In This Issue:
- PHS Action Plan for Women's Health
- Comprehensive Child Development Program
- Fetal Alcohol Syndrome
- Medicaid Expansions: Prenatal Care
PHS ACTION PLAN FOR WOMEN'S HEALTH
During the past decade, the issue of women's health gained increasing attention from the public health community. As a result, specific efforts focused on improving the health status of women, raising public awareness of women's health concerns, achieving technological advances in the diagnosis and treatment of disease, understanding how various diseases uniquely affect women, and identifying and reaching women at risk for conditions such as cancer, alcohol and drug abuse, osteoporosis, and depression. In the 1980s the U.S. Public Health Service (PHS), through its Coordinating Committee on Women's Health Issues and its Task Force on Women's Health Issues, conducted comprehensive, nationwide assessments of the health concerns confronting women and recommended actions that could be taken in order to improve women's health status.
The decade of the '90s presents new opportunities for women, and the PHS has renewed its resolve to focus on women's health. The report, PHS Action Plan for Women's Health, presents a comprehensive, agencywide plan that includes specific goals and actions PHS will pursue in promoting women's health. The plan focuses on crosscutting issues that can best be addressed through the combined efforts of the various PHS agencies and offices and is expected to produce results within the next two years. The plan, which builds upon previous PHS efforts and upon the recommendations of Healthy People 2000: National Health Promotion and Disease Prevention Objectives, is designed to provide the necessary leadership to improve the health status of American women.
This plan, developed at the request of the Assistant Secretary for Health with the assistance of the PHS Coordinating Committee on Women's Health Issues, is a framework that includes initiatives in the areas of research, prevention, treatment, health education, training, services, policy, and data collection and analysis. Some of the areas targeted by the Action Plan include substance abuse; mental illness; health services research; the prevalence of smoking among women; breast and cervical cancer; HIV infection in women and children; health professions trainees' knowledge of women's health issues; research on conditions such as osteoporosis, cancer, and sexually transmitted diseases; health concerns of minority women; and immunization.
The newly established PHS Office on Women's Health within the Office of the Assistant Secretary for Health oversees implementation of the Action Plan. Dr. Agnes Donahue, Director of the Office on Women's Health, can be reached on 202-245-7650. Copies of the plan, #1624.1, are available from PIC.
COMPREHENSIVE CHILD DEVELOPMENT PROGRAM--A NATIONAL FAMILY SUPPORT DEMONSTRATION
Historically, human services systems for low-income families have been criticized as being fragmented because they have focused on achieving singular objectives and have attempted to serve some, but not all, family members. Three decades of research on early intervention programs have shown that these programs work best if they begin at or before the child's birth and continue until entrance into school; if they focus on the child's intellectual, social, emotional, and physical development; if they include all family members as program participants; and if they coordinate service delivery with agencies already serving the community. The Comprehensive Child Development Program (CCDP) accomplishes all of these goals.
Established in 1988 with the passage of the Comprehensive Child Development Act, CCDP provides low-income children with intensive, comprehensive services such as health care, early childhood education, developmental screenings and assessments, and nutrition services from the time of the child's birth until enrollment in school. These programs also serve parents by providing them with prenatal and postpartum care, training in infant and child development, mental health care, vocational training, and substance abuse education and treatment. The ultimate goals of the program are to enable families to become economically and socially self-sufficient and to reduce welfare dependency.
The report, Comprehensive Child Development Program -- A National Family Support Demonstration, assesses how well the CCDP demonstration has been implemented after the first 18 months of funding and addresses management issues regarding CCDP operations. The process evaluation involved reviewing management information system (MIS) data and visiting 12 of the 24 CCDP grantees.
The analysis shows that the projects initially had difficulties recruiting the targeted number of families by the enrollment deadline. Grantees had, however, established linkages with clinics, medical centers, mental health facilities, and drug and alcohol treatment centers to provide clients with routine health care, individual and family counseling, substance abuse treatment, and other services. Case management was a key aspect of CCDP, allowing the projects to build relationships with families and to coordinate the delivery of services. The 12 grantees visited had developed a core of qualified staff who were committed to the program.
Additionally, the process evaluation reveals that the projects that were most successful in implementing CCDP generally had strong management teams; attempted to phase in program operations and start-up tasks, rather than undertaking many activities simultaneously; and had ready access to community resources.
The report concludes that, although the first year of CCDP was a challenging one, the projects were already having a positive impact upon the families being served. Staff members had already begun to see changes in families' attitudes toward life and in parents' feelings of self-esteem and efforts to become self-sufficient.
The report was written by CSR, Incorporated, and Information Technology International under contract to the Head Start Bureau, Administration on Children, Youth and Families. The study's project officer, Allen N. Smith, can be reached on 202-245-0566. Copies of the executive summary, #4426, are available from PIC.
FETAL ALCOHOL SYNDROME AND PREGNANT WOMEN WHO ABUSE ALCOHOL: AN OVERVIEW OF THE ISSUE AND THE FEDERAL RESPONSE>
Alcohol consumption by pregnant women has been the subject of research for 20 years and has been linked to physical and behavioral abnormalities and birth defects. In the early 1970s researchers identified Fetal Alcohol Syndrome (FAS), which affects 4,000 to 12,000 infants annually; is caused by chronic, heavy drinking among pregnant women; is the leading known preventable cause of mental retardation; and is associated with growth retardation, nervous system dysfunction, and abnormal facial features. When fetal abnormalities can be attributed to the mother's drinking but FAS has not been diagnosed, the term alcohol-related birth defects (ARBD) is used.
