Maternal and Child Health Library

This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html

February 12, 2010

1. Brief Highlights Key Principles to Help the Ongoing Success of Home Visiting Programs as They Are Taken to a National Scale
2. Report Commemorates 1-Year Anniversary of Children's Health Insurance Law
3. Women's Health Care Physicians Release Opinion on Screening for Depression During and After Pregnancy
4. National Project Reports Lessons Learned in Implementing Developmental Screening and Referral
5. Authors Investigate the Relationship Between Income, Income Inequality, and Childhood Dental Caries

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1. BRIEF HIGHLIGHTS KEY PRINCIPLES TO HELP THE ONGOING SUCCESS OF HOME VISITING PROGRAMS AS THEY ARE TAKEN TO A NATIONAL SCALE

Realizing the Promise of Home Visitation: A Guide for Policy Makers is designed to help policymakers and advocates build a national policy framework to maximize the effectiveness and reach of early childhood home-visiting programs. The policy brief, published by the Family Violence Prevention Fund with support from the Avon Foundation for Women, is the culmination of many efforts over the last year including a meeting held in October 2009 in Washington, DC, to support the expansion of home-visitation services in the United States. Following a brief overview of home visitation, the authors discuss home visiting and domestic violence, the link between domestic violence and child abuse and neglect, improving outcomes for children by addressing domestic violence, promising programs to address domestic violence within home visitation, and opportunities for integrating domestic violence into federal home visitation initiatives. Federal policy recommendations, practice recommendations, and additional considerations are included. A safety card that home visitors can share with their clients to help discuss domestic violence and other safety resources is also available. The press release, policy brief, and safety card are available at http://endabuse.org/content/features/detail/1458

• There are multiple depression-screening tools available. Sensitivity should be the determining factor to maximize the number of women with depression identified.
• Depression is very common during pregnancy and the postpartum period.
• At this time there is insufficient evidence to support a firm recommendation for universal antepartum or postpartum screening. There are also insufficient data to recommend how often screening should take place.
• Women with a positive assessment require follow-up evaluation and treatment, if indicated. Medical practices should have a referral process for identified cases.
• Women with current depression or a history of major depression warrant particularly close monitoring and evaluation.
• The appropriate diagnosis code depends on the nature of the woman's depression. Medical practices should check with all payers concerning coverage for mental health services before billing for these services.

• Fifteen of the 17 practices selected one or both of two parent-completed screening instruments. The factor most commonly cited in selecting screening instruments was concern about clinic flow.
• During the 9-month implementation period, monthly screening rates across practices increased from 68 percent to 86 percent of children who presented for recommended screening visits. During the last 4 months of the project, practices consistently screened more than 85 percent of all target children.
• Monthly referral rates among children with failed screens ranged from a high of 78 percent in September 2006 to a low of 48 percent in January 2007, averaging 61 percent over the entire study.
• Most clinics divided responsibilities among staff at multiple levels, and most identified the need for change by reviewing systematically collected data on rates of screen distribution and completion.
• Common challenges in implementing developmental screening included the following: distributing screening instruments to children at screening ages but not to other children, screening consistently when clinics were busy, and staff turnover.
• Many clinics chose not to implement a 30-month well-child visit, routine screening when surveillance had already suggested delays, and dual referral of all children to both medical subspecialists and early-intervention programs.
• The nine practices that attempted to track outcomes of their referrals found that referral tracking required a clinic-wide implementation system distinct from their system for developmental screening.

• In the entire sample of countries, income but not income inequality was significantly correlated with the dmft index. Higher levels of national income were related to lower dmft scores among children ages 5 and 6.
• Among rich countries, income inequality but not income was significantly correlated with the dmft index. Greater income inequality was related to higher dmft scores among children ages 5 and 6.
• In rich countries, adjusting for income inequality did not change the lack of association between income and the dmft index. On the other hand, income inequality remained significantly correlated with the dmft index after adjusting for income.