Maternal, Child and Adolescent Health Publications
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Children's Asthma Management: Partnering to Improve Clinical Training, NIHCM Foundation, February 2015. 2 pp.
Uncontrolled pediatric asthma accounts for over 600,000 emergency room visits in the U.S. each year and is responsible for the highest total costs of any preventable pediatric hospitalizations. To reduce these traumatic and costly events, Health Care Service Corporation and the American Lung Association of the Upper Midwest teamed up to help health care providers with high-risk patients integrate guidelines-based asthma care into their practices. The result: patients are showing sustained improvement across asthma care quality metrics. This fact sheet lays out the structure of the project, including how project partners identify and communicate with providers, the promising results, and the scalability of this approach.
Preventing Early Childhood Obesity in North Carolina, NIHCM Foundation, September 2014. 2 pp.
More than 8 percent of two- to five-year-olds are obese, and another 23 percent are overweight and at substantial risk of becoming obese by the eighth grade. These early years are a critical time to focus on the development of healthy habits. In 2011, the Blue Cross and Blue Shield of North Carolina Foundation and the North Carolina Partnership for Children developed Shape NC to help improve the nutrition and physical activity of young children through child care centers and community alliances. This new fact sheet highlights the early success of Shape NC and details plans to expand the initiative, to refine the way outcomes are measured and to deploy a new evidence-informed framework for community-led systems change.
Born Too Early: Improving Maternal and Child Health by Reducing Early Elective Deliveries, NIHCM Foundation, March 2014. 12 pp.
Despite the potential consequences for babies, up to 10 percent of pregnant women opt to deliver through C-section or induction prior to 39 weeks gestation without medical indication. Many women are unaware that early elective deliveries are associated with serious risks such as low birth weight and respiratory distress syndrome, not to mention poor maternal outcomes and higher costs. The American College of Obstetricians and Gynecologists has long recommended against early elective deliveries and has now issued guidelines calling for safe prevention of C-sections across the board. This brief highlights strategies for public and private collaboration around education and payment reforms to put an end to unnecessary and dangerous early deliveries.
Missed Opportunities to Prevent Cervical Cancer: Strategies to Increase HPV Vaccination, NIHCM Foundation, March 2014. 3 pp.
The CDC has declared adolescent vaccination against human papillomavirus (HPV) one of the top five public health priorities of 2014. Last month the President's Cancer Council also issued an urgent call to action to improve HPV vaccination rates. HPV vaccination has failed to keep pace with recommendations despite the fact that the available vaccines are safe and effective at preventing devastating cancers and other HPV-related illnesses. This fact sheet lays out barriers to HPV vaccination and highlights strategies health plans can use to improve uptake of the vaccines.
Community Partnerships to Prevent Childhood Obesity in Florida, NIHCM Foundation, October 2013. 2 pp.
For over a decade, rising obesity rates have topped the nation’s child health concerns, with one in three youth now overweight or obese. While we may be seeing these trends begin to subside, sustained progress will depend on continued action by the government, communities and the private sector. Across Florida, communities have been taking action to address childhood obesity with support from an initiative of the Florida Blue Foundation. Through Embrace a Healthy Florida, six organizations in different parts of the state are given resources and training to build coalitions and distribute grants for local prevention activities. This Promising Practices in Maternal and Child Health fact sheet looks at how a community-driven approach has allowed the Florida Blue Foundation to target efforts based on the specific needs and opportunities facing a diverse state.
Bringing the Blue Zones® to Iowa–Collaborating to Improve Statewide Health, NIHCM Foundation. February 2013. 2 pp.
Iowa is on a mission to become the healthiest state in the nation by 2016, and it has a plan. One of the centerpieces of that plan is the Blue Zones Project, a cutting-edge program to improve individual health through community-wide environmental and social change. Project partners Wellmark Blue Cross and Blue Shield, Healthways, and Blue Zones, together with local leaders, are working to restructure communities in a way that guides residents toward healthier behaviors. This Promising Practices in Maternal and Child Health fact sheet describes the evidence and theory behind the Blue Zones Project and how stakeholders in 19 demonstration sites are working to make healthy lifestyles the local custom.
