Michigan Council for Maternal and Child Health Friday Notes

January 23, 2015

In this issue

Governor Announces MDCH, DHS Merger

Pediatric Hospice and Bereavement Support in Michigan

Many Women of Childbearing Age Take Narcotic Painkillers: CDC

Governor Announces MDCH, DHS Merger

In his State of the State speech delivered this week, Governor Rick Snyder cited an opportunity to make fundamental changes to government, especially in the way it delivered services to persons needing help to get back into the mainstream of life by combining the departments of Community Health and Human Services.

He titled his proposal "the River of Opportunity," saying the changes he would enact would help streamline and personalize programs.

When the merger of the departments is completed, Nick Lyon, current director of both departments, said in interviews this week he hopes a client will have an easier time navigating the various services available and a caseworker will have an easier time finding the help that client needs.

Getting to that point will require some intensive work, he said, as the departments graft together personnel functions, coordinate systems and review federal policies. Lyon said he expected the new Department of Health and Human Services to be up and running by October 1, the start of the 2015-16 fiscal year.

The first step to be completed is the actual executive order that will formally direct creation of the new department. The order is expected to be issued in early February, close to the February 11 date for release of the 2015-16 budget recommendation from Governor Snyder.

When the two departments are combined, it will have a total budget - including General Fund and federal money - of some $24 billion - easily the largest single budget and 46 percent of the entire state budget. The department also will employ some 14,200 workers.

In an email to DCH/DHS stakeholders this week, Lyon said: "Our vision for the Michigan Department of Health and Human Services is to promote better health outcomes, reduce health risks, and support stable and safe families while encouraging self-sufficiency.

In doing so, we will be placing a specific focus on ensuring that our children are protected and supported on their path to adulthood, and on increasing collaboration among our programs that serve our seniors to ensure that they are getting the services that best fit their needs. Additionally, we will build on the momentum from the Healthy Michigan Plan to continue integrating health services to build a comprehensive health care approach. And in our communities, we will better focus our prevention strategies on increased coordination and collaboration of direct services, so that we can improve our health indicators, lower health care costs, and better serve our citizens."

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Pediatric Hospice and Bereavement Support in Michigan

Attendees at a conference to discuss pediatric hospice and bereavement support agreed there are several related issues to advance in the state, including the need for improved insurance coverage to include concurrent care and expanding the present six-month limitation on pediatric hospice coverage.

Held last November in East Lansing, the conference was sponsored and organized by the Art for Charlie Foundation, Hospice of Michigan and the MSU College of Human Medicine,

to define resources available statewide for pediatric palliative care and support for bereaved parents, compare to standards in other states, and to identify obstacles and make recommendations to remedy gaps and deficiencies.

A report on the conference--available here--discusses major topics the more than 90 attendees reviewed, including pediatric palliative care and the ways it differs significantly from adult care.

Some caregivers present reported that children in their area had not benefited from pediatric
hospice simply because parents and physicians were unaware of its availability. Attendees also noted that hospice care as an insurance benefit is traditionally limited to those patients with a six month or less prognosis, which may not be appropriate in pediatric cases.

Attendees also discussed the societal cost to grief, including the breakdown of the family unit, loss of employment and the less obvious but significant cost in loss of productivity at work.
Some studies suggest that the longer term loss of productivity might be mitigated by
longer bereavement leave, which is an area to explore with further research. There are no national standards for bereavement leave in the United States and bereavement is not a qualifying condition under Family Medical Leave Act.

Organizers are planning a second conference for this fall.

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Many Women of Childbearing Age Take Narcotic Painkillers: CDC

Too many women of childbearing age take narcotic painkillers, putting any unborn babies at risk, U.S. health officials said Thursday.

Thirty-nine percent of females aged 15 to 44 who were enrolled in Medicaid filled a prescription for a narcotic painkiller each year from 2008 to 2012, says a new report from the U.S. Centers for Disease Control and Prevention (CDC). Among privately insured women, that rate was 28 percent.

"We are concerned because we know that 50 percent of all pregnancies in the U.S. are unplanned," said CDC epidemiologist Jennifer Lind.

Using narcotic painkillers in early pregnancy can increase the risk for certain birth defects, including spina bifida (a defect of the spine), gastroschisis (a defect of the abdominal wall) and heart defects, Lind said. These drugs also have been linked with preterm birth, she said.
In addition, infants exposed to narcotics in the womb can be born with a condition called neonatal abstinence syndrome, according to the report. These babies experience symptoms of withdrawal from the drugs taken by the mother during pregnancy.

The study appears in the Jan. 23 issue of the CDC journal Morbidity and Mortality Weekly Report.

