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Show Your Love

February 14th, 2013

Valentine’s Day isn’t just a day of romance, flowers and candy.  The CDC Preconception Health and Health Care Initiative launched a campaign asking all women of childbearing age to Show Your Love by taking good care of themselves.  It’s a national initiative to educate women and couples on the importance of preconception health. Preconception health refers to a woman’s health during the years she can have a child.  A mother’s health before she gets pregnant can affect the health of her baby.  

Women who’d like to become pregnant are urged to “Show Your Love” to your future baby by adopting healthy behaviors now.   Women who are not planning a pregnancy now are encouraged to “Show Your Love” to themselves so they’ll be healthy and have a fulfilling future.  About half of all pregnancies in our country are unplanned, which increases the chances of having a poor birth outcome such as preterm birth, low birth weight, high birth weight, or stillbirth.  Many women become pregnant when they’re not in the best health or while engaging in behaviors that could harm a pregnant woman or her baby.  It makes sense to be healthy at all stages of life. 

The Show Your Love website includes posters, educational videos, TV PSAs and health checklists for use by health care providers and community partners who want to educate the women and couples they work with about the importance of preconception health.  Preconception health is impacted by a number of health issues addressed by various ADHS programs – chronic disease, oral health, nutrition, physical activity, smoking, STD’s, immunizations and mental health.  The Bureau of Women’s and Children’s Health website includes additional preconception health tools. Also, please feel free to email the Bureau at: preconceptionhealth@azdhs.gov .

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Integrated Care Responses On Deck

January 8th, 2013

We all need to take care of both our physical and behavioral health needs in order to be healthy. The mind and body aren’t separated- and neither should the health-care delivery system- especially for folks with a serious mental illness. Folks with a serious mental illness die more than 25 years earlier than the general population… an unacceptable health disparity in anybody’s book. The increased mortality is largely from treatable medical conditions caused by modifiable risk factors like smoking, obesity, substance abuse, and not accessing primary and acute medical care. Population health issues. 

We recognized the need to address this unacceptable health disparity when we put together our Strategic Map and Plan that includes integrating behavioral and acute healthcare. It’s been a long haul and a lot of work- and we passed a major milestone today when folks submitted their bids on our Request For Proposal (otherwise known as RFP) for the delivery of behavioral health services in Maricopa County.  We received bids from: 1) Magellan Complete Care of Arizona, Inc.; 2) Cenpatico of Arizona LLC; 3) Arizona Physicians IPA, Inc. (APIPA), d/b/a UnitedHealthcare Community Plan, operating as UnitedHealthcare Whole Health; 4) Mercy Maricopa Integrated Care; and 5) Partners in Integrated Health, LLC. 

Our evaluation team will begin their analysis shortly…  and we expect the evaluation process to take 8 weeks or so.  The entity that ends up getting the contract will be responsible for delivering both preventative, acute and primary care along with Recovery-based behavioral health services for folks in the public behavioral health system in Maricopa County beginning on 10/1/13.  

It’s difficult to put into words how much work has gone into this solicitation. I know that many of you put this work on top of all your normal work, had put off other projects, and sacrificed some of your home-life for this product- and I just really want you to know that I appreciate it. It’s going to save lives. Stay tuned.

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New Electronic Birth Certificate ‘Round the Corner

December 26th, 2012

Our Vital Records shop does a lot more than manage the State’s birth and death certificate system (which we’ve been doing since 1885).  We’re also an integral part of the Nation’s Vital Statistics System, which serves as the backbone of national data sharing in public health. The data collected under the National Vital Statistics System works in partnership with the National Center for Health Statistics to produce critical information on public health topics like teenage births and birth rates, prenatal care and birth weight, risk factors for adverse pregnancy outcomes, infant mortality rates, leading causes of death, and life expectancy.  All these data are retrieved from the nation’s network of Vital Records shops like ours. 

There have been two birth certificate standards that the states are currently following – the 1989 and the 2003 standard. We’ve been one of the states that had been following the 1989 standard- but not anymore.  Beginning the first week in January, we’ll be turning the key on the new 2003 Standard.  The new Electronic Birth Registration System that we’ll be using will collect a lot more public health surveillance data.  It’s also an electronic system- which will make things much faster and efficient.  The new system will have impacts all throughout our Strategic Plan.  Here are a couple examples: 

  • A1 – Reduce Obesity – The former 1989 standard had zero data on the mother’s height and weight- meaning we couldn’t calculate the mom’s BMI.  Starting next week, we’ll be able to collect this data- which will give us better surveillance- and in turn, help us identify more targeted public health interventions- helping us to make progress in reducing critical risk factors for poor maternal and child health outcomes.
  • A2 – Reduce Tobacco Use and Substance Abuse –  The old system only captured generic measures about maternal smoking during pregnancy.  The new system will have specific cigarette smoking data before and during pregnancy- providing rich data for prevention activities- helping us to improve birth outcomes. 

