exposure to chronic stress undermines cognitive, social-emotional, and regulatory human development as well as the immune system. The parents of boys and young men of color are similarly affected, which affects boys directly in utero and interferes with their parents' abilities to promote their health and development and to protect them from harm as they mature

Linking the Child Care and Health Care Systems: A Consideration of Options

Funded by a grant from the Robert Wood Johnson Foundation, this report examines strategies for linking the health and child care systems in an effort to improve poor children's health. Studies show that poor, African American and Latino children have less access to health care and worse health outcomes than middle-class or non-Hispanic white children. With this reality in mind, the authors present five key strategies, identifying for each: the resources necessary for implementation, the strategy's potential to improve children's health, and the primary strengths and disadvantages -- including each strategy's promise for reaching the most vulnerable children. Drawing on interviews with experts in policy, health and child care, the report provides funders and policymakers with a framework for thinking about future interventions

Shortchanging America's Health 2008: A State-by-State Look at How Federal Public Health Dollars Are Spent

Examines public health indicators in each state, in combination with federal and state funding for programs to promote health. Includes state rankings by funding per capita, percentage of population who are uninsured, disease rates, and other indicators

The U.S. Government's Global Health Policy Architecture: Structure, Programs and Funding

Provides an overview of the history, scope, and role of U.S. engagement in global health, including funding; statutes, authorities, and policies; agencies involved; major initiatives; and countries with U.S. bilateral programs and funding

Sustainability and Spread of Community-based Initiatives: A case study of Community Cares, a Children’s Hospital’s 16 year effort to serve its community

The sustainability and spread of innovations is often elusive, presenting continuous challenges to clinicians and healthcare leaders. Somewhere between 33 - 70% of all innovations are reportedly not sustained, and even fewer are spread beyond the original team, or to other units within an organization. In plain language, sustainability is defined as locking in progress, while continually building upon that foundation, while spread is the exchange of knowledge and experience to others beyond the original implementing team. The literature supports the concept that sustainability is both multi-dimensional and multi-factorial and has several characteristics and pre-conditions. Tax-exempt, not-for-profit organizations in the USA must provide measurable community benefits to the populations they seek to serve. Many of these community benefits take the form of locating necessary services closer to or directly within the communities being served in order to enhance access. A case study of a 16 year effort to provide a medical home-oriented primary care model to underserved children in Houston, Texas Children’s Pediatrics’ Community Cares, is presented as illustrative of such a community benefit. Many of the characteristics and preconditions essential to a model for sustainability and spread are highlighted and the Community Cares case study is discussed from the standpoint of this framework