Maternal Wellness Update A Monthly Program Communication for Maternal Wellness Partners
May 2013
In This Issue Hot Topics o Panel Supports Maintaining the Current Diagnostic Approach for Gestational Diabetes Mellitus o Colorado Health Report Card Shows What it Means to be the Healthiest State o Sequestration Update o Presidential Proclamation—May 2013 is National Mental Health Awareness Month
Colorado Department of Public Health and Environment
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Useful Resources o Quick Health Data Online Fact Sheets Present Demographic Characteristics o How to Support Pregnant/Parenting Teens o Information for Providers on TEXT4BABY o A Comprehensive Approach for Community-Based Programs to Address Intimate Partner Violence and Perinatal Depression o From IOM: Weight Gain During Pregnancy o Action Plan for the National Initiative on Preconception Health and Health Care o Who’s Who in the Children Youth and Families Branch
Articles of Interest o Improving Preconception Health Trends: Behavioral Risk Factor Surveillance System o Weight Gain & Pregnancy Outcomes Medicaid Matters o Medicaid Update - Tobacco Cessation Counseling Benefit for Pregnant Women o 2012 Demographic Profile of Medicaid Clients Training Opportunities o Black Infant Mortality Conference: A National Health Crisis o The Diabetes Prevention Program Reduces Risk of Developing Type 2 Diabetes
Colorado’s Winnable Battles
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Article Submission To submit an article for a future edition of the Maternal Wellness Monthly Update, please click here.
Hot Topics
Maternal Wellness
Panel Supports Maintaining the Current Diagnostic Approach for Gestational Diabetes Mellitus An independent panel convened by the National Institutes of Health has concluded that despite potential advantages of adopting a new diagnostic approach for gestational diabetes mellitus (GDM), more evidence is needed to ensure that the benefits outweigh the harms. The panel recommended following the current diagnostic approach until further studies are conducted.
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“The panel believes that cost-benefit, cost-effectiveness, and cost-utility research is needed to more fully understand the implications of changing diagnostic protocols for GDM,” said Dr. Peter VanDorsten, conference panel chairperson and Lawrence L. Hester, Jr. Professor, Medical University of South Carolina, Charleston. View the NIH GDM Draft Statement here.
- Back to Top – Colorado Health Report Card Shows What it Means to be the Healthiest State Approximately 92,600 fewer adults would report mental health difficulties and 24,900 fewer children would be obese if Colorado were No. 1 among other states in mental health and childhood obesity. That's according to "Keeping Colorado Competitive: Roadmap to a Healthier, More Productive Workforce," a supplement to the 2012 Colorado Health Report Card released in March by the Colorado Health Foundation and the Colorado Health Institute. Now in its seventh year, the Report Card tracks 38 indicators spanning five life stages: Healthy Beginnings, Healthy Children, Healthy Adolescents, Healthy Adults and Healthy Aging. By assigning a letter grade to each of the five life stages that includes ranking Colorado against the other states from best to worst, with No. 1 being the "best" state to No. 50 being the "worst," the Report Card provides a comprehensive picture of the health of Colorado residents. For the first time, the Report Card analysis asks the question, "What if we were No. 1?" illustrating what it would mean if Colorado were to achieve the top ranking in each particular indicator. Among the answers: • 2,100 more babies would be born at a healthy weight • 123,400 more children would have access to a medical home • 32,600 fewer high school students would smoke cigarettes • 376,800 fewer adults would binge drink • 16,200 more older adults would have all of their recommended immunizations Report Card results: While Colorado is making progress with some key health indicators, the state's overall grades haven't improved much since the Colorado Health Foundation issued its first Report Card in 2006. From 2010 to 2012, the overall grade for Healthy Beginnings (an indicator that measures prenatal care for babies and their mothers) remained unchanged at a mediocre C. During the past year, the
Nurse Home Visitor Program
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state's grade for Healthy Children fell from an unacceptable C- to a dismal D+. Meanwhile, the grades for Healthy Adolescents, Healthy Adults, Healthy Aging improved only slightly between 2011 and 2012.
