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Jefferson County Public Health –Performance Measures 2010 - Report
FAMILY HEALTH
BUDGET/PROGRAM: Community Health: Family Support Programs
Maternal Child Health (MCH) including Maternity Support Services (MSS)/Infant Case Management, Nurse-
Family Partnership (NFP), Children with Special Health Care Needs (CSHCN), Women Infants and Children
(WIC), and the Child Protective Services (CPS) Contract Programs: Early Family Support Services, Early
Intervention Program (EIP), and Passport.
MISSION:
The mission of the Family Support Program is to offer health education and support to all Jefferson County
pregnant women and families with young children as they build a secure foundation for a lifetime of health,
learning, and community contribution.
The Family Support Team consists of public health nurses, registered dietician, and support staff.
Our goals are:
-To support and guide families by building on their strengths to create a safe, healthy, and hopeful
future for their children.
-To collaborate with community partners in our shared goal of improving health, preventing adverse
childhood experiences and creating a seamless continuum of services.
-To provide high quality services that have expected outcomes after a community assessment, commitment to
best practices, professional continuing education and program evaluation.
GOALS and OBJECTIVES FOR FY2010:
Goal: Improve the quality of caregiving for infants and children through support, education, and intervention
for parents and caregivers.
Objective: Jefferson County Public Health (JCPH) will offer services to all Jefferson County pregnant women,
families, and caregivers of young children through an array of programs designed to fit the diverse and complex
needs and risks of each child and family. JCPH will work with other agency staff and families in the schools,
child care facilities, health care settings, and in the community. Spanish speaking families will receive
interpretive services along with forms and educational materials in Spanish.
Goal: Prevent harm to mothers, infants, and families at risk for or affected by maternal depression.
Objective: Depression screening and education will be offered to all pregnant and parenting women who are
participating in JCPH programs and appropriate referrals will be made for those who have a positive screen.
Data will be collected by staff and become part of program evaluation and community assessment.
Goal: Encourage and support breastfeeding for optimal nutrition and health for infants and mothers.
Objective: Provide education and support to all pregnant women and their families about the benefits of
breastfeeding through WIC and weekly Breastfeeding Tea. Collaboration with Jefferson Healthcare staff for
lactation support ensures all families receive the services they need.
Goal: Prevent nutritional related problems for pregnant, post-partum, and breastfeeding women and children
under five in Jefferson County.
Objective: Provide WIC nutrition education and support to all eligible county women and children.
Goal: Prevent unintended pregnancies.
Objective: Assist parents in making goals and plans around family size and child spacing through education
and referrals for birth control.
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Goal: Improve birth outcomes by preventing birth defects, prematurity, and infant mortality. Promote health
and development in children with special health care needs.
Objective: Provide education and support to women who are or are planning to be pregnant about potential
risks, healthy choices and ways to reduce risks to themselves and their fetus/infant. Screening, referrals, risk
reduction, and education will include substance/tobacco use, domestic violence, mental health, and health and
nutrition. Provide developmental and health screening of newborns and children to identify children with
special health and development needs and assist families to have evaluation and intervention services. Staff will
collaborate with community providers to ensure quality, comprehensive services for each family. Monitor state
collected data on first trimester access to prenatal care.
Goal: Decrease child abuse and neglect through outreach, education, collaboration, prevention, and
intervention.
Objective: Awareness, assessment, prevention and intervention of the child abuse /neglect cycle is an integral
component of all Family Support Service Programs. Referrals are made and received from Child Protective
Services (CPS)/Division of Children and Family Services (DCFS) and services will be provided to families at
risk or involved in child abuse/neglect through local contracts with CPS. Staff will collaborate closely with
other providers to develop a comprehensive plan of care to keep children safe. Staff will engage in clinical
supervision, consultation, and professional education to ensure high quality care and staff safety.
Goal: Maintain program fidelity, quality, and caseload capacity of the Family Nurse Partnership Program as an
evidence based best practice.
Objective: Support the Nurse-Family Partnership program capacity and program fidelity by providing
opportunities for ongoing support and education to the nurses through weekly clinical supervision, professional
consultation and education and participation in the Washington State Consortium for Nurse-Family Partnership.
Program and client data will be collected and analyzed by the national NFP office. Quarterly reports resulting
from this analysis will guide JCPH staff in program quality control.
Goal: Improve quality of services through collecting and analyzing data on health risks and intervention
outcomes.
Objective: Maintain fidelity of the research based programs such as Nurse Family Partnership (NFP) and
Promoting First Relationships while developing technology systems to collect and analyze data on promising
programs. Design local system and collaborate with state in collecting, sharing, analyzing data in program
design, delivery, and client/program outcomes.
Goal: Increase awareness and support of the Family Support Program mission through community outreach,
involvement, and collaboration.
