Colorado’s MCH Program

Colorado’s MCH program is administered by the Colorado Department of Public Health and Environment (CDPHE). Colorado’s MCH program collaborates with programs across CDPHE, other state agencies and statewide organizations, local public health agencies and community partners to implement strategies that have a population impact on Colorado’s statewide MCH priorities.

2021-2025 MCH Priorities

The MCH Framework for the current five-year block grant cycle is based on the statewide MCH needs assessment and prioritization process that was completed in 2020. Some strategies have continued from the last block grant cycle, in addition to new strategies to address the following seven prioritized needs:

• Increase prosocial connection
• Create safe and connected built environments
• Improve access to supports
• Increase social emotional wellbeing
• Promote positive child and youth development
• Increase economic mobility
• Reduce racial inequities

MCH Priority Implementation

Evidence-informed strategy measures and associated objectives are outlined in logic models and action plans for each priority and are posted on www.MCHColorado.org. The logic models and action plans, used to guide Colorado’s state and local MCH work, are a combination of best and promising practices, along with emerging practices to drive innovation. MCH funds are leveraged with state resources, as well as aligned with other federally-funded programs and initiatives, to support priority implementation efforts. MCH funds are also used to build the capacity of the state and local MCH workforce in the areas of racial equity, community inclusion and moving upstream. Interim progress toward the performance measures is tracked through quarterly performance management reporting and evaluation summaries are produced each year to monitor impact on each priority. A summary for each MCH priority and associated performance measure is included below.

Increase Prosocial Connections

National Performance Measure: Percent of adolescents, ages 12 through 17, who are bullied or who bully others.

Data and research has shown that youth who have a trusted adult are less likely to experience bullying, as well as other health outcomes like suicide and substance use. Research also shows that if prevention efforts are focused on those who are most disproportionately impacted, it will also improve the outcomes for other youth. Evidence-based strategies supported through Colorado’s MCH program include integrating a positive youth development approach into youth-serving programs throughout the state and supporting model policies and practices, such as Gender Sexuality Alliances, which increase trusted adults in young people’s lives and enhances school climate and connectedness. The MCH program also supports the implementation of best practice youth violence prevention programs in schools.

Create Safe and Connected Built Environments

State Performance Measure: Percent of children ages 0-17 years who live in a supportive neighborhood.

Daily experiences such as feeling safe, taking a walk, visiting a park, having healthy food nearby, and being part of social networks are critical to physical, mental, and social well-being. Thoughtful planning and design of a community’s buildings, streets, sidewalks, transportation networks, parks, and homes can make it easier for children, youth, and families to engage, connect with others, and access resources in their communities. Safe and accessible built environments increase opportunities for physical activity by being able to walk, bike, or wheelchair roll to everyday destinations and decrease violence by creating safer environments for people to meet and connect. The MCH program funds built environment staff to build cross-sector partnerships and increase capacity for implementing place-based policy strategies that promote equity, community safety, and activity-friendly routes. CDPHE built environment staff partnered with the Colorado Department of Transportation and the Department of Local Affairs to develop the Revitalizing Main Streets program. Revitalizing Main Streets provided funding to Colorado’s small and rural communities to repurpose their streets for more space for walking, biking, social interaction, and commerce while also social distancing. The program has grown from a $3 million to $30 million program and has now increased to a $115 million dollar program through 2021 state transportation legislation.

Access to Supports

National Performance Measure: Percent of children with and without special health care needs having a medical home

As outlined in the National Standards for CYSHCN, it’s essential that families are kept at the center of their care and inform design and evaluation of programs and services. The Colorado MCH program supports inclusion of diverse community and family members to identify barriers to access to a medical home and to implement equitable solutions to address these barriers. Additionally, the MCH program will continue to work with key statewide partners to influence policy recommendations that support strong co-management and family engagement principles.

When policies, systems, and providers use a family-centered approach, families are more likely to access meaningful supports and services, thereby creating environments where families are engaged, involved, and supported. MCH-funded strategies for this priority focus on: increasing equitable access to and use of specialty care, enhancing provider and system capacity to bridge healthcare and other partners; and using data to identify, illuminate, and address access, utilization, and outcome inequities.

National Performance Measure: Percent of children, ages 10 through 71 months, receiving a developmental screening using a parent-completed screening tool

Colorado remains in the top tier amongst states for developmental screening rates, with rates higher than the national average (50.5% v. 33.5%, respectively). However, 40% of children who receive a referral for early intervention follow up do not complete an evaluation. Barriers between child and family-serving systems in Colorado make it difficult to access and share data to know when children are screened, referred and, ultimately, whether they are able to access needed services. This results in children and families not receiving appropriate and timely support, and providers being unable to coordinate care. To address this challenge, the MCH program is supporting a developmental screening and e-referral pilot project to improve communication and coordination among providers, early intervention partners, and families. 