Fostering Healthy Families Through Stable Housing—The Role of the Health Care System, NIHCM Foundation. November 2012. 3 pp.
The 1 in 45 children who are homeless in the U.S. are sick four times as often as their peers and are more likely to suffer from acute and chronic illness. Although the Affordable Care Act promises better care for some of these children through expansions in Medicaid eligibility and funding for federally qualified health centers, insurers also have a powerful role to play in addressing this complex, cross-sector issue. This fact sheet considers how health plans and their foundations can contribute to improving housing and health care for homeless and at-risk children, and it provides examples and resources to guide health plan efforts.
Delivering Improvements in Infant Mortality Rates, NIHCM Foundation. October 2012. 2 pp.
In some parts of Tennessee, the infant mortality rate is roughly twice the national average, and across the state poor birth outcomes are responsible for an estimated $610 million in health care costs each year. In response to these statistics, the BlueCross BlueShield of Tennessee Health Foundation has developed partnerships with innovative organizations that are making headway in improving maternal and infant health. This Promising Practices in Maternal and Child Health fact sheet highlights two examples of these partnerships: a program that couples socio-emotional counseling with medical care for expectant mothers, and a telemedicine initiative that connects at-risk pregnant women in isolated areas with physician specialists.
Preventing Early Childhood Obesity in North Carolina, NIHCM Foundation. September 2012. 2 pp.
The nutrition and physical activity children receive while in day care is a vital part of helping them develop healthy behaviors. Elevating the health policies, practices and facilities of child care providers in North Carolina is one of the primary goals of Shape NC, a three-year, three-million-dollar partnership between the Blue Cross and Blue Shield of North Carolina Foundation and the North Carolina Partnership for Children. This Promising Practices in Maternal and Child Health fact sheet details how the Shape NC partnership is joining grant funding and training resources with a vast network of community-based alliances, and it highlights early data showing that participating communities and care centers are indeed shaping up.
Investing in the Future of the Health Care Workforce, Kathryn L. Santoro, MA and Claire Speedling, MPH, CHES. July 2012. 12 pp.
Health care provider shortages and maldistribution continue to be significant hurdles to ensuring that women and children have access to high-quality health care. This issue is set to become even more acute as demand for health services escalates due to the growth and aging of the population, the increasing need for chronic disease treatment, and the ACA insurance expansions, which could cover as many as 14.6 million additional women and 3.2 million additional children. Health plan foundations are helping to build community capacity to meet this demand through grant programs and initiatives designed to bolster the health care workforce. This brief highlights several of these efforts and outlines strategic opportunities for health plan foundations to have even greater impact in the future.
Leveraging Human Capital to Promote Youth Empowerment: The Blue Cross Blue Shield of Massachusetts-Crossroads for Kids Partnership, NIHCM Foundation. June 2012. 2 pp.
Over the course of two community service initiatives led by employees at Blue Cross and Blue Shield of Massachusetts (BCBSMA), a unique partnership developed between the health plan and a Massachusetts-based youth mentoring program called Crossroads for Kids. This Promising Practices in Maternal and Child Health fact sheet shows how BCBSMA’s highly tailored approach to meeting community needs and strategic deployment of staff talents, as well as the enthusiastic participation and clear vision of Crossroads for Kids, ensured a successful collaboration that promises to expand access to important youth empowerment activities for years come.
Health Plan Approaches to Preconception Health, Kathryn L. Santoro, MA and Claire Speedling, MPH, CHES. May 2012. 11 pp.
Twelve percent of babies born in the U.S. each year are premature, representing $26 billion in health care costs and an immeasurable emotional toll on families. Any significant improvements in birth outcomes will require system-wide intervention to support women’s health not only during pregnancy but also prior to conception. Despite evidence and recommendations on the importance of preconception health, millions of women do not currently receive adequate care. This brief outlines the innovative ways health plans and their foundations are reaching women of childbearing age, and it suggests strategies for direct and cost-effective outreach programs.
Preventing Bullying in Schools Through Partnerships, NIHCM Foundation. April 2012, updated January 2013. 2 pp.