Other important data elements include information on breastfeeding, whether mother received food during pregnancy from the WIC program (helping us to better evaluate our WIC program), critical medical data elements like congenital anomalies, and fertility treatments (Assisted Reproductive Technology)…  all of which provide newer opportunities for prevention.  The public health applications that the new system will provide are too long to list in a short blog like this… but they’re substantial- believe me.  We’re even going to be able to incorporate the data we’ll be collecting in the new system into our new Midwife rules. 

From a customer service perspective, the new system has improved security for fraud prevention and will provide speedier transactions for printing birth certificates at the county level.  Thanks to all the IT and vital records team that put in the endless hours to make this new application possible.

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Tobacco Use & the Target Market

November 15th, 2012

One of the things you learn in business school is the importance of using the concept of a “target market” as a core of your business marketing plan.  That’s what we do when it comes to tobacco cessation.  We examine our tobacco surveillance data and look at demographic patterns for target populations and look for the leverage points to develop our interventions.  Since 50% of tobacco products are purchased by folks with a mental illness and/or chronic disease- this demographic is a key focus of our tobacco prevention strategies. 

We’ve been working hard for the last 3 years to make inroads into this target population with some pretty good success.  Our folks in the Division of Behavioral health and our Bureau of Tobacco and Chronic Disease and ASHLine have trained clinical behavioral health staff on how to get folks into smoking cessation (quit) services-  establishing systemic change within the behavioral health system for cessation services- moving Arizona toward being tobacco free.  This involves assessing every single patient at every single visit in our behavioral health system for tobacco use and providing them the opportunity to be referred for tobacco cessation coaching.  Since our initial efforts 3 years ago- ASHLine referrals from behavioral health locations have skyrocketed.  

The ASHLine referral development team is focusing training new nurse practitioners at Magellan’s Integrated Home Health on ASHLine Ask, Advice, Refer protocol & nicotine replacement therapy prescription guidelines.  Additionally, our Tobacco and Chronic Disease team submitted a manuscript to the CDC’s online journal Preventing Chronic Disease which describes the success of our interventions and illustrating how the behavioral health population is using cessation services and quitting tobacco at the same rate as the general population.

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Integrating Physical & Behavioral Health Services to Save Lives

October 11th, 2012

We all need to take care of both our physical and behavioral health needs in order to be healthy. The mind and body aren’t separated- and neither should the health-care delivery system- especially for folks with a serious mental illness. Folks with a serious mental illness die more than 25 years earlier than the general population… an unacceptable health disparity in anybody’s book. The increased mortality is largely from treatable medical conditions caused by modifiable risk factors like smoking, obesity, substance abuse, and not accessing primary and acute medical care. 

We recognized the need to address this unacceptable health disparity when we put together our Strategic Map and Plan. It’s been a long haul and a lot of work- and we passed a major milestone this week when we released our Request For Proposal (otherwise known as RFP) for the delivery of behavioral health services in Maricopa County. The entity that ends up getting the contract will be responsible for delivering both preventative, acute and primary care along with Recovery-based behavioral health services for folks in the public behavioral health system in Maricopa County. The new contract is scheduled to start on 10/1/13. 

It’s difficult to put into words how much work has gone into this solicitation. I know that many of you put this work on top of all your normal work, had put off other projects, and sacrificed some of your home-life for this product- and I just really want you to know that I appreciate it. It’s going to save lives. You can check out the full solicitation on the State’s Procurement website hub- called ProcureAZ.

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Posted in Behavioral Health

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AZ Smokes the Field

June 15th, 2012

AZ had the biggest % decrease in teen smoking rates in the country according to the new CDC Youth Risk Behavior Survey this week. Smoking rates among AZ teens dropped 12% in the last couple of years- while rates generally stayed flat across the country.  That’s 11,000 fewer teen tobacco users between 2009 and 2011.  About half of the teenagers in AZ that smoke tried to quit in the last year too.  

We attribute our success to an array of evidence-based interventions that our statewide team has implemented over the last 3 years or so. We did test marketing of messages with teen focus groups about 5 years ago- developed a strategic plan right after that and then implemented our new evidence based program for teen prevention in early 2009. These efforts include the successful youth prevention campaign www.venomocity.com and the launch of the statewide youth coalition Students Taking a New Direction www.standaz.com 

Venomocity focused on the fact that tobacco is addicting- and that addiction controls you. Teens don’t like to be controlled. So, instead of telling them not to smoke, we let them know that tobacco is addictive, it’ll addict them if they start, that addiction will then control them- threatening their goal of self-determination. Then, we meet them where they are- via the facebook, twitter, and other social media. 

This work goes to show you that careful research, strategic planning and creative implementation, along with continuous evaluation to make corrections works!

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Smoke Free AZ Turns 5

May 30th, 2012

It’s hard to believe- but our Smoke Free Arizona program turned 5 this month.  Voters approved the Act back in November of ’06 by a few percentage points.  The Initiative language gave us a super-short turn-around time (just like medical marijuana)…  and we turned the key on the program by May of ’07.  Implementation of the Initiative was smooth from the get-go and compliance with the voter approved law has been very good- as you can see in our most recent Annual Report.  But how come? 

