The mission of the California Department of Public Health (CDPH) is to protect the health and well-being of people and communities in California. As part of CDPH and the Center for Family Health (CFH), the mission of the Maternal, Child and Adolescent Health (MCAH) Division is to support CDPH by implementing strategies to improve and foster health, support the development of children and adolescents, and promote well-being and health equity across the reproductive life course. The Title V Maternal and Child Health (MCH) Block Grant provides core funding to California that allows MCAH to lead, fund, partner, and support activities to meet its mission.
Through Title V funding, MCAH leads efforts to reduce maternal and infant mortality, implements and supports a variety of programs such as the Black Infant Health (BIH) Program, the Comprehensive Perinatal Services Program (CPSP), and the Adolescent Family Life Program (AFLP).
CDPH/MCAH funds 61 Local Health Jurisdictions (LHJs) comprised of 58 county and three city health departments that differ widely by population and socioeconomic factors and vary from urban to rural to frontier areas. LHJs play a critical role in the collaborative development of policies and programs that drive the MCAH mission and receive 48% of California’s Title V funding for local implementation of services.
CDPH/MCAH also funds other partners including State and local agencies, community-based organizations, and universities to drive programmatic efforts that improve the health of the MCAH population. In addition, California receives Federal Maternal, Infant, and Early Childhood Home Visiting funding to lead home visiting programs across the State and state general funds to support this work.
CDPH/MCAH collaborates with partners across the State that support our mission and partners with and supports a number of entities including the CDPH/Office of Oral Health, CDPH Violence Prevention Initiative, Department of Health Care Services (DHCS), California Maternal Quality Care Collaborative (CMQCC), California Perinatal Quality Care Collaborative (CPQCC), and the Preconception Collaborative Improvement and Innovation Network (CoIIN) Project. MCAH lends its support to improve issues such as preconception health, maternal mental health, opioid addiction, developmental screening, and maternal and infant nutrition.
The following is an overview of the eight MCAH priority health areas that CDPH/MCAH leads, funds, partners, or supports through Title V funding.
Priority 1: Improve access and utilization to comprehensive, quality health services for women.
CDPH/MCAH funds 61 LHJs to develop and implement activities to improve the health and well-being of women and families. Programs and initiatives aim to serve California's diverse population and provide best practice interventions, resources, and information on topics such as reproductive health, family planning, healthy pregnancy, access to prenatal care, and intimate partner violence.
In collaboration with the LHJs, CDPH/MCAH leads the Comprehensive Perinatal Services Program (CPSP). The program delivers a wide range of culturally competent services to Medi-Cal eligible, low-income pregnant and postpartum women, from conception through 60 days postpartum. In addition to standard obstetric services, women receive enhanced services in the areas of nutrition, psychosocial support, and health education.
The 2018-20 California Preconception CoIIN, led by CDPH/MCAH, the March of Dimes, and other state preconception health experts aims to develop, implement, and disseminate a woman-centered, clinician-engaged, community-involved approach to the well-woman visit to improve the preconception health status of women of reproductive age, particularly low-income women and women of color.
CDPH/MCAH partners with the CDPH/Sexually Transmitted Diseases (STD) Control Branch to support the needs of our LHJs to address sexual health issues and congenital syphilis in California. CDPH/MCAH and the STD Control Branch partner in ongoing, regular discussions regarding areas to work together regarding congenital syphilis prevention and control. CDPH/MCAH participates in the STD Control Branch, perinatal communicable diseases working group, and partners to convene an in-person congenital syphilis meeting.
CDPH/MCAH also partners with the CDPH/Center for Healthy Communities in a department wide Violence Prevention Initiative with a focus on building resiliency, reducing exposure to Adverse Childhood Experiences (ACEs) and promoting better understanding of the critical constructs for healthy relationships.
