Services Block Grant Research Articles

Transformation of the title V maternal and child health services block grant.

This paper describes the transformation of the Title V Maternal and Child Health (MCH) Services Block Grant. The Maternal and Child Health Bureau of the Health Resources and Services Administration led a 21-month visioning process to engage input from MCH stakeholders and other national, state and local MCH leaders, families and other partners to improve, innovate, and transform the Title V MCH Services Block Grant. The process has helped inform the development of a new grant guidance for the next 5-year cycle beginning in fiscal year 2016. The triple aims of the transformation are to reduce burden, maintain flexibility, and increase accountability. State reporting burden is reduced by aligning and streamlining the needs assessment, annual report and application, reducing the number of forms States have to fill out, eliminating Health Systems Capacity Indicators, and prepopulating the annual report and application with State data using national data sources. State flexibility is maintained through the needs assessment process whereby State needs and priorities drive the selection of National Performance Measures and State-specific Performance Measures, and the development of State Action Plan and Evidence-based/informed Strategy Measures. Accountability is increased through the new three-tiered performance measurement framework, which will help States tell a more coherent and compelling story about the impact of Title V on the health of the Nation’s mothers, children, and families. The ultimate success of the transformation will be measured by how much the transformed Title V program moves the needle in MCH in the States and for the Nation.

Pseudo-hypoglycémie : penser à la macroglobuline

Welfare reform and related changes have the potential to significantly affect states' financing of child welfare services both directly and indirectly. While the actual effects of these changes are not yet known, there have been no baseline data on states financing practices upon which to measure change. This article seeks to fill this data gap, reporting the results of a survey that collected information from state child welfare administrators on the amount states spend on child welfare services, the sources of these funds, and the amount expended on different types of services. Total spending in State Fiscal Year 1996 exceeded $14.4 billion. The majority of both federal and state child welfare funds supported children in out-of-home care. States relied heavily on federal Medicaid, Emergency Assistance, and Social Services Block Grant funds to pay for child welfare services though states were found to vary significantly in their financing practices. Implications of these findings for welfare reform implementation are discussed.

Looking at Graduates of Title V MCHB-Funded Training Programs Through the Lens of the MCH Pyramid

To examine the distribution of professional responsibilities as reflected in each level of the MCH Pyramid for 208 graduates of five Maternal and Child Health Bureau (MCHB)-funded training programs-Leadership Education in Neurodevelopmental and Related Disabilities, nutrition, pediatric dentistry, public health, and social work-at the University of North Carolina at Chapel Hill. Graduates completed a web-based survey, 1-8years after graduation. For each program, we constructed means of the reported percentages of total work time spent in infrastructure-building, population-based, enabling, and direct health care services. Although generally consistent with the goals of the training programs, the percentages of time spent in each level of the Pyramid varied substantially among the five programs. For example, for a clinically focused program like pediatric dentistry, 80.2% of time is spent in direct care services in contrast to 14.8% for public health graduates. For each program, however, graduates report responsibilities among the different levels of the Pyramid. Reporting job responsibilities within the MCH Pyramid provides a more informative picture of the contributions of training program graduates than do conventional metrics such as institutional or agency appointments. The fact that graduates from all five programs engage multiple roles is consistent with the MCHB workforce training goal to develop leaders in the field of MCH. Given the central role of the MCH Pyramid in planning and reporting for the MCH Services Block Grant, MCH training programs should include metrics such as graduates' roles according to the MCH Pyramid to assure that training goals are more closely aligned with workforce needs.

Health Reform and the Scope of Benefits for Mental Health and Substance Use Disorder Services

Health Reform and the Scope of Benefits for Mental Health and Substance Use Disorder Services

The Role of MENC: The National Association for Music Education in Early Childhood Music Education 1980–2007