Healthy Baby Resources
- Back to Top – Sequestration Update The Colorado Department of Public Health and Environment is still awaiting notice from the Maternal and Child Health Bureau on our final Maternal and Child Health budget for FY13. Below is an announcement shared by the Association of Maternal and Child Health Programs (AMCHP) at the end of March regarding sequestration. At the end of March, the President signed into law the Consolidated and Further Continuing Appropriations Act (H.R. 933), which provides funding for the remainder of FY 2013 (Mar. 27-Sept. 30). This legislation locks in sequestration for FY 2013. It also provides funding for most federal agencies at FY 2012 levels minus a small across the board reduction. All grants funded via formula should expect at least a 5 percent reduction as a result of sequestration. For the Title V Maternal and Child Health Services Block Grant after sequestration and the small across the board cut AMCHP projects the new baseline for FY 2013 could be $606 million or less. Also due to sequestration, the Maternal, Infant and Early Childhood Education Home Visitation program will be cut by $20 million. However, this bill does provide increased funding for some agencies and programs. Specifically: • National Institutes of Health +$71 million • Special Supplemental Nutrition Program for Women, Infants and Children (WIC) +$150 million • Child Care and Development Block Grants +$50 million • Head Start +$33.5 million While an important accomplishment in this budget climate, these programs will still suffer net reductions due to sequestration. Importantly, for WIC the funding increase along with unspent SNAP transfer funds, contingency funds, unspent recovered funds means that WIC will likely be able to manage through the rest of the fiscal year without cutting any participants. AMCHP will continue to advocate on your behalf urging Congress to provide sustained funding for the Title V MCH Block Grant and other maternal and child health programs. We are disappointed that sequestration is moving forward for this fiscal year and we hope that Congress will develop a plan to repeal sequestration and address our nation’s long-term fiscal health without further cutting discretionary programs.
- Back to Top – Presidential Proclamation—May 2013 is National Mental Health Awareness Month President Obama calls upon citizens, government agencies, organizations, health care providers, and research institutions to raise mental health awareness and continue helping Americans live longer, healthier lives. For many of the tens of millions of Americans who are living with a mental health issue, getting help
For gestational weight gain resources and information, click here.
starts with a conversation; talking about it with someone they trust and consulting with a health care provider. You can find nearby treatment through SAMHSA's Treatment Referral line at 1-800-662-4357 (HELP). This toll-free service provides round-the-clock information confidentially on where to go for help on prevention, treatment, and recovery issues related to mental illness or substance use disorders (assistance available in English and Spanish). Similarly, the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) provides free, confidential, immediate round-the-clock assistance to people in crisis. Both lines are open to all Americans—including service members, veterans, and their families—365 days a year. Heed the President's call and use the month of May to raise mental health awareness.
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Useful Resources Quick Health Data Online Fact Sheets Present Demographic Characteristics Quick Health Data Online Fact sheets are now available for each of the 50 states and the District of Columbia. Each fact sheet presents a snapshot of demographic characteristics as well as a variety of health status indicators for females within the area. These include: • • • • • • • • • • •
Health Status Access to Care Health Conditions and Risk Factors Preventive Services and Screenings Mortality Prenatal Care and Pregnancy Risk Birth Outcomes Sexually Transmitted Infections Violence and Abuse Mental Health and Teen Health
A PDF copy of Colorado's fact sheet can be accessed here.
- Back to Top – How to Support Pregnant/Parenting Teens Current estimates of teen pregnancy indicate that one out of every 10 young women in the United States gives birth before they reach the age of 20. To better serve the needs of pregnant and parenting teens, the Office of Adolescent Health (OAH) in the Department of Health and Human Services (HHS), contracted with Child Trends to produce Promising Strategies and Existing Gaps in Supporting Pregnant and Parenting Teens.
Maternal and Child Health
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This report outlines existing challenges and promising practices in supporting pregnant and parenting teens and summarizes the discussions and suggestions of national experts in the field. Download the full report here.
Department of Health Care Policy and Financing
- Back to Top – Information for Providers on TEXT4BABY A new resource for providers from text4baby provides information on how the program can help educate pregnant and new moms. A new video explains how text4baby works and shares testimonials from providers on how they have successfully enrolled moms in the service. Learn more about the value of text4baby and how it helps reinforce the health and safety messages that you're already sharing with patients. Watch it now and share it with your colleagues and networks!
To view the latest Health Care Policy and Financing At A Glance Newsletter click here.
- Back to Top – A Comprehensive Approach for Community-Based Programs to Address Intimate Partner Violence and Perinatal Depression A Comprehensive Approach for Community-Based Programs to Address Intimate Partner Violence and Perinatal Depression highlights innovative state and community-based strategies and provides a resource that assists community-based organizations with addressing the intersection of intimate partner violence and perinatal depression. The toolkit will help you: • Understand why you should address intimate partner violence and perinatal depression • Assess your readiness • Build and sustain partnerships • Create a successful intimate partner violence/perinatal depression awareness campaign • Ensure your efforts are culturally and linguistically appropriate for your community • Become familiar with policies that address intimate partner violence and perinatal depression • Identify standards of care guidelines and recommendations • Evaluate your efforts To view a recent webinar presentation on this new tool, click here.