Lind said that most of the women in the study were prescribed narcotic painkillers to treat moderate to severe pain, such as after surgery. "We encourage doctors to make sure that they are discussing pregnancy potential with their patients and understand that they may be treating two patients whenever they are prescribing reproductive-aged women," Lind said.

"We recommend that they use the lowest effective dose for the shortest amount of time possible, and birth control to reduce the risk of becoming pregnant while taking them," Lind said.

Dr. Jose Cordero, a member of the March of Dimes Board of Trustees, agreed. "If you are using an opioid painkiller, you should also be practicing effective birth control," he said in a statement Thursday. "If you decide to get pregnant or do become pregnant, tell your health care provider about all the medications you are taking right away. You may be able to switch to a safer alternative," Cordero said.

Addiction to painkillers is a serious problem, Lind said. Depending on the pain level and the patient's medical condition, doctors may recommend an over-the-counter pain medication rather than a narcotic, she said. The narcotic painkillers most commonly prescribed are hydrocodone, oxycodone and codeine, also found in some prescription cough medicines, Lind said. "Some familiar brand names are Vicodin and Percocet," she noted.

The higher rates of narcotic painkiller use among Medicaid patients than those of privately insured women might be because of differences in the medications covered under their health insurance plan, differences in health care services, or differences in the prevalence of underlying medical problems, the researchers said.

For the study, CDC researchers analyzed 2008-2012 data from Medicaid, and another database of claims from women with private health insurance. Data from private insurance indicated that prescriptions for narcotic painkillers were highest among reproductive-aged women in the South and lowest in the Northeast. From Medicaid, the researchers found that white women of reproductive age had nearly 1.5 times as many prescriptions for narcotic painkillers as black or Hispanic women.

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Contributors to this Issue
Gongwer News Service
HealthDay
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Quick Links . . .

February is National Children's Dental Health Month

Approximately 51 million school hours are missed each year due to dental-related issues? Poor oral health can have a significant negative impact on a child's quality of life, their performance in school, and their success later in life. In celebration of National Children's Dental Health Month, the Michigan Caries Prevention Program (MCPP), a new statewide children's oral health initiative, is encouraging schools to promote oral health throughout February. Learn more here.

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Job Posting: Health Care Quality Project Coordinator I
The MSU Institute for Health Policy located in East Lansing is searching for a Health Care Quality Project Coordinator to manage complex projects involving public/private sector agencies with an emphasis on maternal child health. Responsibilities also include providing consultation and technical assistance to MDCH, local public health departments, Medicaid health plans, health systems, and other agencies/entities regarding designing and implementing quality improvement initiatives and program evaluation. Candidates will possess a master's degree in a health related field, three years of related and progressively more responsible work experience in health care administration or quality management. Experience in developing and monitoring grant proposals; conducting needs assessments; identifying and collecting data and conducting appropriate statistical analyses preferred. To learn more and apply for this position, visit jobs.msu.edu. Refer to posting #0680. Closing date is February 2, 2015. MSU is an affirmative -action, equal-opportunity employer.

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Job Posting: MI Collaborative Quality Initiative Nurse
The Michigan Primary Care Association has posted a nursing position for a Michigan Collaborative Quality Initiative Nurse. This nurse will work closely with the Michigan Collaborative Quality Initiative (MICQI). The MICQI is a group of professionals from the NICUs across the state, and a few Level I/II hospitals who work on a Neonatal Abstinence Syndrome project. The full posting is available here.

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More Extreme Preemies Are Surviving, Study Finds

More extremely premature U.S. infants -- those born after only 22 to 28 weeks of gestation -- are surviving, a new study finds. From 2000 to 2011, deaths among these infants from breathing complications, underdevelopment, infections and nervous system problems all declined. However, deaths from necrotizing enterocolitis, which is the deterioration of intestinal tissue, increased.
And despite the progress that's been made, one in four extremely premature infants still don't survive to leave the hospital, the researchers found.
"Although our study demonstrates that overall survival has improved in recent years among extremely premature infants, death still remains very high among this population," said lead author Dr. Ravi Mangal Patel, an assistant professor of pediatrics at Emory University School of Medicine in Atlanta. Read more

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MCH Nutrition Success Stories: 2014

This resource focuses on state agency efforts to promote good nutrition in the maternal and child health (MCH) population. Contents include information about projects to train home visit staff to be lactation consultants in New Hampshire, a shared meals initiative in Oregon, developing and implementing an early care and education nutrition and physical activity strategic plan in Kentucky, increasing nutrition counseling skills in New Hampshire, and supporting systems and environmental change programs in California.
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