Maternal, Child and Adolescent Health

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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.

NIHCM Foundation would appreciate your comments on this paper. Please take a moment to submit a brief feedback form. For a free hard copy of the publication, email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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.

NIHCM Foundation would appreciate your comments on this paper. Please take a moment to submit a brief feedback form. For a free hard copy of the publication, email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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.

NIHCM Foundation would appreciate your comments on the paper. Please take a moment to submit a brief feedback form. Please email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it if you would like to receive a free hard copy of the publication.

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.

NIHCM Foundation would appreciate your comments on the issue brief. Please take a moment to submit a brief feedback form. Please email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it if you would like to receive a hard copy of the publication.

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.

NIHCM Foundation would appreciate your comments on the paper. Please take a moment to submit a brief feedback form. Please email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it if you would like to receive a hard copy of the publication.

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.

NIHCM Foundation would appreciate your comments on the paper. Please take a moment to submit a brief feedback form. Please email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it if you would like to receive a hard copy of the publication.

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.

NIHCM Foundation would appreciate your comments on the paper. Please take a moment to submit a feedback form, available here. Please email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it if you would like to receive a hard copy of the publication.

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.

NIHCM Foundation would appreciate your comments on the paper. You can return a feedback form, available here, by fax to 202-296-4319, or send an email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it . Please email us if you would like to receive a hard copy of the publication.

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.

Action Briefs

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:

Women's Health: Successes and Challenges in Prevention and Promotion - Action Brief 13 (April 2005)

Children's Mental Health: New Developments in Policy and Programs - Action Brief 12 (March 2005)

Childhood Obesity: Advancing Effective Prevention and Treatment - Action Brief 11 (November 2003)

Improving Children's Mental Health: The Bright Futures Approach - Action Brief 10 (March 2002)

Coordinating Efforts on Childhood Obesity - Action Brief 9 (March 2002)

Perspectives on Implementing Bright Futures - Action Brief 8 (Dec. 2001)

Making the Future Bright for Chronically Ill Kids - Action Brief 7 (June 2001)

Preventing Childhood Injuries for a Bright Future - Action Brief 6 (Aug. 2000)

Getting Kids Coverage - Action Brief 5 (March 2000)

Strengthening Health Supervision for Adolescents - Action Brief 4 (Feb. 2000)

Improving Quality of Care for Children - Action Brief 3 (Aug. 1999)

Outreach: Private and Public Sector Efforts That Work - Action Brief 2 (Nov. 1998)

Bright Futures and Managed Care - Action Brief 1a (March 1998)

Children's Health Insurance Program (CHIP) - Action Brief 1b (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.

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