When Highmark Foundation launched a new initiative to increase schools’ capacities to mitigate instances of bullying, it started by building a coalition of leaders in bullying prevention. Together the Foundation and its coalition are responsible for the largest implementation of the Olewus Bullying Prevention Program in the United States. This Promising Practices in Maternal and Child Health fact sheet calls attention to the dynamics that ensured a successful partnership, such as building upon the established work of coalition members and supporting ongoing evaluation. The coalition also created a road map for other organizations to use to justify and implement new school-based bullying prevention programs.
The Case for Investing in Youth Health Literacy: One Step on the Path to Achieving Health Equity for Adolescents, Kathryn L. Santoro, MA and Claire Speedling, MPH, CHES. October 2011. 16 pp.
The health literacy of adolescents is a significant concern, especially as teens are increasingly accessing health information online and the credibility of this information is largely unknown. This issue brief discusses opportunities for health plans and foundations to potentially reduce future health care spending by investing in programs and initiatives to improve health literacy during adolescence, a critical developmental time period when many health behaviors are initiated. The brief shares recent strategies proposed by the federal government to achieve health equity and improve health literacy, including specific strategies relevant to health plans and foundations. It also highlights several examples of current health plan and health plan foundation efforts to improve adolescent health literacy.
Partnering to Promote Healthy Babies, NIHCM Foundation. August 2011. 2 pp.
Public-private partnerships have been critical to the success of text4baby, the nation’s first free health text messaging service aimed at improving the health of new mothers and their infants. In this Promising Practices in Maternal and Child Health fact sheet, NIHCM Foundation highlights how health plans and health plan foundations support text4baby and suggests ways plans and foundations can partner with state and local governments and community organizations to further promote the service. Health insurers such as Blue Cross Blue Shield plans, Aetna, and 75 other commercial and Medicaid health plans are important and active partners in developing innovative strategies to encourage pregnant women and new mothers to sign up for text4baby.
Protecting Confidential Health Services for Adolescents & Young Adults: Strategies & Considerations for Health Plans, Kathryn L. Santoro, MA. May 2011. 16 pp.
Adolescents and young adults are likely to forgo health care when they feel they lack access to confidential care. As the Patient Protection and Affordable Care Act of 2010 (ACA) expands access to private and public health insurance for adolescents and young adults, it may also raise challenges for ensuring confidential care is delivered to a newly insured segment of the adolescent and young adult population. This issue brief reviews the legal protections in place to ensure confidential care delivery for adolescents and young adults, the effect of privacy and confidentiality concerns on the use of health services, and health insurance system barriers and other challenges to delivering confidential care to this population. This brief also presents several strategies for health insurers to assure that their billing processes are protecting adolescents' access to confidential care.
Improving Access to Perinatal Oral Health Care: Strategies & Considerations for Health Plans , Kathryn L Santoro, MA, Hillary Peabody, MPH, NIHCM Foundation; Jessie Buerlein, MSW, Children’s Dental Health Project. July 2010. 16 pp.
Most women do not access oral health care during pregnancy, despite evidence that poor oral health can have an adverse impact on the health of a pregnant woman and her child. In fact, a recent study in four states found that only 23 to 35 percent of women accessed dental care during pregnancy. This issue brief explores how oral health practices and utilization of dental care among pregnant women may affect a woman’s overall health, her birth outcome, and the oral health of her children. Oral health guidelines and statements are reviewed, and barriers that limit utilization of perinatal dental care are explained. The brief concludes with opportunities for health plans to play a role in removing these barriers to ensure that all pregnant women have access to needed dental care during pregnancy.
Creating Healthy Opportunities: Conversations with Adolescent Health Experts, A project of the Partners in Program Planning for Adolescent Health (PIPPAH) Initiative; 2010. 20 pp.