CDPH/MCAH was awarded the Public Health Crisis Response Notice of Funding Opportunity to improve provider and hospital knowledge and practice on perinatal opioid screening and referral of women with opioid use disorder. The Centers for Disease Control and Prevention (CDC) will fund MCAH to accomplish the work and the Association of State and Territorial Health Officials (ASTHO) will fund the California American College of Obstetricians and Gynecologists. Additionally, ASTHO will develop a perinatal opioid/substance abuse public health toolkit. The University of California, San Francisco Family Health Outcomes Project was contracted to promote the toolkit throughout MCAH and Special Supplemental Nutrition Programs for Women, Infants, and Children (WIC) in targeted high-need counties.
CDPH/MCAH leads the development and implementation of the Maternal and Infant Health Assessment (MIHA) survey. MIHA is a collaborative effort of the MCAH Division, WIC and UCSF Center on Social Disparities in Health. MIHA collects self-reported information about maternal and infant experiences and about maternal attitudes and behaviors before, during and shortly after pregnancy. In summer 2018, MIHA released and distributed a data brief on the symptoms of depression during and after pregnancy.
CDPH/MCAH and a volunteer advisory group leads the California Diabetes and Pregnancy Program (CDAPP), Sweet Success©, that provides comprehensive technical support and education to medical personnel and community liaisons to assist in promoting improved pregnancy outcomes for women with pre-existing diabetes and women who develop diabetes while pregnant. The CDAPP Sweet Success© Affiliates is an organization made up of medical providers who undergo standardized training and use the CDAPP Sweet Success© Guidelines for Care to provide direct patient care to women with diabetes while pregnant.
CDPH/MCAH leads and supports the Regional Perinatal Programs of California (RPPC). RPPC evolved from the need for a comprehensive, cooperative network of public and private health care providers within geographic areas to assure the well-being of pregnant women and their babies and to promote access to appropriate levels of high quality care. RPPC provides quality improvement resources, consultation, and technical assistance to hospitals and health care providers.
CDPH/MCAH provides funding for Stanford University’s California Maternal Quality Care Collaborative (CMQCC) to end preventable morbidity, mortality and racial disparities in California maternity care. CMQCC uses research, quality improvement toolkits, statewide outreach collaborative and its innovative Maternal Data Center to improve health outcomes for mothers and infants.
CDPH/MCAH leads the California Home Visiting Program (CHVP). CHVP funds agencies to implement evidence-based home visiting models, including Nurse-Family Partnership (NFP) and Healthy Families America (HFA). CHVP collaborates with Title V funded programs on the implementation of common objectives and opportunities.
Perinatal/Infant Health Domain
Priority 2: Reduce infant morbidity and mortality.
CDPH/MCAH funds and partners with all 61 LHJs to lead and support the California Sudden Infant Death Syndrome (SIDS) Program. The SIDS Program promotes public awareness and education of newborn and infant care practices to reduce the risk of SIDS through the dissemination of educational and informational materials. In addition, the Program provides crisis intervention and grief/bereavement support services for parents who have experienced the sudden unexpected loss of their infant.
CDPH/MCAH funds the Fetal and Infant Mortality Review (FIMR) in 16 LHJs. FIMR is a community-based initiative that reviews contributing factors to fetal and infant deaths within a LHJ. FIMR community groups identify the necessary actions to prevent these deaths, thus improving health services for families.
CDPH/MCAH leads the implementation of the Black Infant Health Program (BIH) in 14 LHJs to reduce Black infant mortality. BIH focuses its implementation strategy on the key contributing factors of disparities, namely the toxic stress of chronic racism. Participants learn proven strategies to reduce stress and develop life skills through a group-based approach with complementary case management.
CDPH/MCAH will establish the Perinatal Equity Initiative (PEI) in 2019 through State General Funds to address the causes of persistent infant mortality inequality and identify best practices to address Black/White disparities in infant mortality. PEI will promote the use of specific interventions designed to fill gaps in current programming offered through the BIH Group Model.
CDPH/MCAH funds the California Perinatal Quality Care Collaborative (CPQCC) to improve the quality of care for California’s most vulnerable infants. CDPH/MCAH shares a common goal of improving health care outcomes of Newborn Intensive Care Unit (NICU) babies through data surveillance and the implementation of hospital quality improvement projects.