If you remember back to the election of ’06- a group ran a ballot initiative called Proposition 206 to compete with the Smoke Free AZ Act (or Proposition 201).  Prop 206 would have prohibited smoking in some indoor places but would have allowed smoking to continue in bars and some restaurants.  206 lost and 201 won.  The key to smooth implementation came next- in our Rulemaking process. 

The first thing we did was to contact the folks involved with both campaigns to get a feel for what we needed to do to get smooth implementation.  I basically asked the 206 folks what they needed in order for them to support our implementation and to encourage compliance with their association members.  They said that if we had a fair “patio“ policy they’d be in.  So that’s what we did.  We put together what we think are reasonable criteria for smoking on patios and a fair compliance system.  The result?  An almost controversy-free implementation and effective broad compliance. 

Working well with others really is the most important grade you ever get in school.

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Healthy Babies are Worth the Wait

April 13th, 2012

Being born too soon is the number one killer of infants in Arizona and in the nation (birth defects is a close second).  Death rates from prematurity are declining but babies born too soon (before 37 weeks) often face medical, developmental and social challenges as they get older. More than 8,000 babies in Arizona were born too soon last year. Our latest March of Dimes Premature Birth Report Card was average- but there was good news related to the reduction in the percentage of uninsured women and the number of women who smoke.  

Some of the things that can cause prematurity include diabetes, high blood pressure, obesity, smoking, and alcohol or drug abuse.  One of our main approaches to reducing prematurity rates is to improve the health of women before they get pregnant- called preconception health.   Prenatal care is still important- but poor health practices during pregnancy will usually trump good prenatal care. 

Our interventions include implementing evidence-based practices to get moms to stop smoking, improve physical activity and nutrition and behavioral health- all are part of our Preconception Health Strategic Plan and our Every Woman Arizona educational materials, grants to implement preconception health strategies, and home visitation programs that address many of the things that lead to prematurity.  Our WIC program and clinics also work with young moms in their reproductive years to improve their health.  We also work with the Arizona March of Dimes and the Arizona Perinatal Trust to encourage hospitals to adopt policies designed to ensure that elective births aren’t approved before 39 weeks gestation. 

BTW… This Saturday is the March for Babies in Phoenix.  The annual fundraiser for the March of Dimes started more than 30 years ago and helps moms in Arizona have full-term pregnancies and healthy babies.  What they’ve accomplished so far is phenomenal and you can help.  ADHS has a team and would love to have you join us or you can donate…  Registration starts at 7 am – it’s at Wesley Bolin Plaza by the Capitol.

 

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What’s a GASO?

November 17th, 2011

Today is the Great American Smoke Out – started by the American Cancer Society to encourage smokers to quit, even if it is just for one day.  Arizona is doing very well compared to the rest of the country when you talk about stopping smoking.  Our state is down to 16% of the adult population that smokes – the national average is 21%.  But those that are left are the most addicted – so we need to help them any way we can.

The Arizona Smokers’ Helpline is expanding its arsenal of resources to help smokers quit tobacco with the addition of the Call It Quits app.  The app debuted on ASHLine’s Facebook page this week and will soon be introduced as an iPhone app.

Support from friends and family are essential and things like nicotine replacement medication or patches can help make the difference between success and failure when quitting smoking.  People in Arizona can tap into free telephone quit coaching through the ASHLine at 1-800-55-66-222 and free online quit coaching services via WebQuit™ at www.ASHLine.org. The Arizona Smokers’ Helpline has one of the best quit rates in the country and has been helping people for 15 years.

Business owners can help too – take a look at your health plans and see if they support your employees who want to quit. It can be a good investment – the Centers for Disease Control and Prevention estimates comprehensive smoking-cessation benefits cost between $1.20 and $4.80 per person per year, miniscule when compared with the $1,623-per-smoker per year in excess medical expenditures.

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What’s Preconception Health- and Why’s it Important?

November 7th, 2011

Being born too soon is the number one killer of infants in Arizona and in the nation.  Death rates from prematurity are declining but babies born too soon (before 37 weeks) often face medical, developmental and social challenges as they get older. More than 8,000 babies in Arizona were born too soon last year.   This week the March of Dimes released the 2011 Premature Birth Report Card that grades States on their premature birth rates.  While Arizona was average- there was good news related to the reduction in the percentage of uninsured women and the number of women who smoke.   

Some of the known factors impacting prematurity include having twins/triplets, having a chronic disease such as diabetes, high blood pressure, being obese, smoking, and alcohol or illegal drug use.  One of our main approaches to reducing prematurity rates is to improve the health of women before they get pregnant- called preconception health.   Prenatal care is still important- but poor health practices during pregnancy will usually trump good prenatal care.   

Our interventions include implementing evidence-based practices to get moms to stop smoking, improve physical activity and nutrition and behavioral health- and all are part of our Preconception Health Strategic Plan which includes Every Woman Arizona educational materials, grants to six local communities to implement preconception health strategies, and home visitation programs that address many of the factors that can lead to prematurity.  Our WIC program and clinics also work with young moms in their reproductive years to improve their health.  We also work with the Arizona March of Dimes and the Arizona Perinatal Trust to encourage hospitals to adopt policies designed to ensure that elective inductions aren’t approved before 39 weeks gestation.

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