NIHCM Foundation, in collaboration with the Partners in Program Planning for Adolescent Health (PIPPAH) initiative, is pleased to release a series of print interviews featuring Shay Bilchik, JD , Georgetown University Public Policy Institute; Jane Brown, PhD, University of North Carolina; Angela Diaz, MD , MPH, Mount Sinai School of Medicine; Abigail English, JD, Center for Adolescent Health & the Law; and Richard Kreipe, MD, Golisano Children’s Hospital at Strong. The interviews were commissioned by the PIPPAH initiative of the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA) and were conducted by Karen Brown, a public radio reporter and freelance journalist who specializes in health care.
A series of podcast clips of the interviews with these adolescent health experts is now available on NCSL's website.
Identifying & Treating Maternal Depression: Strategies & Considerations for Health Plans, Kathryn L. Santoro, MA and Hillary Peabody, MPH; June 2010. 28 pp.
Between 10 and 20 percent of women experience maternal depression, either during pregnancy or in the year following delivery. Maternal depression can lead to serious health risks for both the mother and baby, including health complications that are costly and long lasting. Yet many women go undiagnosed as a result of social stigma and a lack of standard screening practices among health professionals. This issue brief reviews the prevalence of maternal depression, health risks of untreated depression, and economic consequences of depression and its associated health complications. Additionally, the brief provides recommendations and tools for health care providers to identify and treat maternal depression and shares opportunities for health plans to promote a comprehensive approach to early identification and treatment of maternal depression.
Preventing Adolescent Injury: The Role of Health Plans, Kathryn L. Santoro, MA, Julie A. Schoenman, PhD, NIHCM Foundation; Ellen Schmidt, Monique Sheppard, PhD, Children’s Safety Network. April 2010. 6 pp.
In the United States, unintentional injuries are the leading cause of death among adolescents and a leading cause of medical spending for adolescents aged 11 to 18 years old. Most injuries are preventable, however, and prevention often costs less than treating the effects of injuries. This issue brief, produced jointly with the Children’s Safety Network, highlights the prevalence, consequences and costs of adolescent injuries to explain why health plans should want to invest in injury prevention and how they can help prevent adolescent injury, thereby reducing injury-related mortality and health care spending for adolescents.
Improving Early Identification & Treatment of Adolescent Depression: Considerations & Strategies for Health Plans , Kathryn L Santoro, MA and Brigid Murphy, MHA; January 2010. 20pp. Depression is the most common mental health disorder among adolescents with over 25 percent of adolescents affected by at least mild symptoms. Unfortunately, depression is often undiagnosed in adolescence despite the availability of effective screening tools and recommendations for screening in primary care from the Institute of Medicine and the U.S. Preventive Services Task Force. Health plans are in a unique position to support the integration of screening into primary care by training providers to use screening tools, creating a reimbursement mechanism for use of these tools, and coordinating referrals for depression treatment. This issue paper examines the prevalence of adolescent depression, consequences of unidentified depression and costs of screening and treatment. The issue brief reviews recommendations and tools for primary care providers to identify and treat adolescent depression and shares opportunities for health plans to support providers in identifying and treating adolescent depression.
Strategies to Support the Integration of Mental Health into Pediatric Primary Care, Susanna Ginsburg, MSW and Susan Foster, MPH, MSSW; August 2009. 36pp.
Seventy-five percent of children with diagnosed mental health disorders are seen in the primary care setting, yet most primary care physicians lack the tools and resources to effectively identify and treat mental health problems. Recent recommendations, emerging evidence and policy trends support integration of mental health into primary care but require considerable buy-in and changes to current practice structures and financing mechanisms on the part of providers and health plans. This issue paper examines the landscape for mental health service delivery to children, including a discussion of the role of federal and state agencies, as well as public and private insurance. With the aim of informing and facilitating discussions on how mental health care can be fully integrated into pediatric primary care, the issue brief reviews information on mental health programs, practices and guidelines, and discusses strategies health plans can utilize to improve early identification and treatment for children in primary care.