CDPH/MCAH is the lead for maintaining and disseminating CDPH’s Infant Feeding Guide as a tool for California programs and providers to provide consistent messaging. Through the RPPC contract, CDPH/MCAH takes the lead in developing the Model Hospital Policy and providing breastfeeding policy education to California’s labor and delivery hospitals.
Priority 3: Improve the cognitive, physical and emotional development of all children.
Priority 8: Increase the proportion of children, adolescents and women of reproductive age who maintain a healthy diet and lead a physically active lifestyle.
CDPH/MCAH funds the California Statewide Screening Collaborative (SSC), a multi-agency organization, in partnership with the Department of Developmental Services, to improve developmental screening and referrals in California. The SSC develops and shares resources for providers, including the Healthcare Provider Developmental Screening Toolkit. CDPH/MCAH programs (CHVP, AFLP, and BIH) incorporate information on child development and developmental screening for participants.
In FFY 2019, CDPH/MCAH will provide technical assistance to the new Undersecretary of Health’s Advisory Council on Early Childhood Development as well as provide data and support to the new California Surgeon Generals whose current focus is addressing the negative health impacts of traumatic experiences in childhood. For 2019-20, the Governor’s Budget proposes to allow Medicaid providers to bill and receive reimbursement for both developmental and trauma screening of children and youth and in their care using Proposition 56 funding.
The Nutrition and Physical Activity Initiative (NUPA) works to make nutrition and regular physical activity the preferred lifestyle choice for women of reproductive age and their families. This includes increasing the percent of women with recommended weight gain during pregnancy, folic acid intake prior to pregnancy, and reducing childhood obesity.
Children and Youth with Special Health Care Needs (CYSHCN) Health Domain
Priority 4: Provide high quality care to all CYSHCN within an organized care delivery system.
Priority 5: Increase access to California Children’s Services (CCS)-paneled providers such that each child/youth has timely access to a qualified provider of medically necessary care.
CDPH/MCAH partners with DHCS/CCS program and other partners to improve systems of care at the state and local level, promote coordination between agencies, and provide case management, family engagement, screening and links to services.
CDPH/MCAH is currently engaged in a year of learning to connect with stakeholders, build partnerships, and expand knowledge about the greatest needs and opportunities to support CYSHCN and their families. CDPH/MCAH is partnering with Family Voices of California to provide training and support to LHJs on how to involve families at the local level.
Other CYSHCN highlights from the past year include two stakeholder meetings bringing together experts from different organizations and sectors, including family members to share information and coordinate through a collaborative of the Big 5 states (California, Florida, Illinois, New York, and Texas). CDPH/MCAH also established the role of the Title V CYSHCN Director within MCAH for the first time.
Priority 6: Promote and enhance adolescent strengths, skills and supports to improve adolescent health.
CDPH/MCAH funds AFLP to implement a strengths-based case management program to support expectant and parenting youth in California. AFLP is implemented in 20 LHJs and community-based organizations in 18 counties with high need for services. CDPH/MCAH has led the development, implementation and evaluation of the evidence-informed Positive Youth Development (PYD) Model for expectant and parenting youth. The PYD Model is based on a resiliency framework, which holds that all youth have strengths and benefit from protective factors that include supportive relationships, high expectations, and opportunities to make meaningful contributions in their lives, families and communities.
CDPH/MCAH leads and partners to advance adolescent sexual health and wellness among youth through the statewide Adolescent Sexual Health Work Group (ASHWG). ASWHG is a strategic governmental and non-governmental partnership working to strengthen systems and collaboration between public health, health care, education, and social services to improve adolescent sexual and reproductive health outcomes and health equity, increase access to exemplary sexual health education and services, and promote positive youth development and healthy relationships among California youth.
CDPH/MCAH is committed to hearing the youth voice as demonstrated through a youth panel at the Youth Tech Health conference organized in partnership with ASHWG and the CDPH/MCAH story telling series highlighting the successes of youth that participated in AFLP.
CDPH/MCAH partners as a core team member of the California Adolescent Preventive Health Initiative to improve the quality of and access to preventive health care for adolescents. In addition, CDPH/MCAH supports the department’s school-based health center initiative.
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