The report, Fetal Alcohol Syndrome and Pregnant Women Who Abuse Alcohol: An Overview of the Issue and the Federal Response, reviews the impact of FAS and ARBD, describes prevention and intervention strategies that aim to reduce the incidence of these conditions, examines gaps in knowledge and services, and discusses specific initiatives that federal agencies are undertaking in response to FAS and ARBD.
The study reveals that the human and societal costs of FAS are high. In 1985, the cost of treating the birth defects caused by FAS was estimated at $1.6 billion. Other costs linked to the syndrome, such as psychological costs to children, emotional costs to parents or other caregivers, and the loss of productivity, are difficult to quantify. Research also shows that a large percentage of individuals with FAS do not live with their natural families, that many FAS children eventually come into contact with the child welfare system, and that these children often experience multiple foster care placements because their needs can overwhelm foster parents.
Accordingly, a variety of strategies have been initiated to address the problem of FAS and ARBD. Primary prevention efforts, designed to avert the occurrence of the problem, include conducting public information campaigns, educating the children of alcoholics about the risks of alcohol abuse, and preventing additional alcohol-exposed pregnancies by increasing knowledge and use of contraceptives among women who drink. Secondary prevention, which focuses on treating pregnant women and women of childbearing age for alcohol abuse, employs individual and group therapy, family and marital therapy, and social skills training. Tertiary prevention attempts to minimize long-term disability and reduce the negative effects stemming from FAS. These interventions include diagnosing and reporting the condition and providing comprehensive services for infants with FAS and ARBD and their families.
The report also identifies areas in which further research is needed and describes barriers that impede services to the FAS-affected population. Specifically, policymakers need to know why some children, but not others, are affected by their mothers' drinking; how the father's alcoholism affects the development of the fetus; and which factors place the fetus at greater risk of FAS or ARBD. Additionally, improvements are needed in (1) the detection and diagnosis of FAS and ARBD; (2) surveillance and data collection; (3) prevention of alcohol abuse in pregnant women; (4) treatment and follow-up for alcohol abuse; and (5) appropriate interventions and services for individuals with FAS and ARBD across the life span.
Finally, the report provides an extensive listing of the ways in which the federal government is responding to FAS. The assessment outlines specific initiatives that HHS has undertaken in the areas of FAS research, surveillance, data collection, services, benefits, and alcohol abuse prevention and treatment.
The study was conducted by the Office of the Assistant Secretary for Planning and Evaluation. The study's project officer, Emily Novick, can be reached on 202-245-1880. Copies of the final report, #4423, are available from PIC.
MEDICAID EXPANSIONS FOR PRENATAL CARE: STATE AND LOCAL IMPLEMENTATION
In recent years congressional concerns about the health status of pregnant women have led to eligibility expansions for Medicaid-covered prenatal care. The impetus for the expansions stemmed from the high cost of caring for low- birthweight babies, versus the cost of providing prenatal care; the infant mortality rate; and the growing numbers of low-income women who are not insured for prenatal care.
The inspection, Medicaid Expansions for Prenatal Care: State and Local Implementation, examines state and local efforts to carry out the expansions and to overcome barriers that inhibit the provision of prenatal care. The project involved site visits to 19 communities within eight states, a national survey of the officials responsible for implementing the expansions, and interviews with Medicaid providers, eligibility supervisors, and workers.
The review determines that, to enhance women's access to Medicaid-covered prenatal services, states set their income standard at 133 percent of the federal poverty level and also implemented a number of optional eligibility expansions. Problems such as states' lack of client outreach, difficulties in recruiting providers, and lack of staffing as well as women's failure to complete the application process, however, still prevent newly eligible women from receiving the services.
The inspection also reports that states have taken additional steps to enhance the availability of prenatal care. Several states have developed comprehensive client outreach materials, while others have streamlined the application process, offered incentives to recruit new health care providers, or used case managers to provide prenatal care packages.
In order to expand pregnant women's access to these services, the report recommends that the Health Care Financing Administration (HCFA) develop a comprehensive outreach strategy, monitor the implementation of the expansions, develop incentives to encourage provider participation, and streamline the application process. The study also advises that HCFA develop data collection systems so that the progress of the expansions can be measured and that it establish a centralized authority that will have full responsibility for implementing the expansions.
HCFA's response to the recommendations, contained in Appendix I of the report, states that the agency could work with the Public Health Service (PHS), Administration for Children and Families, state Medicaid directors, and others to identify common elements of effective outreach efforts. HCFA could then develop guides for state agencies illustrating these elements in practice. HCFA concurs that more data are needed to assess the efficacy of the expansions and is working with PHS to develop a national data system that will link birth, death, and Medicaid claims records for infants up to age 1. The agency also has contracted for research to evaluate the expansions. Finally, HCFA agrees that recruiting and retaining providers is an important part of the initiative and is formulating regulations for obstetrical and pediatric payment rates.
The inspection was conducted by the Office of Evaluation and Inspections, Office of Inspector General. Copies of the final report, #4427, are available from PIC.
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SERVICES AVAILABLE FROM THE PIC
The Policy Information Center (PIC) is a centralized source of information on in-process, completed, and on-going evaluations; short-term evaluative research and; policy-oriented projects conducted by HHS as well as other Federal departments and agencies. The PIC on-line database provides project descriptions of these studies. It is available on-line at: http://aspe.hhs.gov/PIC/. Inquiries regarding PIC services should be directed to Carolyn Solomon, Technical Information Specialist, at 202-690-5694. Or E-mail PIC at: firstname.lastname@example.org