Recommended Adolescent Health Care Utilization: How Social Marketing Can Help, W. Douglas Evans, PhD, The George Washington University School of Public Health and Health Services; Kathryn Santoro, MA, Brigid Murphy, MHA, and Julie Schoenman, PhD, of the NIHCM Foundation; March 2009. 14pp. Fewer than half of adolescents receive their recommended annual preventive health care visit, which is cause for concern since adolescence is a critical time period when many risky behaviors begin to develop. This underutilization of services yields missed opportunities for prevention, early detection and treatment. Health plans are assessed on their rates of adolescent well-care visits through HEDIS scores, yet many are struggling to find effective strategies to improve these rates. Social marketing, the use of commercial marketing strategies to promote socially beneficial ideas, attitudes and behaviors, can help increase utilization of services and promote healthy behaviors among adolescents. With the aim of informing and facilitating discussions on how health plans and health care providers can craft targeted messages for adolescents, as well as how they can utilize new media and technologies, the issue brief explores potential future applications of social marketing for health plans, providers and adolescents.
Increasing Access to Health Insurance for Children and Families: Innovative Health Plan Outreach and Enrollment Efforts, NIHCM Foundation staff, February 2009. 20 pp. Providing health insurance for children and families continues to challenge the nation as over eight million children remain uninsured. Public and private sector efforts to provide health insurance to children will be critical during these difficult economic times, as more children become uninsured as their parents lose employer-based insurance and as state budget deficits require cuts in funding for outreach efforts to enroll eligible but uninsured children. This issue brief examines health plan efforts to increase enrollment in Medicaid and CHIP. With the aim of informing and facilitating discussions on how the various sectors of the health care system can work together to ensure access to care, the brief also examines private insurance coverage options for individuals and the increasing role of health plan philanthropic foundations in efforts to promote access to insurance.
Prevention of Adult Cardiovascular Disease Among Adolescents: Focusing on Risk Factor Reduction,Arik V. Marcell, MD, MPH, The Johns Hopkins University; Marc S. Jacobson, MD, Albert Einstein College of Medicine; Nancy M. Copperman, MS, RD, CDN, North Shore Long Island Jewish Health System; Jonathan D. Klein, MD, MPH, University of Rochester School of Medicine and the American Academy of Pediatrics Julius B. Richmond Center; and Kathryn L. Santoro, MA and Hafiza Pirani, MHS, NIHCM Foundation. August 2008. 48 pp. Cardiovascular disease (CVD) is the most prevalent cause of mortality in the United States, contributing to more than half of all deaths – or more than 1.2 million deaths annually. Many of the modifiable risk factors for CVD – lipid abnormalities, high blood pressure, obesity, diabetes, and tobacco use – can and should be addressed during adolescence in order to limit the adverse consequences of CVD in adulthood. This paper examines the prevalence of risk factors for CVD and then explores promising strategies that providers and health plans can take to reduce adolescent risk factors for future CVD. The discussion is guided by the recommendations for adolescent clinical preventive services and the Healthy People 2010 Guidelines.
Reducing Health Disparities Among Children: Strategies and Programs for Health Plans, Dana Hughes, DrPH and Mary Kreger, DrPH, U.C. San Francisco, and Kathryn Kushner, MA, Hafiza Pirani, MHS and Diya Surie, NIHCM Foundation, February 2007, 28 pp. Efforts to reduce, if not eliminate, health disparities among children are a vital means of improving the current status of children’s health and securing their continued health into adulthood. It is important to inform stakeholders, including policy makers, health care professionals, health plans, health care purchasers, and beneficiaries, especially parents and families, about the roots of health disparities and the current state of health disparities among children. This paper is intended provide a brief overview of health disparities, including the importance and limitations of health insurance to address these disparities, concluding with current health plan efforts focused on eliminating health care barriers and improving the cultural competence of health care delivery.
Young People's Health Care: A National Imperative, Claire D. Brindis, Tina Paul Mulye, M. Jane Park & Charles E. Irwin, Jr., The Public Policy Analysis and Education Center for Middle Childhood, Adolescent and Young Adult Health (Policy Center) at the University of California, San Francisco, July 2006, 24 pp. Emerging public and private sector efforts recognize the importance of health insurance coverage and service delivery during the critical transition period from adolescence to adulthood. This issue paper highlights the unique health issues faced by this age group, as well as the vastly different socioeconomic, cultural and demographic factors influencing their health status, access to care and utilization of services. The paper advocates for tailored solutions to prevent a crisis in the health status and access to care of young adults and documents current innovative state, county and local programs targeted to meet the needs of the young adult population. The paper also includes an appendix describing current programs addressing young adult health and selected resources for additional information and research.
