child health and healthcare advisory committee

Child Health and Healthcare Advisory Committee

Meeting ThreeMonday, July 16, 2018

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Agenda• Welcome and introductions• Update on Assessment process• Review new metrics and data• Small group: Preliminary priority topics and outcomes

• Small group: Draft policy goals and strategies

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Deliverables and Timeline

Assessment deliverables

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Assessment deliverables

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Assessment timeline

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Conceptual framework for child health and wellbeingPathway to improved health value (5.17.2018)

World Health Organization definition of health: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

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Conceptual framework for child health and wellbeingPathway to improved health value (5.17.2018)

World Health Organization definition of health: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

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Advisory Committee objectives1. Leverage existing work on Ohio’s State Health

Improvement Plan to create an Assessment of Child Health and Health Care in Ohio

2. Adopt a broad conceptual framework to guide development of the Assessment

3. Provide feedback on the child health and healthcare metrics and outcomes that will be analyzed as part of the Assessment

4. Identify entities that can provide data on pediatric clinical quality outcomes and access to care measures when the data is not publicly available

5. Offer insight on Ohio’s greatest child health and healthcare strengths, challenges and opportunities for improvement

6. Inform policy goals and strategies that will be highlighted in the Assessment to build upon Ohio’s strengths and address Ohio’s greatest child health and healthcare challenges

Meeting three(July)

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New metrics and data

Domain profiles

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New/changed metrics and dataNew and/or changed metrics for the Assessment

OH rank Metric short name. Metric definition

Ohio data values

Trend

U.S. data

values

Base year Mid-year

Most recent year

Most recent year

25Uninsured children. Percent of children ages 0-17 that are uninsured (updated data)

4.8% (2014)4.4%

(2015)3.6%

(2016)+ 4.5%

(2016)

40Infant mortality. Rate of infant deaths per 1,000 live births (updated data) 6.9

(2014)7.2

(2015) 7.4 (2016)

- 5.9 (2015)

46Asthma. Percent of children ages 0-17 currently with asthma (new source)

N/A N/A 11.2% (2016) N/A 8.4%

(2016)

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Physical activity. Percent of children ages 6-17 who exercised, played a sport or participated in physical activity for at least 60 minutes every day during the past week (measure changed) N/A N/A 26.3%

(2016) N/A 24.2% (2016)

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Food insecurity. Percent of children under age 18 living in households, where in the previous 12 months, there was an uncertainty of having, or an inability to acquire, enough food for all household members because of insufficient money or other resources (new metric)

24% (2011-2013)

22% (2012-2014)

20% (2013-2015) +

19% (2013-2015)

25Anxiety. Percent of children ages 3-17 currently with anxiety problems (new metric) N/A N/A 7.6%

(2016) N/A 7.1% (2016)

N/Ae-cigarette use. Percent of Ohio students grades 6-12 that report current e-cigarette use (new metric) 14.6%

(2014) N/A 7% (2016) +* N/A

N/A

Unmet treatment for major depressive episode. Percent of children ages 12-17 with a major depressive episode in the past year who did not receive treatment (updated data)

59.9% (2008-2012)

61.5 (2009-2013)

56% (2011-2015) + N/A

+ Moving in the right direction - Moving in the wrong direction N/A Data not available

DATA IS PRELIMINARY 13

Unintentional injury deaths in Ohio, by type, 2016

Motor vehicle51%

Drowning16%

Other, nontransport

12%

Smoke-and/or fire-

related10%

Poisoning 5%

Other6%

Poisoning 67%

Motor vehicle

29%

Drowning2%

Other2%

Ages 1-17(total deaths = 166)

Ages 18-25(total deaths = 659)

Source: Ohio Department of Health Bureau of Vital Statistics

14DATA IS PRELIMINARY

Top three leading causes of death due to injury or violence for young Ohioans, 2014-2016


2014 2015 2016Rate (per

100,000)

Total deaths

Rate (per

100,000)

Total deaths

Rate (per

100,000)

Total deaths

Motor vehicle accidents

2.5 63 2.5 62 3.4 85

Homicide 2 49 2.4 60 2.3 58Suicide 2.4 59 2 50 2.1 52

Children, ages 1-17

2014 2015 2016Rate (per

100,000)

Total deaths

Rate (per

100,000)

Total deaths

Rate (per

100,000)

Total deaths

Accidental poisoning and exposure to noxious substances

21.9 277 26.2 329 35.5 442

Homicide 12.2 154 13.2 166 16.2 201Suicide 13 165 15.7 197 15.8 197

Young adults, ages 18-25


Focus on equity

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Ohio infant mortality rate, by race and ethnicity, 2016

Number of infant deaths, per 1,000 live births


Percent of children ages 3-17 with Attention Deficit/Deficit-Hyperactivity Disorder, by gender, Ohio, 2016

Source: National Survey of Children’s Health

18.3%

12.2%

5.2% 5.4%

OH U.S.