Increase Social Emotional Wellbeing

State Performance Measure: Percent of women of reproductive age (18-44 years) who report good mental health

As outlined in Postpartum Behavioral Health in Colorado, depression and anxiety continue to be the most common conditions that people experience before and after pregnancy. To improve the awareness and knowledge of pregnancy-related depression among pregnant and postpartum women and to improve women’s perceptions and attitudes toward seeking help, Colorado’s MCH program supports provider education and a statewide public awareness campaign. MCH also coordinates the state’s Maternal Mortality Review Committee. Based on Colorado’s most recent review committee data for 2014-16, suicide and substance use overdose continue to be leading causes of maternal mortality. The MCH program is an active partner in the Colorado Perinatal Care Quality Collaborative, which supports the implementation of the Alliance for Innovation of Maternal Health Opioid Use Disorder bundle with 14 hospitals throughout Colorado.

National Performance Measure: A) Percent of women who smoke during pregnancy

People who smoke during pregnancy are more likely to experience a fetal death or deliver a low birth weight baby. The MCH program partners with the state’s tobacco prevention program to implement evidence-based strategies in every county in Colorado to reduce the number of pregnant people who smoke, such as the community-based Baby and Me Tobacco Free Program and the QuitLine Pregnancy Protocol Program. Quit rates for QuitLine average 28-36% vs. 4-7% for unaided quit attempts. Those who access the Quitline are up to seven times more successful than people who try to quit unaided. A study of the Colorado Baby and Me Tobacco Free Program found program participants saw a 24% to 28% reduction in the risk of preterm birth and a 24% to 55% reduction in the risk of neonatal intensive care unit admissions.

Increase Economic Mobility

State Performance Measure: Percent of households that spend more than 30% of household income on housing costs

As local housing costs have outpaced incomes, households not only struggle to acquire and maintain adequate shelter, but also face difficult trade-offs in meeting other basic needs. The more money Coloradans spend on housing, the less money they have to spend on other critical needs, particularly those that impact health such as healthy food, recreation, and health care. Families with children are particularly at risk for housing insecurity. Affordability and stability are some of the main challenges for families with children, especially if the children are younger than school age. To increase economic mobility, MCH is funding strategies to increase the number of parents who have access to paid family leave. This data brief describes Colorado mothers’ access to paid family leave and the relationship of paid leave to family finances. A 2020 ballot initiative was passed successfully into Colorado state law as the Paid Family and Medical Leave Initiative. The MCH program is supporting awareness of the new law, which is a state-run insurance benefit that requires employers to provide 12 weeks of paid leave in most instances, and up to 16 weeks under certain circumstances. The MCH program is also implementing strategies to identify and overcome barriers to increase the number of Coloradans who access tax credits for which they are eligible. Colorado is tied for the third-lowest earned income tax credit participation rate in the U.S. (73.3%), and has at least 37,000 children in the state who may be eligible for the child tax credit but who haven’t been claimed on a recent tax return.

Promote Positive Child and Youth Development

National Performance Measure: A) Percent of infants who are ever breastfed and B) Percent of infants breastfed exclusively through 6 month

Families experiencing low socioeconomic status have greater breastfeeding disparities, are more likely to experience barriers to breastfeeding, and thus have lower breastfeeding rates. The MCH program is focused on increasing the number of Baby-Friendly designated hospitals that serve high proportions of Medicaid paid births to decrease the breastfeeding disparities.

Research shows as the number of evidence-based Baby-Friendly Hospital Initiative’s Ten Steps to Successful Breastfeeding practices increase in a hospital, breastfeeding rates increase as well. This is especially true for families enrolled in Medicaid or have no health insurance, as well as among families participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), where significant increases in breastfeeding initiation and long term success is shown when Baby-Friendly policies were in place at a hospital.

Reduce Racial Inequities

State Performance Measure: Number of points for racial equity related policy, practices and systems changes implemented at the program, division and department level

Colorado’s MCH program integrates strategies and activities to advance racial equity across each of the priorities. In addition, the program tracks changes to policies and practices and assesses the potential impacts those systemic and institutional changes may have across staff and programs that serve the MCH population.While reducing racial inequities is a priority unto itself, strategies to impact racial inequities are integrated across the action plans for the other statewide priorities.