EXECUTIVE SUMMARY

GUAM’S MCH POPULATION

Guam's population was estimated at 167,358 in 2018, a growth of 8,000 persons from the official census figure of 159,358 in 2010. The estimated population represents a 5.4% increase from the census figure of individuals who call Guam home. Over half of the population (58%) is age 25 or older. The estimated median age is 30.4 years. Males slightly outnumber females, with an overall sex ratio of 1.03; however, for those aged 25 years and older, the sex ratio is 1.0.

Guam’s population is multi-ethnic/multi-racial. Chamorros comprise the largest ethnic group, accounting for 37.2% of the total population. Filipinos make up 26.3%, Whites make up 6.8%, and Other Pacific Islanders comprise 11.5%. The ethnic group with the fastest rate of increase is the Chuukese population; from only 0.1% in 1980, Chuukese currently make up 7% of the population, a 7,000% increase.

GUAM’S FRAMEWORK FOR NEEDS ASSESSMENT, PROGRAM PLANNING, AND PERFORMANCE

The MCH & CSHCN Program is operated as a single organizational unit and serves as both local and state agencies. This single State agency is authorized to administer Title V funds and is responsible for both Maternal and Child Health and Special Needs Children Services.

The services coordinated through the Title V MCH Program in Guam can be broadly grouped into three categories:

• Preventive/primary care services for all pregnant women, mothers and infants up to age one;
• Preventive and primary care services for all children; and
• Services for children and youth with special health care needs (CYSHCN)

In an effort to improve the health and well-being of MCH populations under these three broad categories, the Guam Title V agency followed HRSA / MCHB guidelines to identify the needs and develop strategies/action plans to address those needs. Pursuant to identifying and prioritizing the needs through the five-year needs assessment process, resources are assigned, and program activities are implemented to address these priorities specifically. Guam's five-year needs assessment process led to the identification of the following eight national and five state priority areas that will be targeted through 2025 by the Guam Title V program:

• Women’s Health Priority Need - To improve maternal health by optimizing the health and well-being of women of reproductive age.
• Infant Health Priority Need - To reduce infant mortality and morbidity.
• Child Health Priority Ned - To improve cognitive, physical, and emotional development of all children.
• Adolescent Health Priority Need - To promote and enhance adolescent strengths, skills, and supports to improve adolescent health.
• Children with Special Health Care Needs Priority Need - To provide a whole child approach to services to children and youth with special health care needs.

The priority needs of the state's Title V Program related to the performance measures are discussed in the respective performance measure narrative. Progress is monitored by tracking each of these performance measures. Both budgeted dollars and expenditures are categorized and tracked across the three service levels in the MCH Pyramid: direct health care services, enabling services, and public health services and systems.

In completing the 2021 application, Guam reviewed our previous objectives and strategies in order to maintain alignment of our activities with the core needs of improving the health and well-being of the MCH population. During this process, objectives and strategies across all MCH population domains were identified for continuation, revision, or completion. This process enables Guam to establish how activities are correlating with the state established National Priority Measures (NPM), State Performance Measures (SPM), and Evidence-Based or -Informed Strategic Measures (ESM).

DOMAIN: WOMEN/MATERNAL HEALTH

A well-woman visit and/or preconception visit provides a critical opportunity to receive recommended clinical preventive services as well as anticipatory guidance to ensure the health of future pregnancies.

Good health is an important contributor to an individual’s quality of life and general well-being, as well as a vital indicator of a population’s health. According to the 2018 BRFSS, over 80% of women rated their general health as good, very good, or excellent, very similar to the percentage of U.S. women who rated their general health as good, very good, or excellent.

Younger women (18 to 49 years old) were more likely to report good to excellent health than women older than 45 years of age. In 2018, 57% of women aged 25 to 34 years reported good to excellent health, followed by 49% of women aged 45 to 64 years, followed by 27% of women aged 35 to 44, 26% of 18 to 24 years, and finally 21% of women aged 65 and older. 

Data from the Guam BRFSS show that an estimated 75.9% of adult women on Guam received a preventive medical visit in 2018 and 70.3% in 2017. The national estimate for 2017 was 70.4%. In 2018, the prevalence of Guam women having a routine check-up within the past year increased with household income levels. Fewer women with less than a high school education (63.7%) reported having had a routine check-up within the past year than did women who were high school graduates (78.5%) had some college (74.7%) or were college graduates (84.6%) in 2018.

Strategies identified in the MCH action plan include: 1) Ensure comprehensive preconception health care services; 2) Partner with stakeholders and relevant health care providers to increase the prevalence of women receiving preventive health visits; and 3) Develop culturally and linguistically policies and protocols to reduce discrimination, disparities, and stigmatization related to maternal health and wellness issues.

DOMAIN: INFANT HEALTH

As reported in the National Immunization Survey (NIS), the percentage of infants who were ever breastfed peaked in 2014 at 86%, that percentage declined in 2016 by 3.6%. However, Guam reached the Healthy People 2020 target of 81.9%.

While Guam has high initiation rates of breastfeeding, exclusive breastfeeding is significantly lower. Research has shown that breastfeeding benefits are highest when the baby is exclusively fed breastmilk for the first six months. In 2019, only 16% of mothers receiving WIC reported exclusive breastfeeding at three months, and that percentage decreased to 6% at six months. The National Immunization survey reports higher rates within the general population. At three months, 46.8% of mothers reported exclusive breastfeeding, and 26.4% reported exclusive breastfeeding at six months in 2016.