Objective: JCPH will continue to engage our community partners in exploring the issues of, and finding
solutions to, family and community health issues. We will continue to collaborate with and provide information
to community groups, agencies, and providers through our website, local newspapers, and community forums.
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PERFORMANCE INDICATORS: 2006
Actual
2007
Actual
2008
Actual
2009
Actual
2010
planned
2010
Actual
1. Number of depression screenings completed 65 87 85 53 90 56
2. Number of Home and Office visits provided
by Family Support Staff in all programs.
1144 1170 1363 1349 900 863*
3. Families served annually in Family-Nurse
Partnership
20 20 25 25 25 25
4. Total number of women infants and children
served by WIC in Jefferson County (from CIMS
Enrolled annual report)
829 872 881 868 880 872
5. Number of children with special health care
needs Birth through age 18 referred for Public
Health Nurse Case Management.
81 70 85 75 60 66
6. Number of families served through
CPS/DSHS contract.
20 30 40 57 50 35
*722 home & office visit MSS/MCH/CSHCN, 141 home & office visits CPS Programs (EFSS and EIP)
SUMMARY OF 2010 KEY FUNDING/SERVICE ISSUES:
Family Support Program’s goal in 2010, with fiscal constraints and uncertainties in revenues, is to clarify our
priorities and be deliberate in protecting our prevention priorities and community services. Our current level of
services were modified in July 2010 when MSS funds were decreased at the state and in 2011 they were
reduced further. In 2009 JCPH had to eliminate universal newborn follow up and some breast feeding support
and ended all contracts for on-call staff. JCPH is collaborating with our community partners to minimize the
impact of these changes on local families.
2010 JCPH had reductions in Maternity Support (MSS) visits to pregnant women based on State reductions in
funding and changes in the State criteria for who qualifies for MSS. NFP received in 2010 funding from the
1/10 of 1% Mental health and Chemical dependency treatment tax, and in 2011 successful Prop 1 vote supports
one community family nurse.
2010 one year grant JCPH developed a new assessment tool for parents of young children. We will be
collecting data such as the Center for Disease Control short form Adverse Childhood Experiences questionnaire
and some Behavioral Risk Factor Surveillance System questions to better understand our clients and our
community.
Study/Analysis:
In 2010 Family Health programs continued to implement the reductions and changes in Maternity Support
Services/Infant Case Management (MSS/ICM) programs started in the 2009 cuts. Our home and office visits
decrease in numbers from 2009 to 2010 reflect that JCPH is not funded to do as many visits to women and
infants as previously. We have maintained fidelity to the Nurse Family Partnership model and so those women
have been served even with the MSS/ICM budget cuts.
Jefferson County low income families have been affected by budget cuts at every agency and service provider.
DSHS has also changed Medicaid eligibility procedures for all clients but pregnant women and infants are being
seriously impacted. Infants are being dropped from coverage and are subsequently not accessing medical care
and pregnant women delay seeing a prenatal care provider while awaiting Medicaid. The most recent DOH data
on access to prenatal care indicates we have a persistent challenge in access to prenatal care. This data shows
the percentage of pregnant women starting prenatal care in the 1st trimester in Quilcene/Brinnon statistically
worse from 84% in 1992-94 to 60% in 2007-09; rest of Jefferson County statistically worse from 85% to 74%
over the same period. Particularly concerning is the income disparity effect: access to 1st trimester prenatal care
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is lower among all Jefferson Co women with Medicaid-paid births 64% compared to non-Medicaid 86%. We
will continue to support access to care by outreach and education to pregnant women and referrals to DSHS and
prenatal care.
Our goals in Family Health programs are best achieved by an active collaboration with community partners who
share these health goals. For 2 years we have met almost every month with the local OB and family practice
physicians for care conferencing and discussion and collaborations around access to care and health concerns.
These meetings have led to better client services through increased phone contacts from the physicians for
collaboration and increased referrals to and from the medical providers for a variety of health and social
concerns.
The number of depression screens is less than previous years because of 2 factors: fewer women are eligible for
our services due to changes in state First Steps guidelines and more women are already being treated for
depression by their physician.
2011 Children’s Administration is on track with the legislative mandate to privatize services for families
involved with CPS. Our contracts for home visits to CPS involved families have been reduced and we have had
less referrals as CPS has changed their procedures making fewer families eligible for services.
For example; a mother who’s newborn tests positive for methamphetamine is now offered a voluntary service
plan and the infant goes home. If the family chooses not to accept any services the case is closed. Previously the
level of involvement would have been intense and often the infant placed in foster care. These changes place a
high level of responsibility on all Family Health programs including WIC as we strive to provide a safety net
for these very vulnerable infants and families.
March 7, 2011