During the last one hundred years, MENC: The National Association for Music Education has provided immeasurable support for American music educators. Although a central tenet of MENC's philosophy has been to promote music education as key in the cognitive development of the very young, few researchers have documented its role in early childhood music education. Alvarez, in her doctoral dissertation, Preschool Education and Research on the Musical Development of Preschool Children: 1900 to 1980, provides comprehensive details of early childhood music education during that time period--including the role of MENC. Because the last twenty-five years remain largely unexamined, the purpose of this research was to examine the role MENC has taken in developing early childhood music education in the United States between 1980 and 2007. Examining the last quarter century has shown that MENC has supported early childhood music learning and teaching in at least two ways: (1) advocating for music education in early childhood, and (2) providing structural support through facilitating research, publication, and practice. In this paper, we will provide a brief background of the socio-political circumstances that encouraged MENC to adopt specific positions regarding music education for the very young, and describe MENC's activity associated with both categories. Music and Preschool Education Since World War II During the 20th century, social and economic changes enacted by the federal government significantly affected the nature and quality of music education for preschoolers. As the latter part of the century saw increased enrollment in preschool programs, accompanied by decreased federal funding for these services, MENC began to adopt official positions regarding early childhood music education. The increase in dual-worker families in the years following World War II meant that more childcare was needed. In order to assist children of these families, Congress proposed and enacted several financial initiatives between 1950 and 1980. One of the most significant, the Economic Opportunity Act (1964), (2) appropriated federal funding for 1,676 Head Start facilities, serving 375,842 children. (3) Between 1964 and 1978, the percentage of the 3-4 year-old population enrolled in childcare programs--including Head Start--rose from 10 percent to 30 percent for white students, and 10 percent to 40 percent for non-white students. That increase may be partially explained by a parallel increase in the number of females in the labor force according to U.S. Census reports, but the data are far from conclusive. (4) The most significant appropriation of federal funds for childcare during the latter part of the century came from Title XX of the 1974 Social Service Amendments, which appropriated more than $700 million yearly for child care and child neglect services. (5) For many states, such funds became the sole means of federally subsidized childcare available, and therefore their only way to expose children to structured music education. The funding did not last, as the economic recession of the late 1970s pressured lawmakers to use federal funding for social programs in the most efficient way, forcing them to reexamine Title XX. In 1981, the Social Services Block Grant (SSBG) replaced Title XX as the appropriations vehicle for many social services, including childcare. While the SSBG allowed individual states more freedom in determining how funds could be used, it decreased the level of authorized funding by 20 percent--from $2.9 billion to $2.4 billion--and eliminated $200 million earmarked for childcare, a trend that continued during next two decades. Federal funding for childcare and other services from the SSBG was reduced by 58 percent, from $6.626 billion in 1981 to $2.8 billion in 1994 dollars. (6) MENC Advocating Early Childhood Music Education As enrollment in early childhood music education programs increased and support funding decreased, government relations and advocacy for arts education became a necessary cornerstone of activity for MENC. …

Policy And Finance For Preconception Care: Opportunities for Today and the Future

This special supplement of Women's Health Issues offers 2 types of articles related to the policy and finance context for improving preconception health and health care. These articles discuss the impact of finance and policy on preconception health and health care, as well as the strategies that are being used to overcome the challenge of implementing preconception care with limited resources and inadequate health coverage for women. Invited papers from authors with expertise in health policy and finance issues describe how women's health and preconception care fit into the larger debates on health reform and how the paradigm for women's health must change. Other invited papers discuss opportunities and challenges for using programs such as Medicaid, Title X Family Planning, Title V Maternal and Child Health Services Block Grant, Healthy Start, and Community Health Centers in improving preconception health and health care. Contributed articles on health services research in this supplement characterize the types of change occurring across the country. This paper also presents a framework for understanding the role of policy and finance in the larger Centers for Disease Control and Prevention Preconception Health and Health Care Initiative.

The Relationship Between State Capacity Measures and Allocations to Children and Youth with Special Needs Within the MCH Services Block Grant

To examine the association between state economic, political and health services capacity and state allocations for Title V capacity for Children and Youth with Special Health Care Needs (CSHCN). Numerous datasets were reviewed to select 13 state capacity measures: per capita Gross State Product (economic); governor's institutional powers and legislative professionalism (political); percent of Children with Special Health Care Needs, percent of uninsured children, percent of children enrolled in Medicaid, state health funds as a percent of Gross State Product, ratio of Medicaid to Medicare fees, percent of children in Medicaid enrolled in managed care, per capita Medicaid expenditures for children, ratios of pediatricians/family practitioners and pediatric subspecialists per 10,000 children, and categorical versus functional state definition of CSHCN (health). Five measures of Title V capacity were selected from the Title V Information System, four that reflect allocation decisions by states and the fifth a state assessment of the role of families in Title V decision-making: ratio of state/federal Title V spending; per capita state Title V spending; percent of state Title V spending on CSHCN; state per child spending on CSHCN; and, state Title V Family Participation Score. OLS regression was used to model the association between state and Title V capacity measures. The percentage of the state's gross state product (GSP) accounted for by state health funds and the per capita GSP were positively associated with the per capita expenditures on all children. The percentage of CSHCN in the state was negatively associated with the ratio of state to federal support for Title V and the per child expenditures on CSHCN. Lower family participation scores were associated with having a hybrid legislature; however, higher family participation scores were found in states using a functional definition of special needs. Measures of state economic, political and health services capacity do not demonstrate consistent and significant associations with the Title V capacity measures that we explored. States with greater economic capacity appear to devote more financial resources to Title V. Our finding that per capita CSHCN expenditures are negatively associated with the percentage of CSHCN in the state suggests that there is an upper limit on what states devote to CSHCN. Our current understanding of what state factors influence Title V capacity remains limited.