- Back to Top – From IOM: Weight Gain During Pregnancy A new website from the Institute of Medicine (IOM) is part of an effort to ensure that women know how much weight to gain during pregnancy, both for their own health and for the health of their baby. Your Health and the Health of Your Baby / Tu Salud y la de tu Bebe presents resources developed by the IOM through the Kellogg Health of the Public Fund. The project goal is to reach Latina women -- particularly Mexican-American women -- with messages from IOM's 2009 report, Weight Gain During Pregnancy: Reexamining the Guidelines. Contents include Pregnancy Weight Myths and Facts and Pregnancy Weight Tracker, as well as a poster, a postcard, and an infographic. The IOM has also released two booklets, Guidelines on Weight Gain and Pregnancy (for women) and Implementing Guidelines on Weight Gain and Pregnancy (for health professionals). All of these resources are available on the new website.
Covering Kids and Families Coalition
To view the latest Covering Kids and Families Coalition Update, click here.
- Back to Top – Action Plan for the National Initiative on Preconception Health and Health Care (PCHHC) The Action Plan for the National Initiative on Preconception Health and Health Care (PCHHC) 2012-2014 outlines goals, objectives, strategies, and action steps that can: 1) move science into clinical practice; 2) market messages and images that will raise consumer awareness of preconception care; 3) inform policy development, implementation, and innovation; 4) guide public health and prevention programs in efforts to improve the health of women, infants, and families; and 5) monitor the processes and impact of preconception and interconception care at the local, state, tribal, territorial, and national levels.
- Back to Top – Who’s Who in the Children Youth and Families Branch The Maternal Wellness team joined the Children, Youth and Families branch in October 2012. Learn about who is in the CDPHE Children, Youth and Families Branch and their roles! Download the CYF Branch organization chart here.
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Articles of Interest Improving Preconception Health Trends: Behavioral Risk Factor Surveillance System This article assesses emerging trends in the 21st century, if any, in preconception health indicators among women of reproductive age. Methods: This is a secondary analysis of cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS), 2003-2010. Subjects were a sample of noninstitutionalized, 18-44-year-old, nonpregnant, women in the United States grouped into
Colorado Breastfeeding Update
Issues of the Colorado Breastfeeding Update newsletters are now available at www.breastfeedcol orado.com. Click on the Health Care Provider tab and select Colorado Breastfeeding Update Newsletter.
two categories, 2003-2006 and 2007-2010. Overall crude and adjusted prevalence odds ratios were calculated for preconception indicators before 2006 and after 2006. Results: Significant improvements were found for any and heavy alcohol use, smoking, social and emotional support, moderate/vigorous physical activity, and having had an influenza shot in the last year. In contrast, binge drinking, having a medical condition (i.e., diabetes, high blood pressure, asthma, or obesity), and self-reported health significantly worsened. No change was found for mental distress, HIV testing, and having a routine checkup. Conclusions: As the 21st century unfolds, emerging trends suggest that we need to focus on educating women, providers, and public health advocates about improved health before pregnancy, especially for women with chronic conditions and those who binge drink alcohol. To access the full article, click here.
- Back to Top – Weight Gain & Pregnancy Outcomes A study appearing in the May 2013 edition of the journal Obstetrics and Gynecology evaluates pregnancy outcomes according to 2009 Institute of Medicine (IOM) gestational weight gain guidelines. In 2009, the IOM released new guidelines for weight gain during pregnancy. The recommendation is for underweight, normal weight, overweight, and obese women to gain 28-40, 25-35, 15-25, and 11-20 pounds, respectively. Changes from the initial guidelines set forth in 1990 include: a range for weight gain in obese women instead of a lower limit and a change in classification parameters resulting in the classification of fewer women as underweight and more women as overweight. Of over 8,200 pregnancies studied, 9.5% had weight gain below, 17.5% within, and 73% above IOM guidelines. With excess weight gain, all body mass index (BMI) categories had an increased risk of hypertensive disorders; normal weight and overweight women also had increased risk of cesarean delivery and neonatal birth weight at or above the 90th percentile, but a decreased risk of weight below the 10th percentile. Click here to review the study online.