MaleFemale


Percent of children ages 3-17 with Attention Deficit/Deficit-Hyperactivity Disorder, by percent of

federal poverty level (FPL), Ohio and U.S., 2016

*Data value is unreliable due to width of confidence intervals for the estimate


13.1%

10.0%

15.7%

7.9%

0.0%*

7.4%

11.5%

8.4%

OH U.S.

0-199% FPL200-299% FPL300-399% FPL400% FPL or higher


Percent of children ages 3-17 with anxiety, by percent of federal poverty level (FPL), Ohio and U.S., 2016



13.2%

7.7%

0.0%*

7.0%

5.7%6.9%

6.4%6.9%

OH U.S.



Percent of youth ages 12-17 with at least one major depressive episode in the past year, by gender, U.S., 2016

Source: National Survey of Drug use and Health

5.8%

19.5%

Male Female


Percent of youth ages 12-17 with at least one major depressive episode in the past year, by race/ethnicity,

U.S., 2016

Source: National Survey of Drug Use and Health

12.6%13.4%

9.0%9.7%

Hispanic White, non-Hispanic

Black, non-Hispanic

Asian, non-Hispanic


Suicide death rate per 100,000 population,ages 1-25, by gender, Ohio, 2016


2.7

10.6

Female Male


Percent of children ages 0-17 with asthma, by race/ethnicity, Ohio, 2016

Source: Ohio Behavioral Risk Factor Surveillance System (BRFSS) Annual Report

5.8%

9.5%8.9%

13.0%

White, non-Hispanic

Black, non-Hispanic

Hispanic Multi-racial


Percent of children ages 10-17 who are overweight or obese, by percent of federal poverty level (FPL), Ohio and

U.S., 2016



0.0%*

38.1%

0.0%*

37.8%

32.7%31.1%

26.7%23.0%

OH U.S.



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Priority topic areas and outcomes

What do we mean by…

Priority topic

Priority outcome

Priority metric

Priority population

Policy goal

Evidence-based

strategy

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Preliminary priority areas and outcomes

Data

Advisory committee feedback

Prioritization criteria

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Preliminary priority topics and outcomesPriority topic

Maternal and infant health

Mental health and addiction prevention and

treatment

Chronic disease prevention and management

Priority outcome

• Infant mortality

• Preterm birth

• Teen birth

• Suicide deaths• Depression• Attention Deficit/Deficit-

Hyperactivity Disorder (ADD/ADHD)

• Anxiety• Tobacco/nicotine use• Alcohol use

• Childhood asthma

• Active living and healthy eating (healthy weight/obesity, physical activity, food insecurity)

Cross-cutting factor: Access to care at the right time, in the right place

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Preliminary priority topics and outcomesPriority topic


Mental health and addiction prevention and

treatment

Chronic disease prevention and management

Priority outcome

• Infant mortality

• Preterm birth

• Teen birth

• Suicide deaths• Depression• Attention Deficit/Deficit-

Hyperactivity Disorder (ADD/ADHD)

• Anxiety• Tobacco/nicotine use• Alcohol use

• Childhood asthma

• Active living and healthy eating (healthy weight/obesity, physical activity, food insecurity)

Cross-cutting factor: Access to care at the right time, in the right place

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Priority topic Priority outcome Priority Metric Priority population (EXAMPLE)


Infant mortality Infant mortality. Rate of infant deaths per 1,000 live births (Source: Ohio Department of Health Bureau of Vital Statistics)

Black infants

Preterm birth Preterm birth. Percent of babies born prior to 37 weeks of pregnancy (gestation) (Source: Centers for Disease Control and Prevention Vital Statistics)

Black infants

Teen birth Teen birth rate. Total birth rate for females ages 15-19 per 1,000 births (Source: Centers for Disease Control and Prevention Vital Statistics)

Low-income

Preliminary priority metrics and populations

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Small group discussion round one: Provide feedback on priority topics

and outcomes

Small group questionsBased on the Assessment data findings and the purpose of the Assessment, please discuss the following questions within your small group. HPIO will use feedback from the small group discussions to finalize the priority topics and outcomes included in the Assessment.

1. Are the three priority topics (maternal and infant health, mental health and addiction prevention and treatment, chronic disease prevention and management) and the priority outcomes listed under each priority topic the most important priorities to include in the Assessment? If not, what changes do you suggest and what Assessment findings support the change?

2. Is the cross-cutting factor (access to care at the right time, in the right place) framed in a way that will help to develop an effective set of policy goals and strategies for the Assessment?