Health Care Advocates Worry About Proposed '07 Budget

Back to table of contents Previous article Next article Government NewsFull AccessHealth Care Advocates Worry About Proposed '07 BudgetRich DalyRich DalySearch for more papers by this authorPublished Online:18 Aug 2006https://doi.org/10.1176/pn.41.16.0014The Senate Appropriations Committee approved a draft Fiscal 2007 Labor-HHS-Education spending bill in late July that raised the possibility that Congress may approve the primary mental health spending measure before the next fiscal year begins.The bill (S 3708) would provide $142.8 billion in health-related discretionary spending, which is $5 billion more than President Bush requested and $1.3 billion more than the Fiscal 2006 amount. The House version (HR 5647) would provide $141.9 billion for discretionary programs. The rest of the funding in both health budget bills is allocated for Medicare, Medicaid, and other entitlement programs.“While [the Senate's funding level] amounts to a modest dollar increase in health spending, it is still higher than the House's version,” said Nicholas Meyers, director of APA's Department of Government Relations.The Senate bill would provide $28.5 billion for the National Institutes of Health (NIH), an increase of $220 million over Fiscal 2006 and $200 million over the president's budget request.The House version, which also provides $28.5 billion for NIH, has been approved by that chamber's Appropriations Committee.Congressional negotiators will reconcile differences in the two versions after both chambers pass their versions of the bill.Rep. David obey (D-Wis.) criticized the proposed budget for NIH as insufficient, given a “substantial” inflation in research costs. Sen. Arlen Specter (R-Pa.) said that even in the more-generous Senate version, NIH funding is $3.78 billion below the inflation-adjusted Fiscal 2006 level.For the three mental health institutes within NIH, the Senate measure would provide $1.4 billion to the National Institute of Mental Health (NIMH), $1 billion to the National Institute on Drug Abuse, and $436 million to the National Institute on Alcohol Abuse and alcoholism. These amounts are similar to the current year's funding levels for the three institutes.The Senate bill would provide $3.34 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA), an increase of $77 million over the president's budget request. SAMHSA is responsible for supporting mental health programs and alcohol and other drug abuse prevention and treatment services.The Senate bill would restore the $630 million for SAMHSA's Community Services Block Grant, which was proposed for elimination in the president's budget.Proposed Budgets for VAThe Senate Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies approved a $94.3 billion Fiscal 2007 Military Construction-VA appropriations bill (HR 5385). Of that amount, $77.9 billion is earmarked for the Department of Veterans Affairs, which includes health care spending for veterans. The bill, however, does not include a proposal from the president to increase TRICARE fees for some veterans. President Bush had requested an increase in premiums for some veterans and their families in TRICARE, the program that funds health care for this population, as well as higher enrollment fees, deductibles, and prescription drug copayments for some military retirees. The House bill, which would allocate $36.5 billion for VA discretionary programs, also does not include the proposal.Both the House and Senate bills would provide $32.7 billion for the Veterans Health Administration and $3.6 billion for VA medical facilities.The House's allocation for the overall VA spending bill is $136.1 billion. It is dramatically higher than the Senate's $94.3 billion total because the House bill would fund some defense accounts that the Senate bill would not, including the Defense Health Program. Following Senate passage, negotiators will have to hammer out differences between the House and Senate versions of the bill.Family Treatment AddressedIn addition to its work on a health care funding bill, the Senate passed legislation concerning children who are placed in the child welfare system because they are affected by methamphetamine use. The Improving Outcomes for Children Affected by Methamphetamine Act of 2006 (S 3525) amends the Promoting Safe and Stable Families program to reserve $40 million for grants to create regional partnerships to improve outcomes for children affected by methamphetamine abuse or addiction. This bill was sponsored by Sen. Charles Grassley (R-Iowa), and the president is expected to sign the measure.“By emphasizing comprehensive family treatment, we are promoting a promising strategy for families to recover from meth addiction together,” Grassley said at a hearing on the bill.Information about the Labor-HHS bill is posted at<http://thomas.loc.gov/cgi-bin/bdquery/z?d109:h.r.05647:>; the Senate version of the VA spending bills is posted at<http://thomas.loc.gov/cgi-bin/bdquery/z?d109:h.r.05385:>.▪ ISSUES NewArchived

