MCH functions framework: a guide to the role of government in maternal and child health in the 21st century

Training maternal and child health epidemiologists: leaders for the twenty first century

This paper reports on the structure, implementation and outcomes of the Maternal and Child Health (MCH) Epidemiology (MCHEPI) program at the University of Illinois School of Public Health (UIC-SPH) and discusses the successes and challenges in developing MCH Epidemiology leaders for the local, state, and national public health workforce. The MCHEPI program at UIC-SPH offers both the MPH and PhD degree and is based on six key components: integration across school divisions, competency-based training, tailored curricula, practica/dissertations with public health agencies, personal leadership training and development, and socialization. Based on data from the 1998-2012 cohorts, all former and current MCHEPI MPH students (n = 28) have participated in practica with local or state public health agencies and former and current MCHEPI doctoral students at the dissertation stage (12 out of 15) have partnered with local, state or national public health agencies in conducting their dissertations. The alumni of the MCHEPI MPH program (n = 25) appear to serve in higher level positions in their second compared to their first placements post-graduation. All MCHEPI doctoral alumni (n = 8) serve at the emerging senior level or senior scientist level upon graduation, in local, state and federal agencies, or in academe. Explicit linkage of MCHEPI students to practice through tailored curricula, practica, and dissertations with public health agencies, and the development of an identity as a member of the MCHEPI field appear to be important to the generation of epidemiology leaders for the MCH workforce. Leadership development is a lifelong process and as such, snapshots of current students and alumni at any one point in time do not provide the entire picture of the impact of MCH epidemiology training programs. Examining the trajectories of emerging leaders over time is essential for evaluating the true success of Maternal and Child Health Bureau workforce and training investments.

Preconception care: a systematic review

OBJECTIVES

To perform a systematic review of published research trials of preconception care services to determine what evidence for effectiveness of care at improving the course of pregnancy or its outcomes has accumulated since the last major review in 1990.

METHODS

The review was conducted adapting the systematic methods developed by the Cochrane Collaboration to collect evidence from published clinical research literature with as little bias as possible. The review included literature published after January 1990, and posted on MEDLINE by July 1999.

RESULTS

Although more than 40 preconception risk conditions were searched and 470 articles were abstracted, only four problem areas and 19 research trials met the review criteria. New evidence of effectiveness was found for screening women who are seeking family planning for risk conditions; having sexually active women of reproductive age take dietary folate supplements; and providing women affected by certain metabolic conditions (diabetes and hyperphenylalanemia) with nutrition services.

CONCLUSIONS

To help improve pregnancy outcomes MCH professionals need to promote the concept of readiness for pregnancy and help see that women are as healthy and appropriately nourished as possible before they become pregnant.

The MCH Certificate Program: a new path to graduate education in public health

OBJECTIVE

The purpose of the MCH Certificate Program was threefold: to develop a new educational initiative in response to national and local demands for increased MCH workforce capacity, to eliminate key financial and nonfinancial barriers to advanced MCH academic preparation, and to improve rates of recruitment and retention of students from minority communities, thus enhancing the quality of MCH services available to the region.

METHODS

An MCH Certificate Program, designed for clinicians (e.g., nurses, occupational therapists and nutritionists) and public health practitioners as a bridge to graduate programs in public health, combined a competency based curriculum with skills workshops, leadership seminars, mentoring, small group activities, and an interactive teaching format. RESULSTS: Students from the first two cohorts (n = 45) report an expansion of core public health knowledge (issues, policies, and strategies), enhanced self-confidence, and efficacy. Half have experienced job changes that represent increased responsibility, leadership, and professional advancement. A third are enrolled in or have completed a formal program of graduate study in MCH.

CONCLUSIONS

This innovative MCH Certificate Program, now in its fourth year, is a new approach to increasing workforce capacity and a successful model of instruction for adult learners. It has the potential for adaptation to a variety of educational settings and MCH populations, and helps to expand the continuum of MCH training experiences in schools of public health.

Model indicators for maternal and child health: an overview of process, product, and applications

OBJECTIVES

Further improvements in the health of mothers and children depend, in part, on collecting, analyzing, and interpreting relevant data correctly. Despite consistent efforts to improve data capacity and use during the past two decades, the need persists for a model set of maternal and child health (MCH) indicators to guide decisions about health conditions to be monitored, elements to be included in data sets, and definitions of measures. This article describes development, key characteristics, and major applications of a set of MCH Model Indicators (MCH MI) created to address these needs.

METHODS

A conceptual model with five domains was created to organize and guide development of the indicators. The development process included systematic specification of concepts, formulas, age/gender groups, and data sources, as well as recommendations for frequency of surveillance. Information sources included published reports and expert opinion.

RESULTS

There are 217 indicators distributed across domains as follows: 75 health status, 9 contextual characteristics, 16 health systems capacity and adequacy, 49 risk/protective status, and 68 health and related services. Twenty of the indicators, all of them in the health status domain, are recommended for routine surveillance.

CONCLUSIONS

The indicators can be used to identify and address MCH problems, to complement and expand other sets of MCH indicators, to serve as standards for consistent definitions, to provide guidance for creation and revision of MCH and related data bases, and to provide a foundation for the development of related sets of indicators. Some of the indicators require further development, but the total MCH MI package constitutes a solid foundation for subsequent work, as well as for ongoing modifications that are essential if the Model Indicators are to remain responsive to MCH needs.

The role of state maternal and child health programs in the issue of newborn discharge

OBJECTIVES

Since dramatically shortened newborn hospitalization has shifted the focus of care from the hospital, a central policy question has become how to assure a system of care that extends into the home and community. The objective of this study was to examine the role of the state Maternal and Child Health Title V programs in the assessment of the issue of newborn discharge, the development of policies, and the assurance of appropriate care.

METHOD

The director or their designee in all 50 states and the District of Columbia participated in a structured telephone interview lasting 30-60 minutes.

RESULTS

Twenty-eight states reported new or previously implemented mandates for 48 hours of private insurance coverage for postpartum hospitalization. Only 6 states reported mandates concerning private insurance coverage of inpatient services, but 20 states reported mandates for postdischarge services. In the assessment function, only 18 maternal and child health (MCH) programs reported that they had undertaken specific studies on the effects of discharge timing in their states. In policy development, 18 of the 51 respondents reported that the MCH program initiated newborn discharge discussions, 23 reported that the agency participated in discussions, and 10 indicated that they did not participate. In assurance, 29 programs reported that they had taken action to provide technical assistance to local communities in developing follow-up systems. The relationship between the performance of core functions and the development of specific discharge policies in the state was minimal.

CONCLUSIONS

The MCH programs appear to have played varied, but often limited, roles in the development of discharge policies. It is essential for MCH programs to engage actively in the policy-making process. But in the political environment surrounding newborn discharge policy, where laws and regulations consistent with the well-being of infants and mothers were being enacted, the limited MCH program roles may have been appropriate. Arguing against this conclusion, however, is that only 15 programs believed they had been effective and only 19 were satisfied with the discharge policies in their states, which suggests that a more proactive role may be necessary.