MATERNAL WELLNESS STAFF Mandy Bakulski Supervisor Phone (303) 692-2495 Mandy.bakulski@state.co.us
Krista Beckwith Community Projects Coordinator Phone (303) 692-6275 Krista.beckwith@state.co.us
Jennifer Dellaport Breastfeeding Promotion Coordinator Phone (303) 692-2462 Jennifer.Dellaport@state.co.us
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Medicaid Matters
HOME VISITATION STAFF Lucia Waterman
Medicaid Update - Tobacco Cessation Counseling Benefit for Pregnant Women Effective since January 2012, tobacco cessation counseling for pregnant women and women in the early postpartum period (up to 60 days postpartum) is covered with certain limitations. Reimbursement for a limited number of units is available when the counseling is face-to-face and consistent with the counseling practices described in the U.S. Public Health Service publication, Treating Tobacco Use and Dependence (2008 Update): A Clinical Practice Guideline. A maximum of 5 units of 99406+HD will be reimbursed per client per state fiscal year. A maximum of 3 units of 99407+HD (if in a group setting, add the HQ modifier) will be reimbursed per client per state fiscal year. Diagnosis code 649.03 or 649.04 must be included on the claim. Providers must be able to show completion of an approved prenatal tobacco cessation course. For more details about this benefit, including approved training courses, see December 2012 Provider
Home Visitation Director Phone: (303) 692-6290 lucia.waterman@state.co.us
Flora Martinez Operations Coordinator Phone: (303) 692-2603 flora.martinez@state.co.us
Sarah Hernandez Program Coordinator Phone: (303) 691-4095 sarah.hernandez@state.co.us
Bulletin. Website information:
• •
Tobacco cessation Toolkit for primary care providers
Contact information: Please contact Kirstin Michel at Kirstin.Michel@state.co.us or (303) 866 – 2844 with any questions.
- Back to Top – 2012 Demographic Profile of Medicaid Clients The 2012 Demographic Profile of Medicaid Clients in Colorado gives an overview of the people who received benefits through the Medicaid program in 2012. The Medicaid population is described briefly by economic status, geographic region, age, ethnicity and language. It is available on the Healthy Living web page, link on Information for Providers and Stakeholders, on the Department of Health Care Policy and Financing website. - Back to Top –
Training Opportunities Black Infant Mortality Conference: A National Health Crisis When: Friday, May 17, 2013; 8am - 4pm Where: Hilton Garden Inn - Denver, Colorado What: The conference will increase awareness and knowledge concerning interventions and strategies that improve healthy birth outcomes.The keynote speaker for the conference is Johnny Johnson, M.D., an African American Gynecologist, who is an expert in the field of black infant mortality and will present on “Influencing and Facilitating a Paradigm Shift in the Prevention of Black Infant Mortality.” Register: There is no longer a registration fee for this event, if you contact Barbara Richardson directly by May 10th. Email Barbara at brichw@att.net. Please bring a copy of your registration confirmation with you to the conference. For more information and to register, click here.
- Back to Top – The Diabetes Prevention Program Reduces Risk of Developing Type 2 Diabetes The Diabetes Prevention Program (DPP) is a 16-week lifestyle change curriculum that has been shown to greatly reduce participants’ risk of developing type 2 diabetes through healthy eating and active living. The number of organizations offering this program in Colorado is growing, and they currently include, but are not limited to, the YMCA of Metro Denver, Denver Health, Center for African American Health, Kit Carson County Health and Human Services and San Luis Valley Regional Medical Center. For a complete list of Colorado organizations offering the DPP, please visit the CDC's site or have your clients call 1-800-DIABETES (their operators speak English and
Spanish). Eligibility for this program includes adults 18 years or older with a BMI > 24 and: 1. Have a history of gestational diabetes and/or have been diagnosed with pre-diabetes 2. OR score 9 or higher on the following risk test (also available in Spanish) +1
Have you had a baby weighing more than 9 pounds?
+1
Do you have a sister or brother with diabetes?
+1
Do you have a parent with diabetes?
+5
Do you have a BMI > 24?
+5
Are you younger than 65 and do little or no exercise in a typical day?+5 Are you between 45 and 64?
+9
Are you older than 65?
=?
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Colorado’s Winnable Battles To receive up-to-date information on Colorado’s Winnable Battles, go to http://www.coprevent.org/p/collaboratives.html. Next, Scroll down to select the winnable battle topic. Enter your email into the box provided and click “subscribe” to begin receiving the emails. If you want to also access the Google Docs Folder we created for the group to share documents, you will need a Google Account under the same email address as you used to subscribe to the group. If you have any difficulty signing up, please contact: Annie Guo at annie.guo@state.co.us or 303.691.4080.
May 2013