Financing State Newborn Screening Programs: Sources and Uses of Funds

Financing for newborn screening is different from virtually all other public health programs. All except 5 screening programs collect fees as the primary source of program funding. A fee-based approach to financing newborn screening has been adopted by most states, to ensure consistent funding for this critical public health activity. Two types of data are reported here, ie, primary data from a survey of 37 state public health agencies and findings from exploratory case studies from 7 states. Most of the programs that participated in this survey (73%) reported that their newborn screening funding increased between 2002 and 2005, typically through increased fees and to a lesser extent through Medicaid, Title V Maternal and Child Health Services Block Grant, and state general revenue funding. All of the responding states that collect fees (n = 31) use such funds to support laboratory expenses, and most (70%) finance short-term follow-up services and program management. Nearly one half (47%) finance longer-term follow-up services, case management, or family support beyond diagnosis. Other states (43%) finance genetic or nutritional counseling and formula foods or treatment. Regardless of the source of funds, the available evidence indicates that states are committed to maintaining their programs and securing the necessary financing for the initial screening through diagnosis. Use of federal funding is currently limited; however, pressure to provide dedicated federal funding would likely increase if national recommendations for a uniform newborn screening panel were issued.

Nonprofit Federalism and the Csbg Program

To understand more about the functions of community action agencies in the post-Temporary Assistance to Needy Families (TANF) era, a survey of executive directors and staff members was conducted in the state of Missouri. The survey revealed that community action agencies in the state are filling in the service gaps caused by state social service cutbacks. Practitioner focus has shifted from community to individual needs. Although Community Services Block Grant (CSBG) administrators feel the quality of services continues to remain high, clients have been turned away because of the lack of resources. Moreover, administrators perceive increased service demands because of welfare reform. To meet client needs, executive directors and staff members have formed collaborative relationships with other private nonprofit entities and faith-based organizations, raising questions of accountability.

Building a profile of Missouri CSBG community action agencies: Capacities, coping strategies, and the new public management

AbstractGiven the current environment of devolution, welfare reform, and fiscal retrenchment, this study examines the role of local nonprofit entities, called Community Action Agencies, operating under the auspices of the Community Services Block Grant program. Survey results indicate that despite an increase in working poor requiring CSBG services, staffs have been able to cope with increased demands. Community Action Agencies have been able to keep pace with increasing client demands by means of a variety of measures, including fund leveraging, resource competition, and relationship building. Accountability concerns and business‐oriented practices also were found to be a high priority of these agencies.

Making Tradeoffs in Federal Block Grant Programs: Understanding the Interplay Between SSBG and TANF

Welfare reform gave states the option of transferring up to 10 percent of their annual federal Temporary Assistance for Needy Families (TANF) award to the Social Services Block Grant (SSBG). Drawing on administrative data, we consider the impact of TANF transfers on SSBG. We find evidence suggesting that more innovative states, states that experienced larger TANF caseload declines, and states that transferred a higher percentage of TANF funds to the Child Care Development Fund (CCDF) have transferred higher portions of their TANF allocations to SSBG, all else equal. Preliminary analysis of changes in SSBG expenditure patterns from FY 1995 to FY 2000 indicates that states are transferring significant sums to SSBG, but that TANF transfers do not appear to have a consistent effect on SSBG spending priorities across states. Copyright 2004, Oxford University Press.

The potential effects of welfare reform on states' financing of child welfare services

Welfare reform and related changes have the potential to significantly affect states' financing of child welfare services both directly and indirectly. While the actual effects of these changes are not yet known, there have been no baseline data on states financing practices upon which to measure change. This article seeks to fill this data gap, reporting the results of a survey that collected information from state child welfare administrators on the amount states spend on child welfare services, the sources of these funds, and the amount expended on different types of services. Total spending in State Fiscal Year 1996 exceeded $14.4 billion. The majority of both federal and state child welfare funds supported children in out-of-home care. States relied heavily on federal Medicaid, Emergency Assistance, and Social Services Block Grant funds to pay for child welfare services though states were found to vary significantly in their financing practices. Implications of these findings for welfare reform implementation are discussed.

Validity of the Maternal and Child Health Services Block Grant as an Indicator of State Infant Mortality Reduction Initiatives

Since state Maternal and Child Health Services Block Grant applications represent the most comprehensive source of information about community and state needs assessment, policy development, and program assurance for the population of mothers and children, these documents have the potential to play a central role in state accountability to Congress and the Maternal and Child Health Bureau. To measure the validity of block grant applications as a reporting mechanism, we assessed the sensitivity of the applications from seven states to strategies for reducing infant mortality. We used the independent coding of infant mortality strategies from the Healthy Futures/Healthy Generations Program intensive evaluation as the standard. Overall, the sensitivity of the block grant applications was only 45%. Since the open-ended design of the block grant applications does not appear to reflect the extent of state activity in infant mortality reduction, a uniform application should be adopted that will facilitate clear and systematic reporting of state activities.