There have been 317 fetal deaths on Guam between the years 2013 and 2019. The fetal death rate for the seven years combined was 13.8 per 1,000 live births. The number of stillbirths was higher than infant deaths for most of the last 20 years. Guam defines a fetal death as the death of a fetus, 20 weeks' gestation, or when a fetal death occurs to a fetus, which weighs 350 grams.

Strategies identified in the MCH action plan include: 1) Promote and support breastfeeding in the family home visiting program through training and referrals to WIC breastfeeding support, including peer support where available. 2) Increase data collection and reporting capacity by collecting data on breastfeeding exclusivity and improving reporting on breastfeeding measures by cultural identity.

DOMAIN: CHILD HEALTH

Data from an evaluation report from Project Kariñu demonstrated that many children with social-emotional and behavioral challenges had been exposed to multiple risk factors. Caregivers reported that 28.9% of children had witnessed domestic violence; 47.8% had lived with someone with depression; 18.5% had lived with someone with a mental illness other than depression; 23.8% had lived with someone convicted of a crime, and 28.8% had lived with someone with a substance abuse problem.

Strategies identified in the MCH action plan include: 1) Promote resources that provide information and referral services to providers and/or families after a concerning screening result and information and referral hotline and website resources 2) Collaborate with home visiting to facilitate related to developmental screening 3) Connect families to information, community-based services and resources related to pregnancy, child development, parenting, and basic needs.

DOMAIN: ADOLESCENT HEALTH

Well-visits for adolescence foster healthy development by focusing on physical, developmental, social, and emotional well-being. During the visits, providers check physical and mental development using established screening methods, which provides opportunities for early identification, management, and intervention for conditions and behaviors and persist into adulthood.

There were 134 that answered questions in the 2019 CHNA. The majority of the adolescents were aged 14 to 16 years (39.4%), followed by ages 11 to 13 years (37.9%), and lastly, adolescents 17 to 18 years at (22.7%). When asked about their health insurance, 74.6% had Medicaid, 9.7% had MIP, 6.2% had private health insurance, 7.5% had no health insurance, and 1.7% did 'not know what kind of health insurance they had.  

When asked what they thought about their health, 46.6% stated they were in “good health," 29% stated their health was "very good," 114.5% stated their health was "excellent," 8.4% said their health was "fair," and 1.5% stated their health was "poor."

Strategies identified in the MCH state action plan include: 1) Obtain data on the current bullying prevention efforts being implemented in schools.2) Strengthen DPHSS internal capacity to address bullying as a public health issue by providing professional development on bullying and strategies to promote social and emotional wellness.3) Provide evidence-informed LGBTQ cultural competency training to MCH staff who serve adolescents.

DOMAIN: CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS

A medical home is a family-centered approach to comprehensive primary care that values the whole person, communication with patients and families, and coordination of care. Medical homes provide accessible, compassionate, and culturally competent care. A medical home is important for all children, including children and youth with special healthcare needs (CYSHCN

In the 2017 CHNA, parents were asked if their child had any medical condition  - 32.7% responded that their child had asthma, 30.6% had bronchitis, 14.3% had pneumonia, 8.2% had poor eyesight, 6.1% had hearing problems, 2% had heart conditions, and 8.2% of children had "other" medical conditions.

When asked where their child received health care, the majority (44.8%) of parents took their child went to NRCHC for their primary care needs and 30.2% took their child to SRCHC, 14.5% took their child to a private doctor's office, 5.2% took their child to the central public health clinic, 2.4%  had not taken their child to see a provider, 2% took their child to public health extended outreach for medical care.

In 2019, the medical conditions identified by parents were asthma (15.9%), bronchitis (8.7%), pneumonia (1.5%), seizures (5.8%), heart conditions (4.4%), and “other” medical conditions (37.7%).

When asked where their child received health care, 56.7% took their child to NRCHC, 29.9% went to SRCHC, 9.5% went to a private clinic, 1.5% took their child to extended outreach 0.5% had no care.        

Strategies identified in the MCH state action plan include: 1) The Guam MCH program is focusing efforts on the care coordination component of medical home around the areas of family empowerment, system navigation, education, and referral to medical and community-based resources; 2) Guam MCH will maintain its critical Title V role in key areas: Information and Referral, Education and Advocacy, and Systems of Care for children and youth with special

health care needs, and 3) Guam MCH will continue to assist families in accessing appropriate care and services by providing information and referral services to health care, insurance, and community resources for children and youth with special health care need to best meet their needs.

Partnerships and Collaboration

There are also multiple collaborations ongoing between Title V programs and other Guam DPHSS program areas. Those partners include the Office of Vital Statistics, Bureau of Community Health that houses - Chronic Disease Prevention, Tobacco and the Guam Diabetes Program, the HIV and STD Prevention Program, the Guam WIC Program, the Guam Immunization Program, Division of Environmental Health and The Office of Performance Improvement Management.

Several agencies, programs, and community-based organizations serve vulnerable populations comprised of women of reproductive age, children, and adolescents (especially those with special health care needs). Coordination with all these agencies, programs, and community-based organizations is vital in order to reduce the duplication of efforts and fragmentation of services.

Guam MCH has long-standing relationships with numerous public and private organizations and service providers to carry out the scope of work within the MCH Block Grant. Initiatives for partnerships with governmental agencies and non-governmental agencies continue to flourish on Guam. The methodology for supporting and initiating such collaborations comes from different sources. Many times, the directives for the collaborations come from political leaders and state agency heads. Where the Needs Assessment is concerned, partnering methods are developed through strong networking and seeking out nontraditional partners to bring to the table. Guam's needs assessment process has revealed the need to implement collective impact strategies and strategically align partnerships for more focused work. These partnerships are vital to the strength of any Needs Assessment process and improve outcomes for Guam families