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Policy goals and strategies

Policy goals are informed by…

Inventory of evidence-based policies and

programs (from evidence registries and systematic review)

Secondary data analysis

Review of children’s hospital and local health department documents

Suggestions and priorities identified by Advisory

Committee

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Inventory of evidence-based policies and programs

Hi-5: Health Impact in 5

Years (CDC)

6/18(CDC)

Community* Guide

(CDC)

What Works for Health*

(U of WI & RWJF)

U.S. Preventive Services Task

Force Recommendations

*Provides indication of whether strategy is likely to decrease disparities36

Prioritization criteria for policy goalsCriteria DescriptionClarity Policy goal intended outcome is clear and wording is

concise, unambiguous and compelling

Realistic within the policy landscape

Likelihood that the incoming state legislature, state agency leadership, and other relevant decision makers would consider acting on the policy goal

Actionable opportunities given current landscape and awareness of the problem in Ohio

Extent to which:• There are stakeholders in Ohio already working

toward this goal• The goal addresses a widely-acknowledged unmet

need in Ohio

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Draft list of actionable policy goalsPolicy goal 1. Strengthen investments in data collection, research and evaluation of strategies that can improve the health of young Ohioans

Policy goal 2. Eliminate gaps in outcomes by ensuring resources, policies and programs are more strategically directed towards young Ohioans at greatest risk of experiencing poor health outcomes

Policy goal 3. Expand access to high-quality early childhood services and supports for low-income families in Ohio

Policy goal 4. Ensure low-income families in Ohio have the opportunity to achieve financial stability

Policy goal 5. Improve housing conditions to reduce asthma triggers and respiratory problems

Policy goal 6. Prevent and reduce risky behaviors among adolescents and young adults in Ohio

Policy goal 7. Prevent and reduce tobacco use in Ohio

Policy goal 8. Ensure young Ohioans have the opportunity to be physically active and eat healthy in their communities and schools

Policy goal 9. Improve social and emotional well-being among young Ohioans

Policy goal 10. Ensure young Ohioans have access to high-quality and coordinated health services and supports

Policy goal 11. Increase access to behavioral health services for young Ohioans

Policy goal 12. Increase access to reproductive health services and supports 38

Prioritization criteria for evidence-based strategiesCriteria DescriptionStrength of evidence of effectiveness

• Extent to which research has proven the recommended strategy to be effective in meeting the intended outcomes

• How rigorously the strategy has been evaluatedBased on HPIO review of the current research evidence registries and literature

Relevance to a child-focused population

• Extent to which research has demonstrated effectiveness of strategy on a child-focused population

• Relevance to the strengths and needs of children in OhioPotential size of impact on priority topic areas and risk factors

Estimated magnitude of impact on factors that contribute to the identified priority topics and outcomes

Potential size of impact on inequities and disparities

• Extent to which research has indicated that strategy is likely to decrease disparities

• Opportunity to tailor or adapt strategy to target children most at risk for the poor health outcome

Scalability and alignment • Opportunity to build upon and expand the reach of work currently underway in Ohio

• Opportunity to scale up existing pilot projects that have shown evidence of effectiveness

Short-term political feasibility (2 years)*

Likelihood that the incoming state legislature, state agency leadership, and other relevant decision makers would consider implementing the strategy

SHIP alignment Strategy is included in the State Health Improvement Plan (or other statewide plans)

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Evidence-based strategy

Brief description Maternal and infant

health

Mental health and addiction prevention

and treatment

Chronic disease

prevention and

management

Cross-cutting factor: Access to care at the right time, in

the right place

Early childhood education

Center-based early childhood education programs aim to improve the cognitive or social development of children ages 3 or 4 years. Programs generally include an educational component that addresses one or more of the following: literacy, numeracy, cognitive development, socio-emotional development, and motor skills. (Hi-5)

x x x

Full-day kindergarten

Full-day kindergarten is a formal program offered for children aged 4 to 6 years in a school or school-like setting, during the school year prior to entering first grade. (CG)

x

Policy goal 3. Expand access to high-quality early childhood services and supports for low-income families in Ohio

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Small group discussion round two:Provide feedback on policy goals

and evidence-based strategies

Small group questions• We would like to identify a list of no more than eight

actionable policy goals and no more than 16 evidence-based strategies that align with the policy goals to include in the Assessment.

• Please reference the criteria for developing a policy goal and identifying an evidence-based strategy.

• HPIO will use feedback from the small group discussions to finalize the priority goals and evidence-based strategies included in the Assessment.

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Next steps

Contact

Reem Aly, JD, [email protected]

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child health and healthcare advisory committee

Documents