Characterizing State Strategies to Assure Primary Care for Mothers and Children

To assure primary care for all mothers and children, state health officials concerned with maternal and child health must be able to identify and characterize strategies to meet that goal. Since each state's Maternal and Child Health (MCH) Services Block Grant application reflects plans for reaching primary care goals and objectives, we reviewed the 1992 MCH Services Block Grant applications from the eight states in the Southeast (Department of Health and Human Services Region 4) to identify state strategies to improve primary care. We identified two major sets of strategies. The first set was directed toward increasing the number of providers and facilities and accounted for 14% of state strategies. The second set was directed toward improving the quality of care and constituted 86% of state strategies. Of these strategies to improve the quality of care, efforts to enhance the content of care, expand outreach, improve coordination, and improve intake and referral accounted for 46%, 32%, 15%, and 7%, respectively. The review of strategies delineated in state MCH Services Block Grant applications may provide an efficient mechanism to monitor the development of primary care at the state level.

Intergovernmental Politics in the Allocation of Block Grant Funds for Substance Abuse in Michigan

This article examines the intersection between federal programmatic goals and state politics in the allocation ofsubstance-abuse block-grant money by the State ofMichigan. The Alcohol and Abuse and Mental Health Services (ADMS) block grant allows states more flexibility in allocating Drug War funds. The ADMS formula determines the amount of money going to Michigan but does not determine the distribution offunds within the state. An examination of the distribution of ADMS funding among the eighteen coordinating agencies in Michigan finds that neither the state nor the national formulas distribute funds in a manner that reflects substance-abuse deaths. Michigan's formula produces a result consistent with the federalformula, despite the separate state and national formula negotiations. The process is not one of bargaining or even coercion; it may be described as mutually independent decisionmaking-or parallel policies. Models of intergovernmental relations must be revised to include the possibility of joint synergistic action without coordination.

The Relationship between Needs Assessments and State Strategies for Meeting Healthy People 2000 Objectives: Lessions from the Maternal and Child Health Services Block Grant

Recognizing the critical role of needs assessments in the development of public health policy, the Omnibus Budget Reconciliation Act of 1989 required states to include needs assessments in their Maternal and Child Health Services Block Grant applications and to demonstrate a link between needs and programs. We examined this link by analyzing the relationship between strategies to meet health objectives and needs assessments in the applications for fiscal year 1992 for the eight states in the southeast (DHHS Region 4). Overall, the proportion of strategies based on reported needs was 88%. Numerous other needs, however, were not related to any strategies. Furthermore, there were neither needs nor strategies described for many objectives. These data required extensive analysis of the applications. A uniform structured report would facilitate the explicit collection of this information and thus the usefulness of this important document for policy development and accountability.

Decentralizing the Social Service System: A Reassessment

In recent years, Title XX of the Social Security Act and the Social Services Block Grant decentralized the social service system. This is claimed to be an improvement because decentralization strengthens the match between needs and services, adds to the flexibility of workers and agencies, and increases efficiency. However, it is argued in this article that decentralization also contributes to some problematic service delivery patterns, such as specialization and selectivity, a lack of responsiveness to major shifts in patterns of needs, and a loss of effective advocacy to sustain appropriations. This argument is used to explain dilemmas in serving the homeless in Chicago and to question general assumptions about decentralization.

SSBG Planning and Participation Processes: Are the States Becoming Stronger Partners?

This article is based on a 1986 survey of state changes in participation and planning under the Social Services Block Grant (SSBG). In 1981 the Title XX program was converted to SSBG, virtually eliminating national planning and citizen participation requirements. States have adopted a variety of means to continue citizen involvement in the planning process and have used SSBG in combination with other state processes. Almost all states have exceeded the national minimum standard of public review in some way, suggesting that in the absence of stringent requirements, states have the willingness and capacity to move toward a partnership in such federal programs.

Drug abuse prevention funding resulting from the Omnibus Budget Reconciliation Act of 1981.

In 1981, administration and planning of drug abuse prevention and treatment programs shifted from federal to state authorities through the enactment of the Alcohol, Drug Abuse and Mental Health Services Block Grant. This article reviews the funding status of drug prevention under this programmatic change relevant to prevention service programs and prevention research.