Tackling Childhood Obesity Through Public-Private Collaboration, NIHCM Foundation, April 2006. Evaluation of existing health plan programs is critical in order to effectively combat obesity. To address this critical issue, NIHCM Foundation hosted a Leadership Forum, bringing together obesity experts from the CDC with medical directors, researchers and clinical experts from seven NIHCM member plans. Discussions from the forum revealed a number of efforts taken by health plans’ in targeting childhood obesity among their enrollees as well as children in the greater communities in which they serve. Recognizing the relevance and importance of this information to members of the maternal and child health community, NIHCM Foundation prepared this Issue Brief.
Women's Health Prevention and Promotion, Virginia Poole, Ph.D., Poole Consulting, LLC, and Kathryn Kushner, NIHCM Foundation, March 2005, 44 pp. This paper provides an overview of data on selected conditions influencing women's morbidity and mortality, discusses disease prevention and detection, and presents recent guidelines for screening. The topics covered include cardiovascular disease, breast and cervical cancer, mental illness, obesity, healthy behaviors, and special issues such as prenatal care. A resource list of numerous organizations and agencies working on women's health at the federal and state level is also included in the paper, and highlights the National Centers of Excellence in Women's Health (CoEs) and the National Community Health Centers in Women's Health (CCOEs).
Children's Mental Health: An Overview and Key Considerations for Health System Stakeholders, Karen Van Landeghem and Catherine A. Hess, Health Policy Consultants, February 2005, 28 pp. This issue paper is an overview of important considerations for health system efforts to promote and improve the mental health of children and youth. It is also presents key policy considerations for promoting and advancing comprehensive mental health systems for children and youth. A resource list highlighting numerous organizations and initiatives related to children's mental health is included and web-based resources are also available for further guidance.
Childhood Obesity - Advancing Effective Prevention and Treatment: An Overview for Health Professionals, Debra Kibbe and Richard Offner, ILSI Center for Health Promotion, April 2003, 48 pp. This issue paper provides an overview of pediatric overweight as well as the current treatment and prevention options. Key issues discussed include prevalence and trends, etiologic factors, health and economic impact, and intervention programs. A resource list highlighting numerous health care, school, and community initiatives is included and web-based resources are also available for further guidance. Effective partnerships and unique strategies are identified as crucial to successfully address this critical public health issue.
Outreach to Children: Moving from Enrollment to Ensuring Access, MB Carpenter and L. Kavanagh, 1998. Commissioned Paper.
Assuring Quality of Care for Children in Medicaid: EPSDT in a Time of Changing Policy, National Institute for Health Care Management, April 1996, 37 pp., (#95-11). This paper is the product of an October 1995 meeting in which representatives from the U.S. Health Care Financing Administration (HCFA), state Medicaid agencies and health plans discussed some of the problems experienced in implementing managed care programs as well as effective managed care strategies that provide high-quality EPSDT services to children. Among the concerns voiced were the difficulties involved with balancing tight budgets, vague requirements, lack of specific data on EPSDT and states' desire for greater flexibility in program design.
Between 1997 and 2004, NIHCM convened in-person forums in Washington, DC to discuss timely maternal and child health issues and promote public-private sector collaboration to address these issues. These forums were part of a grant from the Health Resources and Services Administration's Maternal and Child Health Bureau. Below are links to ACTION BRIEFS, which are summaries of these child health forums:
Getting Kids Coverage - Action Brief 5 (March 2000)
Bright Futures and Managed Care - Action Brief 1a (March 1998)
Women's, Children's and Adolescents' Health Updates
The Women's, Children's and Adolescents' Health Update is a quarterly report on emerging issues, research and resources relevant to the health of these three groups. A record of past updates is available on our Newsletter Archive page. If you would like to receive the WCAHU via email, please complete the subscription form.